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Petit P, Gondard E, Gandon G, Moreaud O, Sauvée M, Bonneterre V. Agricultural activities and risk of Alzheimer's disease: the TRACTOR project, a nationwide retrospective cohort study. Eur J Epidemiol 2024; 39:271-287. [PMID: 38195954 PMCID: PMC10995077 DOI: 10.1007/s10654-023-01079-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 11/02/2023] [Indexed: 01/11/2024]
Abstract
Data regarding Alzheimer's disease (AD) occurrence in farming populations is lacking. This study aimed to investigate whether, among the entire French farm manager (FM) workforce, certain agricultural activities are more strongly associated with AD than others, using nationwide data from the TRACTOR (Tracking and monitoring occupational risks in agriculture) project. Administrative health insurance data (digital electronic health/medical records and insurance claims) for the entire French agricultural workforce, over the period 2002-2016, on the entire mainland France were used to estimate the risk of AD for 26 agricultural activities with Cox proportional hazards model. For each analysis (one for each activity), the exposed group included all FMs that performed the activity of interest (e.g. crop farming), while the reference group included all FMs who did not carry out the activity of interest (e.g. FMs that never farmed crops between 2002 and 2016). There were 5067 cases among 1,036,069 FMs who worked at least one year between 2002 and 2016. Analyses showed higher risks of AD for crop farming (hazard ratio (HR) = 3.72 [3.47-3.98]), viticulture (HR = 1.29 [1.18-1.42]), and fruit arboriculture (HR = 1.36 [1.15-1.62]). By contrast, lower risks of AD were found for several animal farming types, in particular for poultry and rabbit farming (HR = 0.29 [0.20-0.44]), ovine and caprine farming (HR = 0.50 [0.41-0.61]), mixed dairy and cow farming (HR = 0.46 [0.37-0.57]), dairy farming (HR = 0.67 [0.61-0.73]), and pig farming (HR = 0.30 [0.18-0.52]). This study shed some light on the association between a wide range of agricultural activities and AD in the entire French FMs population.
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Affiliation(s)
- Pascal Petit
- CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, Univ. Grenoble Alpes, 38000, Grenoble, France.
- Centre Régional de Pathologies Professionnelles et Environnementales, CHU Grenoble Alpes, 38000, Grenoble, France.
- AGEIS, Univ. Grenoble Alpes, 38000, Grenoble, France.
| | - Elise Gondard
- CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Gérald Gandon
- Centre Régional de Pathologies Professionnelles et Environnementales, CHU Grenoble Alpes, 38000, Grenoble, France
| | - Olivier Moreaud
- Centre Mémoire de Ressources et de Recherche, CHU Grenoble Alpes, 38000, Grenoble, France
- Laboratoire de Psychologie et Neurocognition, UMR 5105, CNRS, LPNC, Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, 38000, Grenoble, France
| | - Mathilde Sauvée
- Centre Mémoire de Ressources et de Recherche, CHU Grenoble Alpes, 38000, Grenoble, France
- Laboratoire de Psychologie et Neurocognition, UMR 5105, CNRS, LPNC, Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, 38000, Grenoble, France
| | - Vincent Bonneterre
- CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, Univ. Grenoble Alpes, 38000, Grenoble, France
- Centre Régional de Pathologies Professionnelles et Environnementales, CHU Grenoble Alpes, 38000, Grenoble, France
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Yoshimoto H, Mitsutake N, Goda K. Predicting Medical Event Occurrence Using Medical Insurance Claims Big Data. Stud Health Technol Inform 2024; 310:654-658. [PMID: 38269890 DOI: 10.3233/shti231046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Medical events are often infrequent, thus becomes hard to predict. In this paper, we focus on predictor that forecasts whether a medical event would occur in the next year, and analyzes the impact of event's frequency and data size via predictor's performance. In the experiment, we made 1572 predictors for medical events using Medical Insurance Claims (MICs) data from 800,000 participants and 205.8 million claims over 8 years. The result revealed that (a) forecasting error will be increased when predicting low-frequency events, and (b) increasing the number of training dataset reduces errors. This result suggests that increasing data size is a key to solve low frequency problems. However, we still need additional methods to cope with sparse and imbalanced data.
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Affiliation(s)
| | | | - Kazuo Goda
- Institute of Industrial Science, The University of Tokyo, Japan
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Xu KY, Huang V, Williams AR, Martin CE, Bazazi AR, Grucza RA. Co-occurring psychiatric disorders and disparities in buprenorphine utilization in opioid use disorder: An analysis of insurance claims. Drug Alcohol Depend Rep 2023; 9:100195. [PMID: 38023343 PMCID: PMC10630609 DOI: 10.1016/j.dadr.2023.100195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023]
Abstract
Background As the overdose crisis continues in the U.S. and Canada, opioid use disorder (OUD) treatment outcomes for people with co-occurring psychiatric disorders are not well characterized. Our objective was to examine the influence of co-occurring psychiatric disorders on buprenorphine initiation and discontinuation. Methods This retrospective cohort study used multi-state administrative claims data in the U.S. to evaluate rates of buprenorphine initiation (relative to psychosocial treatment without medication) in a cohort of 236,198 people with OUD entering treatment, both with and without co-occurring psychiatric disorders, grouping by psychiatric disorder subtype (mood, psychotic, and anxiety-and-related disorders). Among people initiating buprenorphine, we assessed the influence of co-occurring psychiatric disorders on buprenorphine retention. We used multivariable Poisson regression to estimate buprenorphine initiation and Cox regression to estimate time to discontinuation, adjusting for all 3 classes of co-occurring disorders simultaneously and adjusting for baseline demographic and clinical characteristics. Results Buprenorphine initiation occurred in 29.3 % of those with co-occurring anxiety-and-related disorders, compared to 25.9 % and 17.5 % in people with mood and psychotic disorders. Mood (adjusted-risk-ratio[aRR] = 0.82[95 % CI = 0.82-0.83]) and psychotic disorders (aRR = 0.95[0.94-0.96]) were associated with decreased initiation (versus psychosocial treatment), in contrast to greater initiation in the anxiety disorders cohort (aRR = 1.06[1.05-1.06]). We observed an increase in buprenorphine discontinuation associated with mood (adjusted-hazard-ratio[aHR] = 1.20[1.17-1.24]) and anxiety disorders (aHR = 1.12[1.09-1.14]), in contrast to no association between psychotic disorders and buprenorphine discontinuation. Conclusions We observed underutilization of buprenorphine among people with co-occurring mood and psychotic disorders, as well as high buprenorphine discontinuation across anxiety, mood, and psychotic disorders.
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Affiliation(s)
- Kevin Y Xu
- Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Vivien Huang
- Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Arthur Robin Williams
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York, USA
- Division of Substance Use Disorders, New York State Psychiatric Institute, New York, New York, USA
| | - Caitlin E Martin
- Department of Obstetrics and Gynecology and the VCU Institute for Drug and Alcohol Studies, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Alexander R. Bazazi
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Richard A. Grucza
- Department of Family and Community Medicine, St. Louis University, St. Louis, Missouri, USA
- Department of Health and Clinical Outcomes Research, St. Louis University, St Louis, Missouri, USA
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Lewis KN, McKelvey LM, Zhang D, Moix E, Whiteside-Mansell L. Risks of adverse childhood experiences on healthcare utilization and outcomes in early childhood. Child Abuse Negl 2023; 145:106396. [PMID: 37573799 DOI: 10.1016/j.chiabu.2023.106396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND The American Academy of Pediatrics recommends all pediatricians to be ready to implement trauma-informed care, including the mitigation of impacts of Adverse Childhood Experiences (ACEs) through screening and identification of at-risk population. Reliable survey tools and knowledge of the consequences of ACEs are needed. OBJECTIVE This study examines the healthcare utilization and diagnoses captured in insurance claims in association with the number of ACEs recorded by the Family Map Inventories (FMI). The FMI offers a comprehensive family assessment, which includes child ACEs (FMI-ACEs) using prospective, proxy risk indicators. PARTICIPANTS AND SETTING Low-income families (N = 1647) with children aged three to five years who completed the FMI were linked to their insurance records. METHODS Multivariable logistic and generalized linear regression models were fitted to explore the association between the number of ACEs (FMI-ACEs scores) and healthcare utilization and health outcomes. RESULTS Children were exposed at rates of 32.4 % to zero, 31.7 % to one, 19.7 % to two, and 16.3 % to three or more ACEs. The FMI-ACEs scores were associated with greater use of non-preventive outpatient visits, filled prescriptions, and overall use of healthcare. Incidences of adjustment disorders were 4 times and attention-deficit conducts were 2 times higher among children with the highest FMI-ACEs scores than those with zero FMI-ACEs. CONCLUSIONS This study marks the first effort to conduct insurance claims data review to ascertain association between a survey measure of ACEs and health utilization and diagnosed conditions. The association of ACEs risk screening and healthcare utilization and diagnoses was observed.
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Affiliation(s)
- Kanna N Lewis
- University of Arkansas for Medical Sciences, Department of Family and Preventive Medicine, 4301 W. Markham St, #530, Little Rock, AR 72205-7199, USA.
| | - Lorraine M McKelvey
- University of Arkansas for Medical Sciences, Department of Family and Preventive Medicine, 4301 W. Markham St, #530, Little Rock, AR 72205-7199, USA
| | - Dong Zhang
- University of Arkansas for Medical Sciences, Department of Family and Preventive Medicine, 4301 W. Markham St, #530, Little Rock, AR 72205-7199, USA
| | - Elise Moix
- University of Arkansas for Medical Sciences, Department of Family and Preventive Medicine, 4301 W. Markham St, #530, Little Rock, AR 72205-7199, USA
| | - Leanne Whiteside-Mansell
- University of Arkansas for Medical Sciences, Department of Family and Preventive Medicine, 4301 W. Markham St, #530, Little Rock, AR 72205-7199, USA
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Busse CE, Latour CD, Dejene SZ, Knittel AK, Wood ME, Kinlaw AC, Dissanayake MV. Incidence of new outpatient long-acting reversible contraceptive insertions among a commercially insured, US population from 2010 to 2020. Contracept X 2023; 5:100101. [PMID: 37823033 PMCID: PMC10562738 DOI: 10.1016/j.conx.2023.100101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 10/13/2023] Open
Abstract
Objectives Characterize new use of long-acting reversible contraceptives (LARCs), highly effective contraceptive methods, in a broad population over time. Study Design We constructed a retrospective cohort of commercially insured individuals aged 15 to 54 years from 2010 to 2020 and estimated monthly incidence of new LARC insertions. Results The monthly standardized incidence increased from 6.0 insertions per 10,000 individuals in January 2010 to 14.1 in December 2020, with a dip in insertions after March 2020. Hormonal intrauterine devices were consistently the most inserted LARC; implants were increasingly favored over time. Conclusions LARCs are increasingly popular forms of contraception among commercially insured individuals. Implications Given the increasing popularity, ensuring access to LARCs is critical.
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Affiliation(s)
- Clara E. Busse
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Chase D. Latour
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Sara Z. Dejene
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Andrea K. Knittel
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mollie E. Wood
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Alan C. Kinlaw
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina School of Pharmacy, Chapel Hill, NC, United States
| | - Mekhala V. Dissanayake
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Hu T, Song Y, Done N, Mohanty S, Liu Q, Sarpong EM, Lemus-Wirtz E, Signorovitch J, Weiss T. Economic burden of acute otitis media, pneumonia, and invasive pneumococcal disease in children in the United States after the introduction of 13-valent pneumococcal conjugate vaccines during 2014-2018. BMC Health Serv Res 2023; 23:398. [PMID: 37098521 PMCID: PMC10127426 DOI: 10.1186/s12913-023-09244-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 03/06/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Streptococcus pneumoniae remains a leading cause of morbidity, mortality, and healthcare resource utilization (HRU) among children. This study quantified HRU and cost of acute otitis media (AOM), pneumonia, and invasive pneumococcal disease (IPD). METHODS The IBM MarketScan® Commercial Claims and Encounters and Multi-State Medicaid databases from 2014 to 2018 were analyzed. Children with AOM, all-cause pneumonia, or IPD episodes were identified using diagnosis codes in inpatient and outpatient claims. HRU and costs were described for each condition in the commercial and Medicaid-insured populations. National estimates of the number of episodes and total cost ($US 2019 for each condition were extrapolated using data from the US Census Bureau. RESULTS Approximately 6.2 and 5.6 million AOM episodes were identified in commercial and Medicaid-insured children, respectively, during the study period. Mean cost per AOM episode was $329 (SD $1505) for commercial and $184 (SD $1524) for Medicaid-insured children. A total of 619,876 and 531,095 all-cause pneumonia cases were identified among commercial and Medicaid-insured children, respectively. Mean cost per all-cause pneumonia episode was $2304 (SD $32,309) in the commercial and $1682 (SD $19,282) in the Medicaid-insured population. A total of 858 and 1130 IPD episodes were identified among commercial and Medicaid-insured children, respectively. Mean cost per IPD episode was $53,213 (SD $159,904) for commercial and $23,482 (SD $86,209) for the Medicaid-insured population. Nationally, there were over 15.8 million cases of AOM annually, with total estimated cost of $4.3 billion, over 1.5 million cases of pneumonia annually, with total cost of $3.6 billion, and about 2200 IPD episodes annually, for a cost of $98 million. CONCLUSIONS The economic burden of AOM, pneumonia, and IPD among US children remains substantial. IPD and its manifestations were associated with higher HRU and costs per episode, compared to AOM and all-cause pneumonia. However, owing to their higher frequencies, AOM and all-cause pneumonia were the main contributors to the economic burden of pneumococcal disease nationally. Additional interventions, such as the development of pneumococcal conjugate vaccinees with sustained protection of existing vaccine type serotypes as well as broader inclusion of additional serotypes, are necessary to further reduce the burden of disease caused by these manifestations.
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Affiliation(s)
- Tianyan Hu
- Merck & Co., Inc, 126 East Lincoln Ave, P.O. Box 2000, Rahway, NJ, 07065, USA
| | - Yan Song
- Analysis Group, Inc, Boston, MA, USA
| | | | - Salini Mohanty
- Merck & Co., Inc, 126 East Lincoln Ave, P.O. Box 2000, Rahway, NJ, 07065, USA.
| | - Qing Liu
- Analysis Group, Inc, Boston, MA, USA
| | - Eric M Sarpong
- Merck & Co., Inc, 126 East Lincoln Ave, P.O. Box 2000, Rahway, NJ, 07065, USA
| | | | | | - Thomas Weiss
- Merck & Co., Inc, 126 East Lincoln Ave, P.O. Box 2000, Rahway, NJ, 07065, USA
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Bell M, Lui H, Lee TK, Kalia S. Validation of medical service insurance claims as a surrogate for ascertaining vitiligo cases. Arch Dermatol Res 2023; 315:541-550. [PMID: 36173455 DOI: 10.1007/s00403-022-02383-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 04/23/2022] [Accepted: 08/02/2022] [Indexed: 11/02/2022]
Abstract
The epidemiology of vitiligo, especially its disease burden on the healthcare system, can be assessed indirectly by analyzing health insurance claims data. Validating this approach is integral to ensuring accurate case identification and cohort characterization. The primary aim of this study was to develop and validate an indirect measure of vitiligo ascertainment using health insurance claims data. These data were used secondarily to identify demographic characteristics, body site involvement, vitiligo subtypes, disease associations, and treatments. This study assessed the validity of identifying vitiligo from billing claims within a Canadian provincial universal health insurance program, versus vitiligo cases accrued from direct medical chart reviews. Claims-based algorithms combining ICD-9-CM diagnostic code 709 with treatment-specific data were derived and tested to identify vitiligo patients. This was compared against cases arising from the manual review of medical records of 606 patient with a diagnostic code for "dyschromia" (ICD-9-CM diagnostic code 709) from January 1 to December 31, 2016. Based on the chart reviews, 204 (33.7%) patients were confirmed to have vitiligo. 42 separate claims-based algorithms combining ICD-9-CM diagnostic code 709 with treatment data specific to vitiligo were modeled and individually tested to evaluate their accuracy for vitiligo ascertainment. One algorithm achieved a sensitivity, specificity, PPV and NPV of 86.8% (95% CI 82.1-91.4), 92.5% (95% CI 90.0-95.1), 85.5% (95% CI 80.7-90.3), and 93.2% (95% CI 90.8-95.7), respectively. There was a 2.2 female-to-male ratio. The most common medical treatments were tacrolimus (74.5%) and topical corticosteroids (54.3%). Hypertension (24.2%) and hypothyroidism (19.6%) were the predominant co-morbidities associated with vitiligo. Health insurance claims data can be used to indirectly ascertain vitiligo for epidemiologic purposes with relatively high diagnostic performance between 85.5 and 93.2%.
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Affiliation(s)
- M Bell
- Department of Dermatology and Skin Science, University of British Columbia, 835 West 10th Avenue, Vancouver, BC, V5Z 4E8, Canada
- Photomedicine Institute, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - H Lui
- Department of Dermatology and Skin Science, University of British Columbia, 835 West 10th Avenue, Vancouver, BC, V5Z 4E8, Canada
- Photomedicine Institute, Vancouver Coastal Health Research Institute, Vancouver, Canada
- Department of Cancer Control and/or Integrative Oncology and Imaging, BC Cancer, Vancouver, Canada
| | - T K Lee
- Department of Dermatology and Skin Science, University of British Columbia, 835 West 10th Avenue, Vancouver, BC, V5Z 4E8, Canada
- Photomedicine Institute, Vancouver Coastal Health Research Institute, Vancouver, Canada
- Department of Cancer Control and/or Integrative Oncology and Imaging, BC Cancer, Vancouver, Canada
| | - S Kalia
- Department of Dermatology and Skin Science, University of British Columbia, 835 West 10th Avenue, Vancouver, BC, V5Z 4E8, Canada.
- Photomedicine Institute, Vancouver Coastal Health Research Institute, Vancouver, Canada.
- Department of Cancer Control and/or Integrative Oncology and Imaging, BC Cancer, Vancouver, Canada.
- Centre for Clinical Evaluation and Epidemiology, Vancouver Coastal Health Research Institute, Vancouver, Canada.
- Division of Dermatology, BC Children's Hospital Research Institute, Vancouver, Canada.
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Caswell-Jin JL, Shafaee MN, Xiao L, Liu M, John EM, Bondy ML, Kurian AW. Breast cancer diagnosis and treatment during the COVID-19 pandemic in a nationwide, insured population. Breast Cancer Res Treat 2022; 194:475-482. [PMID: 35624175 PMCID: PMC9140322 DOI: 10.1007/s10549-022-06634-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/09/2022] [Indexed: 12/30/2022]
Abstract
Purpose The early months of the COVID-19 pandemic led to reduced cancer screenings and delayed cancer surgeries. We used insurance claims data to understand how breast cancer incidence and treatment after diagnosis changed nationwide over the course of the pandemic. Methods Using the Optum Research Database from January 2017 to March 2021, including approximately 19 million US adults with commercial health insurance, we identified new breast cancer diagnoses and first treatment after diagnosis. We compared breast cancer incidence and proportion of newly diagnosed patients receiving pre-operative systemic therapy pre-COVID, in the first 2 months of the COVID pandemic and in the later part of the COVID pandemic. Results Average monthly breast cancer incidence was 19.3 (95% CI 19.1–19.5) cases per 100,000 women and men pre-COVID, 11.6 (95% CI 10.8–12.4) per 100,000 in April–May 2020, and 19.7 (95% CI 19.3–20.1) per 100,000 in June 2020–February 2021. Use of pre-operative systemic therapy was 12.0% (11.7–12.4) pre-COVID, 37.7% (34.9–40.7) for patients diagnosed March–April 2020, and 14.8% (14.0–15.7) for patients diagnosed May 2020–January 2021. The changes in breast cancer incidence across the pandemic did not vary by demographic factors. Use of pre-operative systemic therapy across the pandemic varied by geographic region, but not by area socioeconomic deprivation or race/ethnicity. Conclusion In this US-insured population, the dramatic changes in breast cancer incidence and the use of pre-operative systemic therapy experienced in the first 2 months of the pandemic did not persist, although a modest change in the initial management of breast cancer continued.
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Affiliation(s)
- Jennifer L Caswell-Jin
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
- Center for Clinical Sciences Research, Stanford University School of Medicine, Room 1145C, Stanford, CA, 94305-5405, USA.
| | - Maryam N Shafaee
- Dan L Duncan Cancer, Baylor College of Medicine, Houston, TX, USA
| | - Lan Xiao
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Mina Liu
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Esther M John
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Melissa L Bondy
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Allison W Kurian
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA, USA
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Harwood KJ, Pines JM, Andrilla CHA, Frogner BK. Where to start? A two stage residual inclusion approach to estimating influence of the initial provider on health care utilization and costs for low back pain in the US. BMC Health Serv Res 2022; 22:694. [PMID: 35606781 PMCID: PMC9128255 DOI: 10.1186/s12913-022-08092-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 05/09/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Diagnostic testing and treatment recommendations can vary when medical care is sought by individuals for low back pain (LBP), leading to variation in quality and costs of care. We examine how the first provider seen by an individual at initial diagnosis of LBP influences downstream utilization and costs. METHODS Using national private health insurance claims data, individuals age 18 or older were retrospectively assigned to cohorts based on the first provider seen at the index date of LBP diagnosis. Exclusion criteria included individuals with a diagnosis of LBP or any serious medical conditions or an opioid prescription recorded in the 6 months prior to the index date. Outcome measures included use of imaging, back surgery rates, hospitalization rates, emergency department visits, early- and long-term opioid use, and costs (out-of-pocket and total costs of care) twelve months post-index date. We used a two-stage residual inclusion (2SRI) estimation approach comparing copay for the initial provider visit and differential distance as the instrumental variable to reduce selection bias in the choice of first provider, controlling for demographics. RESULTS Among 3,799,593 individuals, cost and utilization varied considerably based on the first provider seen by the patient. Copay and differential distance provided similar results, with copay preserving a greater sample size. The frequency of early opioid prescription was significantly lower when care began with an acupuncturist or chiropractor, and highest for those who began with an emergency medicine physician or advanced practice registered nurse (APRN). Long-term opioid prescriptions were low across most providers except physical medicine and rehabilitation physicians and APRNs. The frequency and time to serious illness varied little across providers. Total cost of care was lowest when starting with a chiropractor ($5093) or primary care physician ($5660), and highest when starting with an orthopedist ($9434) or acupuncturist ($9205). CONCLUSION The first provider seen by individuals with LBP was associated with large differences in health care utilization, opioid prescriptions, and cost while there were no differences in delays in diagnosis of serious illness.
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Affiliation(s)
- Kenneth J Harwood
- College of Health and Education, Marymount University, Arlington, VA, USA.
| | | | - C Holly A Andrilla
- Department of Family Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Bianca K Frogner
- Center for Health Workforce Studies, Department of Family Medicine, School of Medicine, University of Washington, Seattle, WA, USA
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Abstract
There is abundant literature on efforts to reduce opioid prescriptions and misuse, but comparatively little on the treatment provided to people with opioid use disorder (OUD). Using claims data representing 12-15 million nonelderly adults covered through commercial group insurance during the period 2008-17, we explored rates of OUD diagnoses, treatment patterns, and spending. We found three key patterns: The rate of diagnosed OUD nearly doubled during 2008-17, and the distribution has shifted toward older age groups; the likelihood that diagnosed patients will receive any treatment has declined, particularly among those ages forty-five and older, because of a reduction in the use of medication-assisted treatment (MAT) and despite clinical evidence demonstrating its efficacy; and treatment spending is lower for patients who choose MAT. These patterns suggest that policies supporting the use of MAT are critical to addressing the undertreatment of OUD among the commercially insured and that further research to assess the cost-effectiveness of treatment with versus without medication is needed.
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Affiliation(s)
- Karen Shen
- Karen Shen is a PhD student in economics at Harvard University, in Cambridge, Massachusetts
| | - Eric Barrette
- Eric Barrette is a director, health economics, at Medtronic in Washington, D.C
| | - Leemore S Dafny
- Leemore S. Dafny is the Bruce V. Rauner Professor of Business Administration at Harvard Business School, in Boston, Massachusetts, and the John F. Kennedy School of Government, Harvard University, in Cambridge
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11
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Siracuse JJ, Woodson J, Ellis RP, Farber A, Roddy SP, Kalesan B, Levin SR, Osborne NH, Srinivasan J. Intermittent claudication treatment patterns in the commercially insured non-Medicare population. J Vasc Surg 2021; 74:499-504. [PMID: 33548437 DOI: 10.1016/j.jvs.2020.10.090] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/25/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Despite published guidelines and data for Medicare patients, it is uncertain how younger patients with intermittent claudication (IC) are treated. Additionally, the degree to which treatment patterns have changed over time with the expansion of endovascular interventions and outpatient centers is unclear. Our goal was to characterize IC treatment patterns in the commercially insured non-Medicare population. METHODS The IBM MarketScan Commercial Database, which includes more than 8 billion US commercial insurance claims, was queried for patients newly diagnosed with IC from 2007 to 2016. Patient demographics, medication profiles, and open/endovascular interventions were evaluated. Time trends were modeled using simple linear regression and goodness-of-fit was assessed with coefficients of determination (R2). A patient-centered cohort sample and a procedure-focused dataset were analyzed. RESULTS Among 152,935,013 unique patients in the database, there were 300,590 patients newly diagnosed with IC. The mean insurance coverage was 4.4 years. The median patients age was 58 years and 56% of patients were male. The prevalence of statin use was 48% among patients at the time of IC diagnosis and increased to 52% among patients after one year from diagnosis. Interventions were performed in 14.3%, of whom 20% and 6% underwent two or more and three or more interventions, respectively. The median time from diagnosis to intervention decreased from 230 days in 2008 days to 49 days in 2016 (R2 = 0.98). There were 16,406 inpatient and 102,925 ambulatory interventions for IC over the study period. Among ambulatory interventions, 7.9% were performed in office-based/surgical centers. The proportion of atherectomies performed in the ambulatory setting increased from 9.7% in 2007 to 29% in 2016 (R2 = 0.94). In office-based/surgical centers, 57.6% of interventions for IC used atherectomy in 2016. Atherectomy was used in ambulatory interventions by cardiologists in 22.6%, surgeons in 15.2%, and radiologists in 13.6% of interventions. Inpatient atherectomy rates remained stable over the study period. Open and endovascular tibial interventions were performed in 7.9% and 7.8% of ambulatory and inpatient IC interventions, respectively. Tibial bypasses were performed in 8.2% of all open IC interventions. CONCLUSIONS There has been shorter time to intervention in the treatment of younger, commercially insured patients with IC, with many receiving multiple interventions. Statin use was low. Ambulatory procedures, especially in office-based/surgical centers, increasingly used atherectomy, which was not observed in inpatient settings.
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Affiliation(s)
- Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Mass.
| | - Jonathan Woodson
- Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Mass; Institute for Health System Innovation and Policy, Boston University, Boston, Mass; Questrom School of Business, Boston University, Boston, Mass
| | | | - Alik Farber
- Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Mass
| | - Sean P Roddy
- Division of Vascular Surgery, Albany Medical College, Albany, NY
| | - Bindu Kalesan
- Department of Medicine, Center for Clinical Translational Epidemiology and Comparative Effectiveness Research, Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Mass
| | - Scott R Levin
- Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Mass
| | - Nicholas H Osborne
- Division of Vascular and Endovascular Surgery, University of Michigan Medical Center, Ann Arbor, Mich
| | - Jayakanth Srinivasan
- Institute for Health System Innovation and Policy, Boston University, Boston, Mass; Questrom School of Business, Boston University, Boston, Mass
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Abstract
Patients in the US are more likely to receive out-of-network behavioral health care, including treatment for mental health or substance use disorders, than they are to receive other medical and surgical services out of network. To date, out-of-network and in-network trends in the prices and use of ambulatory behavioral health care have been seldom described. Here we compare levels and growth of insurer-negotiated prices (allowed amounts), patient cost sharing, and use of psychotherapy services in network and out of network in a large, commercially insured US population during 2007-17. For both adult and child psychotherapy, prices and cost sharing were substantially higher out of network than they were in network. These gaps widened during the eleven-year period. Prices and cost sharing for in-network psychotherapy decreased during this period, whereas prices and cost sharing for out-of-network psychotherapy increased. Use of adult and child psychotherapy increased during this period, driven by growth of in-network rather than out-of-network use. The increasing gap in prices and cost sharing between out-of-network and in-network psychotherapy, viewed in the context of a shortage of behavioral health providers who accept insurance, may limit access to ambulatory behavioral health care.
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Affiliation(s)
- Nicole M Benson
- Nicole M. Benson is an instructor in psychiatry at Harvard Medical School, in Boston, Massachusetts, and a psychiatrist at Massachusetts General Hospital and McLean Hospital, in Belmont, Massachusetts
| | - Zirui Song
- Zirui Song is an assistant professor of health care policy and medicine at Harvard Medical School, a general internist at Massachusetts General Hospital, and faculty member in the Center for Primary Care at Harvard Medical School
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13
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Song Z, Johnson W, Kennedy K, Biniek JF, Wallace J. Out-Of-Network Spending Mostly Declined In Privately Insured Populations With A Few Notable Exceptions From 2008 To 2016. Health Aff (Millwood) 2020; 39:1032-1041. [PMID: 32479236 PMCID: PMC8299541 DOI: 10.1377/hlthaff.2019.01776] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
While out-of-network or potential "surprise" billing has garnered increasing attention, particularly in emergency department and inpatient settings, few national studies have examined out-of-network care overall or in other settings. We examined out-of-network spending and use among two large nationwide populations with employer-sponsored insurance. In a primary sample of 27,883,040 people in data for 2008-16 from the Truven MarketScan Commercial Claims and Encounters Database, we found that the unadjusted share of total spending that occurred out of network decreased from 7.0 percent in 2008-10 to 6.1 percent in 2014-16, an adjusted average decline of 0.10 percentage points per year. Using a secondary sample of 13,093,209 people in the Health Care Cost Institute database provided qualitatively similar results, including when provider charges (upper bound for balance billing) were used in place of observed out-of-network prices. In subgroup analyses of the primary sample, the share of out-of-network spending was stable or declined among all segments of care except hospitalist services, pathologist services, and laboratory tests across the study period. Out-of-network use demonstrated comparable patterns. Prices were higher out of network than in network. Policy makers should focus their efforts on protecting consumers from balance billing or potential surprise billing in clinical scenarios where patients often have little choice over their provider.
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Affiliation(s)
- Zirui Song
- Zirui Song is an assistant professor of health care policy and medicine at Harvard Medical School, a general internist at Massachusetts General Hospital, and faculty member in the Center for Primary Care at Harvard Medical School, in Boston, Massachusetts
| | - William Johnson
- William Johnson is a senior researcher at the Health Care Cost Institute, in Washington, D.C
| | - Kevin Kennedy
- Kevin Kennedy is a researcher at the Health Care Cost Institute
| | | | - Jacob Wallace
- Jacob Wallace is an assistant professor of Public Health in the Department of Health Policy and Management, Yale School of Public Health, in New Haven, Connecticut
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Duffy EL, Adler L, Ginsburg PB, Trish E. Prevalence And Characteristics Of Surprise Out-Of-Network Bills From Professionals In Ambulatory Surgery Centers. Health Aff (Millwood) 2020; 39:783-790. [PMID: 32293916 DOI: 10.1377/hlthaff.2019.01138] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Patients treated at in-network facilities can involuntarily receive services from out-of-network providers, which may result in "surprise bills." While several studies report the surprise billing prevalence in emergency department and inpatient settings, none document the prevalence in ambulatory surgery centers (ASCs). The extent to which health plans pay a portion or all of out-of-network providers' bills in these situations is also unexplored. We analyzed 4.2 million ASC-based episodes of care in 2014-17, involving 3.3 million patients enrolled in UnitedHealth Group, Humana, and Aetna commercial plans. One in ten ASC episodes involved out-of-network ancillary providers at in-network ASC facilities. Insurers paid providers' full billed charges in 24 percent of the cases, leaving no balance to bill patients. After we accounted for insurer payment, we found that there were potential surprise bills in 8 percent of the episodes at in-network ASCs. The average balance per episode increased by 81 percent, from $819 in 2014 to $1,483 in 2017. Anesthesiologists (44 percent), certified registered nurse anesthetists (25 percent), and independent laboratories (10 percent) generated most potential surprise bills. There is a need for federal policy to expand protection from surprise bills to patients enrolled in all commercial insurance plans.
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Affiliation(s)
- Erin L Duffy
- Erin L. Duffy ( Erin. Duffy@usc. edu ) is a postdoctoral fellow at the Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California (USC), in Los Angeles
| | - Loren Adler
- Loren Adler is associate director of the USC-Brookings Schaeffer Initiative for Health Policy, Brookings Institution, in Washington, D.C
| | - Paul B Ginsburg
- Paul B. Ginsburg is director of the USC-Brookings Schaeffer Initiative for Health Policy and the Leonard D. Schaeffer Chair in Health Policy Studies, both at the Brookings Institution, and a professor at the Price School of Public Policy and director of public policy at the Leonard D. Schaeffer Center for Health Policy and Economics, both at USC
| | - Erin Trish
- Erin Trish is the associate director of the Leonard D. Schaeffer Center for Health Policy and Economics and an assistant professor of pharmaceutical and health economics in the School of Pharmacy, both at USC
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Broder MS, Cai B, Chang E, Yan T, Benson Iii AB. Treatment adherence, healthcare resource utilization, and costs in patients with lung neuroendocrine tumors (lung NETs) in the USA. Curr Med Res Opin 2018; 34:2151-2156. [PMID: 30047289 DOI: 10.1080/03007995.2018.1505277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To assess first-line treatment adherence, healthcare resource utilization, and costs in lung NET patients initiating pharmacologic treatments. METHODS In two US claims databases, patients aged ≥18 years with ≥1 inpatient or ≥2 outpatient lung NET claims within 12 months were identified. The first claim for pharmacologic treatments (e.g. somatostatin analogs [SSAs], cytotoxic chemotherapy [CC], targeted therapy [TT]) following diagnosis, between July 1, 2009-December 31, 2014, was defined as the index date. A 6-month pre-index period without any NET treatment, and ≥1-year post-index enrollment were required. Proportion of days covered (PDC) was calculated during follow-up. Descriptive statistics, including means, standard deviations, and frequencies/percentages for continuous and categorical data, respectively, were reported. RESULTS Of 354 patients with 1-year of follow-up, 252 initiated CC, 89 SSA, 3 TT, and 10 various combinations. Due to sample sizes, the remaining results focus only on CC and SSAs. Mean PDC (SD) was 0.320 (0.176) for CC and 0.673 (0.322) for SSAs; CC users had a mean (SD) of 33.3 (23.8) office visits and 0.79 (1.39) hospitalizations; SSA users had 23.1 (12.4) visits and 0.48 (1.07) hospitalizations. Mean total (SD) annual cost for CC users was $124,383 (135,836) and $98,713 (81,495) for SSA users. Among 163 patients with 2 years of follow-up, the annual mean cost in the second-year was $43,026 lower and $8110 higher than the first-year for CC and SSAs, respectively. CONCLUSIONS The majority of patients with lung NETs initiated CC; only about one quarter initiated SSA in the first-line. This descriptive study updates the utilization and costs of pharmacologically-treated lung NETs.
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Affiliation(s)
- Michael S Broder
- a Partnership for Health Analytic Research, LLC , Beverly Hills , CA , USA
| | - Beilei Cai
- b Novartis Pharmaceuticals , East Hanover , NJ , USA
| | - Eunice Chang
- a Partnership for Health Analytic Research, LLC , Beverly Hills , CA , USA
| | - Tingjian Yan
- a Partnership for Health Analytic Research, LLC , Beverly Hills , CA , USA
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16
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Broder MS, Cai B, Chang E, Neary MP. Incidence and prevalence of neuroendocrine tumors of the lung: analysis of a US commercial insurance claims database. BMC Pulm Med 2018; 18:135. [PMID: 30103725 PMCID: PMC6088414 DOI: 10.1186/s12890-018-0678-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/19/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND As reported in Surveillance, Epidemiology, and End Results (SEER) data, US incidence and prevalence of neuroendocrine tumors (NET) has increased over recent years. The study objective was to update incidence and prevalence information for lung NET using administrative claims. METHODS This descriptive epidemiological study used 2009-2014 data from 2 US claims databases: MarketScan and PharMetrics. Patients (18-64 years old) had ≥1 inpatient or ≥ 2 outpatient claims with NET of bronchus or lung, identified by International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes. Prevalence was number of lung NET patients divided by number of enrollees/year. Incidence was number of patients with a first observed NET diagnosis who were disease-free for 2 years prior, divided by number of enrollees. Age and gender adjustments performed. RESULTS The annual number of patients with lung NET identified from 2009 to 2014 ranged from 435 to 796 (MarketScan) and 419-648 (PharMetrics). In MarketScan, there was a 7.4% (95%CI 2.1-13.0; p = 0.027) annual percent change (APC) in the age-adjusted incidence for males and 6.8% (- 0.2-14.3; 0.052) for females. In PharMetrics, APC was - 2.9% (- 13.8-9.4; 0.395) for males; 14.7% (- 12.9-51.2; 0.165) for females. In MarketScan, APC in age-adjusted prevalence for males was 9.9% (4.7-15.3; 0.006); 16.2% (11.4-21.1; <.001) for females. For PharMetrics, APCs were 9.5% (2.3-17.2; 0.021) for males; 16.3% (9.6-23.5; 0.002) for females. CONCLUSIONS From 2009 to 2014 there was a statistically significant increase in age-adjusted lung NET incidence for males in MarketScan, and a statistically significant increase in age-adjusted prevalence for both genders in PharMetrics. Incidence and prevalence changes, to the extent they exist, may be due to better diagnostic methods, increased awareness of NET among clinicians and pathologists, and/or an actual increase in US disease occurrence. Differences in rates across databases are difficult to explain. These results suggest the need for awareness of the clinically effective and safe treatment options available for lung NET patients among healthcare providers.
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Affiliation(s)
- Michael S Broder
- Partnership for Health Analytic Research, LLC, 280 S. Beverly Dr. Ste. 404, Beverly Hills, CA, USA.
| | - Beilei Cai
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, New Jersey, USA
| | - Eunice Chang
- Partnership for Health Analytic Research, LLC, 280 S. Beverly Dr. Ste. 404, Beverly Hills, CA, USA
| | - Maureen P Neary
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, New Jersey, USA
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Phiri SC, Prescott MR, Prust ML, McCarthy EA, Kanchele CC, Haimbe P, Shakwelele H, Mudhune S. Impact of passenger engagement through road safety bus stickers in public service vehicles on road traffic crashes in Zambia: a randomized controlled trial. BMC Public Health 2018; 18:872. [PMID: 30005647 PMCID: PMC6043959 DOI: 10.1186/s12889-018-5780-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 06/28/2018] [Indexed: 11/20/2022] Open
Abstract
Background Road Traffic Crashes (RTCs) are the third highest cause of death in Zambia, claiming about 2000 lives annually, with pedestrians and cyclists being the most vulnerable. Human error accounts for 87.3% of RTCs. Minibus and big bus public service vehicles (PSVs) are among the common vehicle types involved in these crashes. Given the alarmingly high rate of road traffic crashes involving PSV minibuses and big buses within Zambia, there is a need to mitigate this through innovative solutions. In other settings, it has been shown that stickers in PSVs encouraging passengers to speak out against reckless driving can reduce RTCs, but it is unclear whether such an intervention could work in Zambia. Based on this evidence, the Zambia Road Transport and Safety Agency (RTSA) has developed a road safety bus sticker campaign for PSVs and before national scale-up, RTSA is interested in evidence of the impact of these stickers. Methods This evaluation will be a stratified two-arm randomized controlled trial with a one-to-one ratio. The sample will be stratified by vehicle type, thus creating a two-arm trial for minibuses and a separate two-arm trial for big buses. The sample will include 2110 minibuses and 300 big buses from four towns in Zambia. The primary outcome of interest will be the difference in the rate of RTCs over a 14-month period (7-months before the intervention and 7 months after) between buses with and without the new RTSA road safety bus stickers. Discussion This study will provide evidence on the impact of the Zambian sticker program on road traffic crashes as implemented through minibuses and big buses, that can help inform the scale up of a national ‘Zambia road safety bus sticker campaign’. Trial registration PACT-R, PACTR201711002758216. Registered 13 November 2017-Retrospectively registered.
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Affiliation(s)
| | | | | | | | | | - Prudence Haimbe
- Clinton Health Access Initiative, PO Box 51071, Ridgeway, Lusaka, Zambia
| | - Hilda Shakwelele
- Clinton Health Access Initiative, PO Box 51071, Ridgeway, Lusaka, Zambia
| | - Sandra Mudhune
- Clinton Health Access Initiative, PO Box 51071, Ridgeway, Lusaka, Zambia
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Vaughn DA, van Deen WK, Kerr WT, Meyer TR, Bertozzi AL, Hommes DW, Cohen MS. Using insurance claims to predict and improve hospitalizations and biologics use in members with inflammatory bowel diseases. J Biomed Inform 2018; 81:93-101. [PMID: 29625187 DOI: 10.1016/j.jbi.2018.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/10/2018] [Accepted: 03/26/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Inflammatory Bowel Disease (IBD) is an inflammatory disorder of the gastrointestinal tract that can necessitate hospitalization and the use of expensive biologics. Models predicting these interventions may improve patient quality of life and reduce expenditures. MATERIALS AND METHODS We used insurance claims from 2011 to 2013 to predict IBD-related hospitalizations and the initiation of biologics. We derived and optimized our model from a 2011 training set of 7771 members, predicting their outcomes the following year. The best-performing model was then applied to a 2012 validation set of 7450 members to predict their outcomes in 2013. RESULTS Our models predicted both IBD-related hospitalizations and the initiation of biologics, with average positive predictive values of 17% and 11%, respectively - each a 200% improvement over chance. Further, when we used topic modeling to identify four member subpopulations, the positive predictive value of predicting hospitalization increased to 20%. DISCUSSION We show that our hospitalization model, in concert with a mildly-effective interventional treatment plan for members identified as high-risk, may both improve patient outcomes and reduce insurance expenditures. CONCLUSION The success of our approach provides a roadmap for how claims data can complement traditional medical decision making with personalized, data-driven predictive medicine.
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Affiliation(s)
- Don A Vaughn
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Welmoed K van Deen
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Disease, David Geffen School of Medicine, Los Angeles, CA, USA; Gehr Family Center for Health Systems Science, Division of Geriatric, Hospital, Palliative and General Internal Medicine, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
| | - Wesley T Kerr
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA; UCLA Department of Biomathematics, Los Angeles, CA, USA; Eisenhower Medical Center, Department of Internal Medicine, Rancho Mirage, CA, USA
| | | | | | - Daniel W Hommes
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Disease, David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Mark S Cohen
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA; UCLA Departments of Psychiatry, Neurology, Radiology, Psychology, Biomedical Physics and Bioengineering, and California Nanosystems Institute, Los Angeles, CA, USA
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Broder MS, Cai B, Chang E, Neary MP, Papoyan E, Benson AB. Real-World Treatment Patterns for Lung Neuroendocrine Tumors: A Claims Database Analysis. Oncology 2018; 94:281-288. [PMID: 29510379 DOI: 10.1159/000486282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 12/11/2017] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The aim of this study was to describe real-world lung neuroendocrine tumor (NET) treatment patterns. METHODS This study examined cytotoxic chemotherapy (CC), somatostatin analogues (SSA), targeted therapy (TT), interferon, and liver-directed therapies in 2 US claims databases. Patients ≥18 years with ≥1 inpatient or ≥2 outpatient claims for lung NET, initiating pharmacologic treatment between July 1, 2009, and June 30, 2014, were identified and followed until the end of enrollment or study end, whichever occurred first. RESULTS A total of 785 newly pharmacologically treated lung NET patients were identified: mean (SD) age was 58.6 (9.1) years; 54.0% were female; 78.2% started first-line therapy with CC, 18.1% with SSA, and 1.1% with TT. Mean duration of first-line treatment was 397 days for SSA, 142 days for CC, and 135 days for TT. 74.1% of patients received no pharmacological treatment beyond first-line. The most common second-line treatment was SSA. CONCLUSIONS Most patients received CC as first-line treatment, with SSA being less common. SSA-treated patients remained on therapy for > 1 year, compared to < 5 months for CC. The high proportion of patients using chemotherapy and the low proportion receiving second-line treatment seems consistent with treatment guidelines for small cell lung cancer rather than for NET. Future studies are warranted to describe reasons for treatment choice, discontinuation, and switching.
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Affiliation(s)
- Michael S Broder
- Partnership for Health Analytic Research, LLC, Beverly Hills, California, USA
| | - Beilei Cai
- Novartis Pharmaceuticals, East Hanover, New Jersey, USA
| | - Eunice Chang
- Partnership for Health Analytic Research, LLC, Beverly Hills, California, USA
| | | | - Elya Papoyan
- Partnership for Health Analytic Research, LLC, Beverly Hills, California, USA
| | - Al B Benson
- Northwestern University, Chicago, Illinois, USA
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Benson III AB, Broder MS, Cai B, Chang E, Neary MP, Papoyan E. Real-world treatment patterns of gastrointestinal neuroendocrine tumors: A claims database analysis. World J Gastroenterol 2017; 23:6128-6136. [PMID: 28970728 PMCID: PMC5597504 DOI: 10.3748/wjg.v23.i33.6128] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/09/2017] [Accepted: 06/19/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To describe real-world treatment patterns of gastrointestinal neuroendocrine tumors (GI NET).
METHODS In this retrospective cohort study, we used 2009-2014 data from 2 United States commercial claims databases to examine newly pharmacologically treated patients using tabular and graphical techniques. Treatments included somatostatin analogues (SSA), cytotoxic chemotherapy (CC), targeted therapy (TT), interferon (IF) and combinations. We identified patients at least 18 years of age, with ≥ 1 inpatient or ≥ 2 outpatient claims for GI NET who initiated pharmacologic treatment from 7/1/09-6/30/14. A 6 mo clean period prior to first treatment ensured patients were newly treated. Patients were followed until end of enrollment or the study end date, whichever was first.
RESULTS We identified 2258 newly treated GI NET patients: mean (SD) age was 55.6 years (SD = 9.7), 47.2% of the patients were between 55 and 64 years, and 48.8% were female. All regions of the United States were represented. 59.6% started first-line therapy with SSA monotherapy (964 with octreotide LAR, 380 with octreotide SA, and 1 with lanreotide), 33.3% CC, 3.6% TT, and 0.5% IF. The remainder received combinations. Mean follow up was 576 d. Overall mean first-line therapy duration was 361 d (449 d for SSA, 215 for CC, 267 for TT). 58.9% of patients had no pharmacological treatment beyond first line. The most common second-line was combination therapy with SSA. In graphical pattern analysis, there was no clear pattern visible after first line therapy.
CONCLUSION In this study, 60% of patients initiated treatment with SSA alone or in combination. The relatively long time to discontinuation suggests possible sustained effectiveness and tolerability.
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Affiliation(s)
| | - Michael S Broder
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA 90212, United States
| | - Beilei Cai
- Novartis Pharmaceuticals, East Hanover, NJ 07936, United States
| | - Eunice Chang
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA 90212, United States
| | - Maureen P Neary
- Novartis Pharmaceuticals, East Hanover, NJ 07936, United States
| | - Elya Papoyan
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA 90212, United States
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Abstract
BACKGROUND Workers with coronary artery disease (CAD) require evidence-based care in order to return to work safely. We assessed the use of cardiac rehabilitation (CR) among workers with CAD, and identified the factors associated with CR use.Methods and Results:A retrospective cohort study based on data from a health insurance claims database was conducted. We identified workers aged ≥18 years who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) between 2006 and 2013, and reviewed the utilization of inpatient or outpatient CR. Logistic regression was used to identify the factors associated with CR use. A total of 1,699 patients were included. The frequency of inpatient and outpatient CR use was 23.7% (n=402) and 4.2% (n=72), respectively. Patients diagnosed with ST-elevated myocardial infarction were most likely to receive inpatient CR, and patients undergoing CABG were more likely to receive inpatient CR than those undergoing PCI. Moreover, inpatient CR use was associated with longer hospitalization duration, catecholamine use, and no history of chronic kidney disease. Furthermore, both unstable and stable angina were negatively correlated with outpatient CR use. CONCLUSIONS Most of the Japanese workers with CAD in this study did not undergo CR. The type of CAD was strongly associated with inpatient and outpatient CR use. Thus, a strong evidence-practice gap exists in secondary preventative care within this group of patients.
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Affiliation(s)
| | - Kenji Ueshima
- Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital
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Dunn A. Health insurance and the demand for medical care: Instrumental variable estimates using health insurer claims data. J Health Econ 2016; 48:74-88. [PMID: 27107371 DOI: 10.1016/j.jhealeco.2016.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 02/26/2016] [Accepted: 03/07/2016] [Indexed: 06/05/2023]
Abstract
This paper takes a different approach to estimating demand for medical care that uses the negotiated prices between insurers and providers as an instrument. The instrument is viewed as a textbook "cost shifting" instrument that impacts plan offerings, but is unobserved by consumers. The paper finds a price elasticity of demand of around -0.20, matching the elasticity found in the RAND Health Insurance Experiment. The paper also studies within-market variation in demand for prescription drugs and other medical care services and obtains comparable price elasticity estimates.
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Affiliation(s)
- Abe Dunn
- Bureau of Economic Analysis, United States.
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23
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Bonafede M, Shi N, Barron R, Li X, Crittenden D, Chandler D. Predicting imminent risk for fracture in patients aged 50 or older with osteoporosis using US claims data. Arch Osteoporos 2016; 11:26. [PMID: 27475642 PMCID: PMC4967418 DOI: 10.1007/s11657-016-0280-5] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/07/2016] [Indexed: 02/03/2023]
Abstract
UNLABELLED Patient characteristics contributing to imminent risk for fracture, defined as risk of near-term fracture within the next 12 to 24 months, have not been well defined. In patients without recent fracture, we identified factors predicting imminent risk for vertebral/nonvertebral fracture, including falls, age, comorbidities, and other potential fall risk factors. PURPOSE Several factors contribute to long-term fracture risk in patients with osteoporosis, including age, bone mineral density, and fracture history. Some patients may be at imminent risk for fracture, defined here as a risk of near-term fracture within 12-24 months. Many patient characteristics contributing to imminent risk for fracture have not been well defined. This case-control study used US commercial and Medicare supplemental insured data for women and men without recent fracture to identify factors associated with imminent risk for fracture. METHODS Patients included were aged ≥50 with osteoporosis, had a vertebral or nonvertebral fracture claim (index date; fracture group) or no fracture claim (control group) from January 1, 2006, to September 30, 2012, continuously enrolled and without fracture in the 24 months before index. Potential risk factors during the period before fracture were assessed. RESULTS Using data from 12 months before fracture, factors significantly associated with imminent risk for fracture were previous falls, older age, poorer health status, specific comorbidities (psychosis, Alzheimer's disease, central nervous system disease), and other fall risk factors (wheelchair use, psychoactive medication use, mobility impairment). Similar findings were observed with data from 24 months before fracture. CONCLUSIONS In patients with osteoporosis and no recent fracture, falls, older age, poorer health status, comorbidities, and other potential fall risk factors were predictive of imminent risk for fracture. Identification of factors associated with imminent risk for vertebral/nonvertebral fracture may help identify and risk stratify those patients most in need of immediate and appropriate treatment to decrease fracture risk.
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Affiliation(s)
| | - N. Shi
- Truven Health Analytics, Cambridge, MA USA
| | - R. Barron
- Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA USA
| | - X. Li
- Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA USA
| | | | - D. Chandler
- Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA USA
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24
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Skogar M, Ahlberg J, Sundbom M. Claims to the patient insurance after bariatric surgery in Sweden 2000-2012. Surg Obes Relat Dis 2014; 11:201-6. [PMID: 25443067 DOI: 10.1016/j.soard.2014.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 06/06/2014] [Accepted: 06/06/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Since 2000, the annual number of bariatric procedures has increased more than 10-fold in Sweden, and in 2012, 94% of these procedures were primary laparoscopic gastric bypass. METHODS We studied claims from the national Patient Insurance (Landstingens Ömsesidiga Försäkringsbolag, LÖF) to evaluate if the number of adverse events (AEs) from a patient perspective had increased unproportionally. All claims related to bariatric surgery from January 2000 to March 2012 were identified by ICD-10 codes and divided into 3 main groups: (1) procedure-related AEs (occurring within 30 days), (2) late AEs, and (3) nonsurgical AEs. Logistic regression was used to study the change in claim rate over time. The setting was a university hospital in Sweden. RESULTS In total, 359 claims were included, corresponding to 14 claims per 1,000 bariatric procedures (laparoscopic 59%, open 24%, revision 17%). Numbers correlated with the expansion of bariatric surgery and type of procedure routinely performed. Of the procedure-related claims (74% of all claims), postoperative leaks or bleedings were most common. In this group, patients frequently needed additional surgery (69%) and intensive care (42%). Half of the late AEs (69 in total) were related to abdominal pain or malnutrition, including 5 cases of Wernicke's encephalopathy. In total 2% died. Of 344 settled claims, economical compensation was given to 29%. CONCLUSION In this cohort of patients with insurance claims after bariatric surgery (1.4% of all procedures), procedure-related AEs were severe, with a large amount of patients requiring reoperation and intensive care. No change in claim rate was seen, in spite of the 10-fold increase of bariatric surgery.
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Affiliation(s)
- Martin Skogar
- Department of Surgical Sciences, Uppsala University, SE-751 85, Uppsala, Sweden.
| | - Jon Ahlberg
- Patient Insurance LÖF, Box 17830, SE-118 94, Stockholm, Sweden
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, SE-751 85, Uppsala, Sweden
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