Longitudinal association between BMI at diagnosis and HIV disease progression.

Increased body mass index (BMI) has been associated with adverse health outcomes but the effect of BMI on HIV immune markers over time post-HAART is not clearly established. Data were abstracted from 396 medical records at the Ryan White Clinic in South Carolina. All HIV-infected adults who were ≥18 years of age, diagnosed between 1997 and 2010, had weight and height measured within 3 months of diagnosis and had at least one follow-up visit within 6 months of diagnosis, were eligible. The mean CD4 count was calculated for each BMI category and mixed regression analyses was used to determine the association between BMI and CD4 count over time. The overall mean BMI was 27.4 kg/m(2). Longitudinally, the mean CD4 count was 611.2 cells/mm(3) for obese individuals, 598.1 cells/mm(3) for overweight individuals and 550.5 cells/mm(3) for normal weight individuals. When compared to the normal weight category, the obese category had significantly larger increases in CD4 count (5.5 cells/mm(3), P < 0.001) versus the overweight category (-2.1 cells/mm(3), P < 0.001). HIV-infected individuals who were obese at diagnosis had larger increases in CD4 counts over time when compared to overweight individuals at diagnosis. This suggests that providers should pay closer attention to weight at diagnosis to predict the response to treatment and disease trajectory.

Long term cost comparisons of radical cystectomy versus trimodal therapy for muscle-invasive bladder cancer.

BACKGROUND: Earlier studies on the cost of muscle-invasive bladder cancer treatments are limited to short-term costs of care. We determined the 2- and 5-year costs associated with trimodal therapy (TMT) vs. radical cystectomy (RC). METHODS: We performed a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Total Medicare costs at 2 and 5 years following RC vs. TMT were compared using inverse probability of treatment-weighted propensity score models. RESULTS: A total of 2,537 patients aged 66 to 85 years were diagnosed with clinical stage T2-4a muscle-invasive bladder cancer. Total median costs for patients that received no definitive treatment(s) were $73,780 and $88,275 at 2-and 5-years. Costs were significantly higher for TMT than RC at 2-years ($372,839 vs. $191,363, Median Difference $127,815, Hodges-Lehmann Estimate (H-L) 95% Confidence Interval (CI), $112,663-$142,966) and 5-years ($424,570 vs. $253,651, Median Difference $124,466, H-L 95% CI, $105,711-$143,221). TMT had higher outpatient costs than RC (2-years: $318,221 vs. $100,900; 5-years: $367,092 vs. $146,561) with significantly higher costs with radiology, medications, pathology/laboratory, and other professional services. RC had higher inpatient costs than TMT (2-years: $62,240 vs. $33,631, Median Difference $-29,174, H-L 95% CI, $-32,364-$-25,984; 5-years: $75,499 vs. $45,223, Median Difference $-29,843, H-L 95% CI, $-33,905-$-25,781). CONCLUSIONS AND RELEVANCE: The excess spending associated with trimodal therapy vs. radical cystectomy was largely driven by outpatient expenditures. The relatively high long-term trimodal therapy costs are prime targets for cost containment strategies to optimize future value-based care.