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1.
Am J Manag Care ; 27(9): e308-e315, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34533913

RESUMO

OBJECTIVES: Patients with chronic respiratory failure resulting from chronic obstructive pulmonary disease (COPD-CRF) have limited treatment options and poor health outcomes. We examined the effect of noninvasive ventilation at home (NIVH) treatment on all-cause mortality, hospitalizations, and emergency department (ED) visits. STUDY DESIGN: Retrospective cohort study. METHODS: Using Medicare claims data between 2012 and 2017, we divided patients with COPD-CRF into a treatment group, defined by NIVH receipt within 2 months of CRF diagnosis, and a control group without NIVH receipt in the entire follow-up period. We modeled time to death, first hospitalization, and first ED visit. Cox regressions were performed, mitigating selection bias using stabilized inverse probability of treatment weights with regression controls. Sensitivity analyses with time-varying exposure to NIVH were conducted on the full sample irrespective of treatment timing. RESULTS: We identified 410 patients treated with NIVH and 36,247 controls. We observed a reduced risk of hospitalizations (HR, 0.790; 95% CI, 0.592-0.988), ED visits (HR, 0.571; 95% CI, 0.457-0.686), and mortality (HR, 0.617; 95% CI, 0.462-0.772). The benefit of NIVH diminished over time for mortality and ED visits but remained constant for hospitalizations. However, no survival benefit was observed in the sensitivity analyses that accounted for immortal-time bias; further exploration suggests that earlier NIVH treatment following CRF diagnosis may be an important factor in improving survival outcomes. CONCLUSIONS: Patients with COPD-CRF who received NIVH had statistically significant reductions in hospitalizations and ED visits compared with patients not treated with NIVH. Further research is needed to examine the effect of NIVH on mortality.


Assuntos
Ventilação não Invasiva , Doença Pulmonar Obstrutiva Crônica , Idoso , Serviço Hospitalar de Emergência , Hospitalização , Humanos , Medicare , Doença Pulmonar Obstrutiva Crônica/terapia , Estudos Retrospectivos , Estados Unidos/epidemiologia
2.
Am J Manag Care ; 26(2): e50-e56, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-32059100

RESUMO

OBJECTIVES: To project the social value of transcatheter aortic valve replacement (TAVR) for inoperable patients with severe, symptomatic aortic stenosis (SSAS). STUDY DESIGN: This study used an economic model with parameters obtained from the literature and from US Census Bureau population projections. METHODS: Our model estimated the economic value that will accrue to inoperable patients with SSAS and to device manufacturers as a result of TAVR utilization. We estimated individual patient value as the monetized gain in quality-adjusted life-years as estimated in the cost-effectiveness literature, net of device costs and cost offsets. We estimated manufacturer value by applying an assumed profit margin to revenue from device sales. We created population-level estimates by combining these individual-level estimates with age-stratified Census Bureau population projections and estimates of the incidence of AS. We assessed model uncertainty through the use of probabilistic sensitivity analyses. RESULTS: Between 2018 and 2028, approximately 465,000 inoperable Americans with SSAS will be treated with TAVR. These procedures will yield a cumulative social benefit of up to $48 billion, with roughly 80% of that benefit accruing to patients and 20% accruing to device manufacturers. CONCLUSIONS: Policy makers and payers should take this social value into account when considering decisions related to the care of inoperable patients with SSAS.


Assuntos
Estenose da Valva Aórtica/cirurgia , Análise Custo-Benefício , Modelos Econômicos , Substituição da Valva Aórtica Transcateter/economia , Humanos , Anos de Vida Ajustados por Qualidade de Vida , Valores Sociais
3.
J Med Econ ; 23(5): 474-483, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31903813

RESUMO

Aims: Model how moving from current disease-modifying drug (DMD) prescribing patterns for relapsing-remitting multiple sclerosis (RRMS) observed in the United Kingdom (UK) to prescribing patterns based on patient preferences would impact health outcomes over time.Materials and methods: A cohort-based Markov model was used to measure the effect of DMDs on long-term health outcomes for individuals with RRMS. Data from a discrete choice experiment were used to estimate the market shares of DMDs based on patient preferences (i.e. preference shares). These preference shares and real-world UK market shares were used to calculate the effect of prescribing behavior on relapses, disability progression, and quality-adjusted life-years (QALYs). The incremental benefit of patient-centered prescribing over current practices for the UK RRMS population was then estimated; scenario and sensitivity analyses were also conducted.Results: Compared to current prescribing practices, when UK patients with RRMS were treated following patient preferences, health outcomes were improved. This population was expected to experience 501,690 relapses and gain 1,003,263 discounted QALYs over 50 years under patient-centered prescribing practices compared to 538,417 relapses and 958,792 discounted QALYs under current practices (-6.8% and +4.6%, respectively). Additionally, less disability progression was observed when prescribed treatment was based on patient preferences. In a scenario analysis where only oral treatments were considered, the results were similar, although the magnitude of benefit was smaller. Number of relapses was most sensitive to how the annualized relapse rate was modeled; disability progression was most sensitive to mortality rate assumptions.Limitations: Treatment efficacy estimates applied to various models in this study were based on data derived from clinical trials, rather than real-world data; the impact of patient-centered prescribing on treatment adherence and/or switching was not modeled.Conclusions: The population of UK RRMS patients may experience overall health gains if patient preferences are better incorporated into prescribing practices.


Assuntos
Imunossupressores/economia , Imunossupressores/uso terapêutico , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Preferência do Paciente , Adulto , Fatores Etários , Comportamento de Escolha , Técnicas de Apoio para a Decisão , Progressão da Doença , Esquema de Medicação , Feminino , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Padrões de Prática Médica , Gestantes/psicologia , Anos de Vida Ajustados por Qualidade de Vida , Reino Unido
4.
Obesity (Silver Spring) ; 28(2): 429-436, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31869002

RESUMO

OBJECTIVE: Obesity and its complications place an enormous burden on society. Yet antiobesity medications (AOM) are prescribed to only 2% of the eligible population, even though few individuals can sustain weight loss using other strategies alone. This study estimated the societal value of greater access to AOM. METHODS: By using a well-established simulation model (The Health Economics Medical Innovation Simulation), the societal value of AOM for the cohort of Americans aged ≥ 25 years in 2019 was quantified. Four scenarios with differential uptake among the eligible population (15% and 30%) were modeled, with efficacy from current and next-generation AOM. Societal value was measured as monetized quality of life, productivity gains, and savings in medical spending, subtracting the costs of AOM. RESULTS: For the 217 million Americans aged ≥ 25 years, AOM generated $1.2 trillion in lifetime societal value under a conservative scenario (15% annual uptake using currently available AOM). The introduction of next-generation AOM increased societal value to $1.9 to $2.5 trillion, depending on uptake. Finally, societal value was higher for younger individuals and Black and Hispanic individuals compared with White individuals. CONCLUSIONS: This study suggests that AOM provide substantial gains to patients and society. Policies promoting broader clinical access to and use of AOM warrant consideration to reach national goals to reduce obesity.


Assuntos
Fármacos Antiobesidade/uso terapêutico , Acessibilidade aos Serviços de Saúde , Obesidade/prevenção & controle , Mudança Social , Adulto , Idoso , Idoso de 80 Anos ou mais , Fármacos Antiobesidade/economia , Estudos de Coortes , Redução de Custos/estatística & dados numéricos , Etnicidade/estatística & dados numéricos , Feminino , Acessibilidade aos Serviços de Saúde/normas , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/economia , Obesidade/epidemiologia , Obesidade/etnologia , Qualidade de Vida , Perfil de Impacto da Doença , Estados Unidos/epidemiologia
5.
J Med Econ ; 23(3): 297-307, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31779508

RESUMO

Aims: To estimate the relationship between functional status (FS) impairment and nursing home admission (NHA) risk in Parkinson's disease (PD) patients, and quantify the effect of advanced PD (APD) treatment on NHA risk relative to standard of care (SoC).Materials and methods: PD patients were identified in the Medicare Current Beneficiary Survey (MCBS) (1992-2010). A working definition based on the literature and clinical expert input determined APD status. A logit model estimated the relationship between FS impairment and NHA risk. The effect of levodopa-carbidopa intestinal gel (LCIG) on NHA risk relative to SoC was simulated using clinical trial data (control: optimized oral levodopa-carbidopa IR, ClinicalTrials.gov NCT00660387 and NCT0357994).Results: Non-advanced PD and APD significantly increased NHA risk when controlling for demographics (p < 0.01). APD status was no longer significant after controlling for FS limitations, implying that FS limitations explain the increased NHA risk in APD patients. Reduced impairment in FS in patients with APD treated with LCIG reduced risk of NHA by 13.5% relative to SoC.Limitations: This study applies clinical trial results to real-world data. LCIG treatment might have a different effect on NHA risk for the nationally representative population than the effect measured in the trial. Both data sources employ different instruments to measure FS, instrument wording and study follow-up differed, which might bias our estimates. Finally, there lacks consensus on a definition of APD. The prevalence of APD in this study is high, perhaps due to the specific definition used.Conclusions: Patients with APD experience a higher risk in NHA than those with non-advanced disease. This increased risk in NHA in patients with APD is explained by greater limitations in FS. The relative reduction in risk of NHA for the APD population treated with LCIG is quantitatively similar to doubling Medicaid home care services.


Assuntos
Antiparkinsonianos/uso terapêutico , Carbidopa/uso terapêutico , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Levodopa/uso terapêutico , Casas de Saúde/estatística & dados numéricos , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/fisiopatologia , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Antiparkinsonianos/administração & dosagem , Antiparkinsonianos/efeitos adversos , Carbidopa/administração & dosagem , Carbidopa/efeitos adversos , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Géis , Humanos , Levodopa/administração & dosagem , Levodopa/efeitos adversos , Masculino , Medicare/estatística & dados numéricos , Método de Monte Carlo , Desempenho Físico Funcional , Índice de Gravidade de Doença , Estados Unidos
6.
Am J Manag Care ; 25(10): 486-493, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31622064

RESUMO

OBJECTIVES: Febrile neutropenia (FN) is a life-threatening complication of chemotherapy that can lead to hospitalizations, chemotherapy dose reductions or delays, and mortality. Granulocyte colony-stimulating factor (G-CSF) prophylaxis reduces the incidence of FN, enabling patients to undergo and remain on myelosuppressive chemotherapy. We estimate the benefits of continuing current G-CSF use patterns and an alternative that aligns prophylactic G-CSF use with guideline recommendations. STUDY DESIGN: Using The Health Economics Medical Innovation Simulation microsimulation, we estimated lifetime social value (SV) of prophylactic G-CSF for a nationally representative US population with breast, lung, and gynecological cancers and non-Hodgkin lymphoma. METHODS: SV estimates included the cost of G-CSF, FN, chemotherapy relative dose intensity (RDI) less than 85% (RDI<85%), medical spending, and deaths for 3 scenarios: current use (current G-CSF use), targeted use (100% G-CSF use among patients with high FN risk), and reduced use (current G-CSF use reduced by 20% across all FN risk categories). RESULTS: Over 10 years, current use, compared with no G-CSF use, would decrease cases of FN by 3.3 million, prevent 354,000 cases of RDI<85%, and generate $96 billion in SV. Compared with current use, targeted use would decrease cases of FN by an additional 3.3 million, prevent 355,000 more cases of RDI<85%, and generate another $119 billion in SV. Reduced use would increase FN and RDI<85%, lowering SV by $18 billion compared with current use. CONCLUSIONS: Current use of G-CSF prophylaxis would provide $96 billion in SV over the next 10 years. Targeting G-CSF prophylaxis to align with guidelines would more than double SV, highlighting the substantial value of appropriate FN risk assessment and targeted G-CSF prophylaxis.


Assuntos
Neutropenia Febril Induzida por Quimioterapia/prevenção & controle , Fator Estimulador de Colônias de Granulócitos/administração & dosagem , Fator Estimulador de Colônias de Granulócitos/economia , Neoplasias/epidemiologia , Simulação por Computador , Análise Custo-Benefício , Relação Dose-Resposta a Droga , Gastos em Saúde/estatística & dados numéricos , Serviços de Saúde/economia , Serviços de Saúde/estatística & dados numéricos , Humanos , Modelos Econométricos , Neoplasias/tratamento farmacológico , Anos de Vida Ajustados por Qualidade de Vida , Índice de Gravidade de Doença
7.
PLoS One ; 14(5): e0217487, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31150444

RESUMO

OBJECTIVES: Diabetic kidney disease (DKD) is a frequent complication of diabetes with potentially devastating consequences that may be prevented or delayed. This study aimed to estimate the health and economic benefit of earlier diagnosis and treatment of DKD. METHODS: Life expectancy and medical spending for people with diabetes were modeled using The Health Economics Medical Innovation Simulation (THEMIS). THEMIS uses data from the Health and Retirement Study to model cohorts of individuals over age 50 to project population-level lifetime health and economic outcomes. DKD status was imputed based on diagnoses and laboratory values in the National Health and Nutrition Examination Survey. We simulated the implementation of a new biomarker identifying people with diabetes at an elevated risk of DKD and DKD patients at risk of rapid progression. RESULTS: Compared to baseline, the prevalence of DKD declined 5.1% with a novel prognostic biomarker test, while the prevalence of diabetes with stage 5 chronic kidney disease declined 3.0%. Consequently, people with diabetes gained 0.2 years in life expectancy, while per-capita annual medical spending fell by 0.3%. The estimated cost was $12,796 per life-year gained and $25,842 per quality-adjusted life-year. CONCLUSIONS: A biomarker test that allows earlier treatment reduces DKD prevalence and slows DKD progression, thereby increasing life expectancy among people with diabetes while raising healthcare spending by less than one percent.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Nefropatias Diabéticas/diagnóstico , Diagnóstico Precoce , Falência Renal Crônica/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/análise , Análise Custo-Benefício , Diabetes Mellitus Tipo 1/economia , Diabetes Mellitus Tipo 2/economia , Nefropatias Diabéticas/economia , Nefropatias Diabéticas/epidemiologia , Progressão da Doença , Feminino , Custos de Cuidados de Saúde , Humanos , Falência Renal Crônica/economia , Falência Renal Crônica/epidemiologia , Expectativa de Vida , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Modelos Econômicos , Método de Monte Carlo , Inquéritos Nutricionais/economia , Inquéritos Nutricionais/estatística & dados numéricos , Prevalência , Prognóstico , Fatores de Risco
8.
Am J Manag Care ; 24(4): 188-195, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29668209

RESUMO

OBJECTIVES: To compare the well-being of long-term cancer survivors with that of US residents of similar age and demographic characteristics, patients recently diagnosed with cancer, and individuals with chronic illness. STUDY DESIGN: Retrospective observational study. METHODS: Using the Health and Retirement Study, a survey of US residents older than 50 years, we defined 4 cohorts: long-term cancer survivors (>4 years post diagnosis), individuals recently diagnosed with cancer (≤4 years post diagnosis), individuals with chronic illness, and US residents older than 50 years ("nationally representative cohort"). Well-being measures included self-reported health, utility, happiness, medical utilization and spending, employment, and earnings, and these measures were compared across cohorts, adjusting for survey year, demographic characteristics, smoking, and number of comorbidities. We imputed medical spending using the Medical Expenditure Panel Survey and the Medicare Current Beneficiary Survey. RESULTS: Long-term cancer survivors fared significantly better than those recently diagnosed with cancer, those with chronic illness, and individuals in the nationally representative cohort in the majority of well-being measures (P <.05), including fewer doctor visits, hospitalizations, and hospital nights; better utility and self-reported health; and greater likelihood of employment. Long-term cancer survivors had lower healthcare spending than those recently diagnosed with cancer (P <.01) and significantly greater happiness than the nationally representative cohort and those with chronic illness (P <.05). CONCLUSIONS: Although patients with cancer experience diminished well-being in the short term across a variety of measures, in the long term, cancer survivors do as well as or better than US residents of similar age and demographic characteristics. This finding is striking given that one might expect long-term cancer survivors to do worse than similar individuals without a history of cancer.


Assuntos
Sobreviventes de Câncer/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Nível de Saúde , Saúde Mental , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doença Crônica/epidemiologia , Feminino , Felicidade , Gastos em Saúde/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Fumar/epidemiologia , Fatores Socioeconômicos , Fatores de Tempo , Estados Unidos
9.
Forum Health Econ Policy ; 20(2)2017 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-31419906

RESUMO

Price controls for prescription drugs are once again at the forefront of policy discussions in the United States. Much of the focus has been on the potential short-term savings - in terms of lower spending - although evidence suggests price controls can dampen innovation and adversely affect long-term population health. This paper applies the Health Economics Medical Innovation Simulation, a microsimulation of older Americans, to estimate the long-term impacts of government price setting in Medicare Part D, using pricing in the Federal Veterans Health Administration program as a proxy. We find that VA-style pricing policies would save between $0.1 trillion and $0.3 trillion (US$2015) in lifetime drug spending for people born in 1949-2005. However, such savings come with social costs. After accounting for innovation spillovers, we find that price setting in Part D reduces the number of new drug introductions by as much as 25% relative to the status quo. As a result, life expectancy for the cohort born in 1991-1995 is reduced by almost 2 years relative to the status quo. Overall, we find that price controls would reduce lifetime welfare by $5.7 to $13.3 trillion (US$2015) for the US population born in 1949-2005.

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