Association Between Dual Trajectories of Opioid and Gabapentinoid Use and Healthcare Expenditures Among US Medicare Beneficiaries.

OBJECTIVES: Little is known about relationships between opioid- and gabapentinoid-use patterns and healthcare expenditures that may be affected by pain management and risk of adverse outcomes. This study examined the association between patients' opioid and gabapentinoid prescription filling/refilling trajectories and direct medical expenditures in US Medicare. METHODS: This cross-sectional study included a 5% national sample (2011-2016) of fee-for-service beneficiaries with fibromyalgia, low back pain, neuropathy, or osteoarthritis newly initiating opioids or gabapentinoids. Using group-based multitrajectory modeling, this study identified patients' distinct opioid and gabapentinoid (OPI-GABA) dose and duration patterns, based on standardized daily doses, within a year of initiating opioids and/or gabapentinoids. Concurrent direct medical expenditures within the same year were estimated using inverse probability of treatment weighted multivariable generalized linear regression, adjusting for sociodemographic and health status factors. RESULTS: Among 67 827 eligible beneficiaries (mean age ± SD = 63.6 ± 14.8 years, female = 65.8%, white = 77.1%), 11 distinct trajectories were identified (3 opioid-only, 4 gabapentinoid-only, and 4 concurrent OPI-GABA trajectories). Compared with opioid-only early discontinuers ($13 830, 95% confidence interval = $13 643-14 019), gabapentinoid-only early discontinuers and consistent low-dose and moderate-dose gabapentinoid-only users were associated with 11% to 23% lower health expenditures (adjusted mean expenditure = $10 607-$11 713). Consistent low-dose opioid-only users, consistent high-dose opioid-only users, consistent low-dose OPI-GABA users, consistent low-dose opioid and high-dose gabapentinoid users, and consistent high-dose opioid and moderate-dose gabapentinoid users were associated with 14% to 106% higher healthcare expenditures (adjusted mean expenditure = $15 721-$28 464). CONCLUSIONS: Dose and duration patterns of concurrent OPI-GABA varied substantially among fee-for-service Medicare beneficiaries. Consistent opioid-only users and all concurrent OPI-GABA users were associated with higher healthcare expenditures compared to opioid-only discontinuers.

Nationally Representative Health Care Expenditures of Community-Based Older Adults with Pain in the United States Prescribed Opioids vs Those Not Prescribed Opioids.

OBJECTIVE: To compare health care expenditures between older US adults (≥50 years) with pain who were prescribed opioid medications and those who were not. DESIGN: Cross-sectional. SETTING: Community-based adults in the 2015 Medical Expenditure Panel Survey (MEPS). SUBJECTS: Nationally representative sample of US adults alive for the calendar year, aged 50 years or older, who reported having pain in the past four weeks. METHODS: Older US adults (≥50 years) with pain in the 2015 MEPS data were identified. The key independent variable was opioid prescription status (prescribed opioid vs not prescribed opioid). Hierarchical linear regression models assessed health care expenditures (inpatient, outpatient, office-based, emergency room, prescription medications, other, and total) in US dollars for opioid prescription status from a community-dwelling US population perspective, adjusting for covariates. RESULTS: The 2015 study cohort provided a national estimate of 50,898,592 noninstitutionalized US adults aged ≥50 years with pain in the past four weeks (prescribed opioid N = 16,757,516 [32.9%], not prescribed opioid N = 34,141,076 [67.1%]). After adjusting for covariates, individuals prescribed an opioid had 61% greater outpatient (ß = 0.477, P < 0.0001), 69% greater office-based (ß = 0.524, P < 0.0001), 14% greater emergency room (ß = 0.131, P = 0.0045), 63% greater prescription medication (ß = 0.486, P < 0.0001), 29% greater other (ß = 0.251, P = 0.0002), and 105% greater total (ß = 0.718, P < 0.0001) health care expenditures. There was no difference in opioid prescription status for inpatient expenditures (P > 0.05). CONCLUSIONS: This study raises awareness of the economic impact associated with opioid use among US older adults with pain. Future research should investigate these variables in greater depth, over longer time periods, and in additional populations.

Validity and Reliability of the Student Refractive Error and Eyeglasses Questionnaire-Revised Version in Myopic Children.

SIGNIFICANCE: Multiple vision-related quality of life (VRQol) instruments exist, but questionnaires designed specifically for myopic children that are appropriate for assessing the impact of refractive error are rare. PURPOSE: This study aimed to assess the validity and reliability of the Student Refractive Error and Eyeglasses Questionnaire - Revised (SREEQ-R) in school-aged children with myopia in the United Kingdom. METHODS: Community optometrists in the United Kingdom invited children up to the age of 18 years presenting for an eye examination with current or previous reported use of eyeglasses for myopia to complete the SREEQ-R, which consists of 20 specific items divided into two sections each with three response categories. The "without glasses" section relates to perceptions of uncorrected vision/not wearing glasses, and the "with glasses" relates to corrected vision/wearing glasses. Rasch analysis was used to explore the psychometric performance (content, construct validity, and reliability) of the questionnaire items and scale using Winsteps software (Winsteps.com. Portland, OR). RESULTS: A total of 125 eligible children with a mean ± standard deviation age of 12.7 ± 2.9 years completed the SREEQ-R. All items fit the Rasch model and were retained, and the scale was found to be unidimensional. All children and item infit and outfit mean square statistics fell within the recommended fit criteria. As per the Rasch analysis, the person reliability coefficients were 0.84 and 0.91, whereas item reliabilities were 0.99 and 0.80 for the without glasses and with glasses sections, respectively. The internal consistency for the SREEQ-R was good; Cronbach α values were 0.84 for without glasses and 0.91 for with glasses. CONCLUSIONS: The SREEQ-R had satisfactory validity and reliability evidence. Construct validity of the scale was supported to measure the impact of uncorrected and corrected refractive error on vision-related quality of life in myopic school-aged children in the United Kingdom. The SREEQ-R could be used in future studies to evaluate vision-related quality of life in children with myopia.

Understanding the information-seeking behavior of pharmacy college faculty, staff, and students: implications for improving embedded librarian services.

OBJECTIVE: Research was conducted on the embedded librarian program at The University of Arizona College of Pharmacy and the Health Sciences Library to understand how this service is relevant to users and identify the potential for further improvement. This study examined users' information-seeking behaviors and considered the implications for the effectiveness of the embedded librarian service. METHODS: The authors conducted 18 semi-structured interviews of faculty, researchers, and students at the College of Pharmacy to obtain descriptive accounts of how they seek information, manage information, and use the library and library services. The authors examined the interview transcripts through qualitative descriptive analysis. RESULTS: The interview responses confirm that users seek information outside of the physical library and tend to ask their peers for information or assistance in obtaining information. They mostly feel comfortable in searching, but some of them may lack sufficient search skills and tend to use a few known databases. While those who are familiar with the librarian seek the librarian's assistance more often, others tend not to seek the librarian's assistance. The ways they manage information vary, which requires customized assistance. CONCLUSIONS: The close proximity of a physically embedded librarian is beneficial to users and positions the librarian to provide proactive assistance in the existing user information-seeking behavior environment. While some users do not seek assistance, the embedded librarian can provide proactive assistance in such areas as making users aware of other database options and helping them choose relevant databases and effectively manage information.

Melatonin for the prevention of postoperative delirium in older adults: a systematic review and meta-analysis.

BACKGROUND: Older surgical patients are at high risk of developing postoperative delirium. Non-pharmacological strategies are recommended for delirium prevention, but no pharmacological agents have compelling evidence to decrease the incidence of delirium. The purpose of this study was to assess whether perioperative melatonin decreases the incidence of delirium in older adults undergoing surgical procedures. METHODS: A systematic search using PubMed/Medline, Embase, PsycINFO, CINAHL, and references of identified articles published in English between January 1990 and October 2017 was performed. Two independent reviewers screened titles and abstracts, and then extracted data following a full-text review of included articles with consensus generation and bias assessment. Studies reporting outcomes for melatonin or ramelteon use to prevent delirium in postoperative hospitalized patients (mean age ≥ 50 years) were eligible for inclusion. Data were pooled using a fixed-effects model to generate a forest plot and obtain a summary odds ratio for the outcome of interest (delirium incidence). Cochran's Q and I2 values were used to investigate heterogeneity. RESULTS: Of 335 records screened, 6 studies were selected for the qualitative analysis and 6 were included in the meta-analysis (n = 1155). The mean age of patients in included studies ranged from 59 to 84 years. Patients in intervention groups typically received melatonin or ramelteon at daily doses of two to eight milligrams around cardiothoracic, orthopedic, or hepatic surgeries for one to nine days, starting on the evening before or the day of surgery. The incidence of delirium ranged from 0 to 30% in the intervention groups versus 4-33% in the comparator groups, and was significantly reduced in the melatonin group, with a summary effect of the meta-analysis yielding an odds ratio of 0.63 (95% CI 0.46 to 0.87; 0.006; I2 = 72.1%). A one study removed analysis reduced overall odds ratio to 0.310 (95% CI 0.19 to 0.50), while reducing heterogeneity (Cochran's Q = 0.798, I2 = 0.000). CONCLUSION: Perioperative melatonin reduced the incidence of delirium in older adults in the included studies. While optimal dosing remains an unanswered question, the potential benefit of melatonin and melatonin receptor agonists may make them a reasonable option to use for delirium prevention in older adults undergoing surgical procedures.

How do pharmacists use and recommend vitamins, minerals, herbals and other dietary supplements?

BACKGROUND: Use of complementary and alternative medicine (CAM), including vitamins, minerals, herbals, and other dietary supplements, is widespread in the United States (ranging from 24% in Hispanics to 50% in American Indians). Pharmacists are an accessible source for healthcare information, but little is known about their use of CAM products and to whom they would recommend these products. METHODS: A cross-sectional survey was sent via email to pharmacists licensed in one state in the United States in 2015. The survey included items about their use of 10 vitamins and minerals, and 21 herbal or other dietary supplements, as well as reasons for use, conditions used to treat, if they would recommend the product to patients, family, or friends, their perception of CAM safety and effectiveness, and four demographic questions. Descriptive statistics were used to summarize the data, and a chi-square test was used to determine differences between pharmacists' use of vitamins/minerals and herbals/other dietary supplements. The a priori alpha level was 0.05. RESULTS: A total of 639 pharmacists completed the survey. Female pharmacists used vitamins/minerals (p = 0.031) and herbals/others (p = 0.039) more than male pharmacists. Older pharmacists used herbals/others more than younger pharmacists (p < 0.001). Fifty-nine percent thought the dietary supplements in the survey were safe while 32% reported they were effective. Seventy-eight percent of respondents reported use of any vitamin or mineral product versus 42% who reported use of any herbal or other dietary supplement. Commonly used products included: multivitamins (91%), vitamin C (71%), fish oil (65%), probiotics (53%), and fiber (53%). The most commonly reported reason for use was general health and wellness (17-90%). Pharmacists most commonly recommend fiber/psyllium (94%) and calcium (90%) to patients, family, and friends. CONCLUSIONS: Pharmacists in this survey selectively used vitamins, minerals, herbals and other dietary supplements, and recommended some of the more commonly used products to patients, family and friends. This is valuable information given that pharmacists are frontline healthcare professionals who may be asked to provide advice about these products.

A comparison of the pharmacologic and nonpharmacologic strategies used to manage chronic pain: Opioid users versus nonusers.

BACKGROUND: Multimodal and multidomain strategies are currently recommended for the management of chronic pain. However, there is little information available on how individuals (opioid users versus nonusers) with chronic pain use multimodal strategies in pain management. METHODS: This cross-sectional study used questionnaire data from a sample of pharmacists with chronic pain. The questionnaire collected data on demographics, pain characteristics, pain management strategies, and pain management outcomes. The association between the number of strategies used and opioid use were evaluated by linear regression. Differences between the groups in nonsteroidal anti-inflammatory drugs (NSAIDs) use and types of strategies used in managing the pain were analyzed using logistic regressions. A hierarchical logistic regression was performed to identify potential predictors differentiating opioid users from nonusers. RESULTS: Fifty-seven opioid users and 100 nonusers with chronic pain completed the questionnaire. Opioid users reported higher levels of pain at baseline (7.6 ± 1.7 vs. 6.7 ± 2.2; P = 0.011); however, pain levels after treatment were comparable (2.9 ± 1.9 vs. 3.2 ± 2.4; P = 0.33). Although there was no significant difference in the total number of strategies, the number of pharmacologic strategies was significantly higher in opioid users (P = 0.007). The type of pain management strategies and the use of NSAIDs were similar in both groups after adjusting for potential confounders. The significant predictors of opioid use from hierarchical logistic regression analysis were: lower use of over-the-counter NSAIDs (odds ratio [OR] 0.4; 95% CI 0.2-0.9), using more interventions (OR 1.2; 95% CI 1.1-1.3), reliance on pharmacologic strategies (OR 10.8; 95% CI 2.1-55.7), using combination of pharmacologic and nonpharmacologic strategies (OR 3.7; 95% CI 0.9-15.8), and less interference with daily activities after treatment (OR 0.2; 95% CI 0.1-0.9). CONCLUSION: Opioid use was primarily related to the use of prescription pharmacologic strategies, but not to age or gender. Posttreatment pain levels were similar between opioid users and nonusers; however, opioid users used more nonopioid medications than nonusers did.

Impact of Diabetes Care by Pharmacists as Part of Health Care Team in Ambulatory Settings: A Systematic Review and Meta-analysis.

OBJECTIVE: To conduct a comprehensive systematic review and meta-analyses examining the impact of pharmacist interventions as part of health care teams on diabetes therapeutic outcomes in ambulatory care settings. DATA SOURCES: PubMed/MEDLINE, EMBASE, Cochrane Library, International Pharmaceutical Abstracts, Web of Science, Scopus, WHO's Global Health Library, ClinicalTrials.gov , and Google Scholar were searched (1995 to February 2017). Search terms included pharmacist, team, and diabetes. STUDY SELECTION: Full-text articles published in English with comparative designs, including randomized controlled trials, nonrandomized controlled trials, and pretest-posttest studies evaluating hemoglobin A1C (A1C), were assessed. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened for study inclusion and extracted data. Quality of the studies was assessed using tools developed based on the framework of the Cochrane Collaboration's recommendations. DATA SYNTHESIS: A total of 1908 studies were identified from the literature and reference searches; 42 studies were included in the systematic review (n = 10 860) and 35 in the meta-analyses (n = 7417). Mean age ranged from 42 to 73 years, and 8% to 100% were male. The overall standardized mean difference (SMD) for A1C for pharmacist care versus comparison was 0.57 ( P < 0.01), a moderate effect representing a mean difference of 1.1% (95% CI = 0.88-1.27). The effects for systolic blood pressure and low-density lipoprotein cholesterol were between small and moderate (SMD = 0.31 and 0.32; P < 0.01). The heterogeneity was high for all outcomes (>83%), indicating functional differences among the studies. No publication bias was detected. CONCLUSION: Pharmacists' interventions as part of the patient's health care team improved diabetes therapeutic outcomes, substantiating the important role of pharmacists in team-based diabetes management.

Effect of Pharmacy-Supported Transition-of-Care Interventions on 30-Day Readmissions: A Systematic Review and Meta-analysis.

OBJECTIVE: To describe pharmacy-supported transition-of-care (TOC) interventions and determine their effect on 30-day all-cause readmissions. DATA SOURCES: MEDLINE/PubMed, EMBASE, International Pharmaceutical Abstracts, ABI Inform Complete, PsychINFO, Web of Science, Academic Search Complete, CINHAL, Cochrane library, OIASTER, ProQuest Dissertations & Theses, ClinicalTrials.gov , and relevant websites were searched from January 1, 1995, to December 31, 2015. STUDY SELECTION AND DATA EXTRACTION: PICOS+E criteria were utilized. Eligible studies reported pharmacy-supported TOC interventions compared with usual care in adult patients discharged to home within the United States. Studies were required to evaluate postdischarge outcomes (eg, rate of readmissions, hospital utilization). Randomized controlled trials, cohort studies, or controlled before-and-after studies were included. Two reviewers independently extracted data and evaluated study quality. DATA SYNTHESIS: A total of 56 articles were included in the systematic review (n = 61 858), of which 32 reported 30-day all-cause readmissions and were included in the meta-analysis. A taxonomy was developed to categorize targeted patients, intervention types, and pharmacy personnel as sole intervener. The meta-analysis demonstrated about a 32% reduction in the odds of readmission (odds ratio [OR] = 0.68; 95% CI = 0.61 to 0.75) observed for pharmacy-supported TOC interventions compared with usual care. Heterogeneity was identified ( I2 = 55%; P < 0.001). A stratified meta-analysis showed that interventions with patient-centered follow-up reduced 30-day readmissions relative to studies without follow-up (OR = 0.70; CI = 0.63 to 0.78). CONCLUSIONS: Pharmacy-supported TOC programs were associated with a significant reduction in the odds of 30-day readmissions.

Interpretation of verbal descriptors for response options commonly used in verbal rating scales in patient-reported outcome instruments.

PURPOSE: To assess the variation in the interpretation of common verbal descriptors (VDs) used in response scales and examine factors associated with those interpretations. METHODS: Subjects were recruited through MediGuard and they assigned interpretation scores (11-point scale; 0 = lowest possible, 10 = highest possible) to five common sets of VDs: set one (none, mild, moderate, severe, very severe); set two (never, rarely, sometimes, often, always); set three (poor, fair, good, very good, excellent); set four (not at all, a little bit, moderately, quite a bit, extremely); and set five (not at all, a little bit, somewhat, quite a bit, very much). One-sample test for proportions and T-tests examined equality of proportions (anchors) and means scores (non-anchors) with the fixed intervals (0.0, 2.5, 5.0, 7.5, and 10.0). Ordinal regression examined adjusted associations between demographic/clinical factors and VD scores. RESULTS: Of the 350 subjects, 68 % were females and mean (SD) age was 56.9 (12.1). Two sets had two VDs with mean (95 % CI) scores not different than the fixed intervals. Set one had mild = 2.50 (2.33; 2.66) and moderate = 5.01 (4.89; 5.13) with 98.8 % (97.3 %; 100 %) assigning none = 0. Set five had a little bit = 2.35 (2.17; 2.53) and quite a bit = 7.65 (7.43; 7.87) with 95.0 % (95 % CI 91.7; 98.2) assigning not at all = 0. Significant associations (p ≤ 0.05) included age and education with somewhat and income and comorbidities with very severe. Age, sex, and education showed associations with other VDs albeit in nonsignificant models. CONCLUSIONS: Sets one and five yielded data closest to the fixed intervals. Demographic and clinical factors are associated with the interpretation of some VDs and should be adjusted for in analyses of non-randomized data.

The impact of pharmacist immunization programs on adult immunization rates: A systematic review and meta-analysis.

OBJECTIVES: To estimate the impact that pharmacist immunization programs have on immunization rates. DATA SOURCES: Pubmed, Ovid/Medline, and Google Scholar were searched. References were checked and citation searches using identified studies conducted. STUDY SELECTION: Studies were eligible for the systematic review and meta-analysis if the study compared pharmacist as immunizer versus usual care. Any study design that involved a comparison group was acceptable. DATA EXTRACTION: Data were extracted by 2 investigators independently with the use of a standardized data extraction form; any differences were resolved by consensus. RESULTS: A total of 8 studies with 11 study arms met inclusion criteria. A wide variety of immunizations were provided, including influenza, herpes zoster, pneumococcal, Tdap, hepatitis A and B, MMR, varicella, meningococcal, and human papillomavirus. Immunizations were provided in a variety of settings, including hospitals, single community sites, multiple sites, and a university. The overall risk ratio (RR) for immunizations was 2.95 (P <0.001) but varied substantially based on type of vaccine administered (heterogeneity: I(2) = 93.28%). For influenza, the RR was 2.23 (P <0.001), for herpes RR was 4.78 (P <0.001), and for other vaccines RR was 3.44 (P <0.001). The RR for comparisons by type of vaccine and sample size was significant (P = 0.010 and P <0.001, respectively). CONCLUSION: Pharmacist immunization programs can have a substantial impact on immunization rates, but the impact varied widely. Widespread implementation of pharmacist immunization programs that include an advocacy component could help in the reaching of Healthy People 2020 immunization goals.

Understanding faculty perceptions and experiences related to climate, diversity, equity, and inclusion at a college of pharmacy: A pilot study.

INTRODUCTION: A climate survey was piloted to obtain an understanding of the perceptions and personal experiences of faculty for intentional planning of future meaningful, effective, and sustainable diversity, equity, and inclusion (DEI) efforts at a college of pharmacy. METHODS: A 48-item, four section, online survey was developed and administered to 69 faculty between October and November 2021. Likert-like five-point scales and free-text items were included to determine an overall assessment of climate, as well as perceptions and/or personal experiences for each domain of DEI, and demographics. RESULTS: Thirty-nine (57%) faculty completed the survey. For climate, every attribute had at least one respondent that observed someone make an insensitive or disparaging remark "rarely," "occasionally," and "frequently." The response pattern was similar for personal experience with insensitive remarks. For participation in diversity activities, "awareness without participation" was selected by 56% of respondents. For perceptions of diversity, "fairly" or "very" was selected by 38% to 54% of respondents. For equity, "attainable for some" to "not attainable" was identified for 15% to 26% of respondents. CONCLUSIONS: These pilot climate survey results inform climate improvement as it relates to DEI and informs survey instrument refinement.

Perceived impact of an interprofessional education program on community resilience: an exploratory study.

The purpose of this study was to explore the perceived impact of an interprofessional education (IPE) program for health sciences students on two culturally diverse, underserved communities. A community resilience/capacity framework, consisting of catalysts (primarily the creation of awareness) and capital components: human (workforce development), social (networking and empowerment) and economic (volunteer labor and money spent by the program), provided the conceptual underpinnings for the study. Focus groups with stakeholders in two communities, one rural and one metropolitan, were audio-recorded, transcribed and analyzed by categorizing data according to each capital component. In addition to the concepts contained in the capacity framework a new category, informational capital (data specific to the community) emerged during the analysis. We suggest that by acting as a catalyst a community based interprofessional program can affect components of community resilience/capacity, primarily human, social, and informational capital. Using the community resilience/capacity framework facilitated exploration of the perceived impact of an educational program on one rural and one urban underserved community beyond assessing student outcomes or number of clients served.

Economic value of knowing BRCA status: BRCA testing for prostate cancer prevention and optimal treatment.

BACKGROUND: We aimed to estimate the incremental lifetime effects, costs, and net-monetary-benefit (NMB) of knowing BRCA information by testing of patients with low-risk localized prostate cancer (PCa) in the US and guiding subsequent screening and treatment, and the cumulative savings or losses of yearly cohort testing over 16 years. We compared two strategies: (1)'with BRCA information' and (2)'without BRCA information.' We also estimated the expected value of perfect information. METHODS: The incremental NMB (INMB) quantified the monetized benefit per person of knowing BRCA status. The net-monetized-value of knowing BRCA information was estimated by multiplying the INMB with the eligible population. RESULTS: The INMBs of knowing BRCA information were $43,357 (payer) and $43,487 (society). in payer and societal perspectives, respectively. Escalated to the eligible patients in 2020, knowing BRCA status resulted in net monetized lifetime value of $1.7 billion (payer and society) for the 2020 cohort; and yielded accumulated net-monetized-value of $28.0 billion (payer) and $28.1 billion (society) over 16 yearly cohorts of eligible PCa patients. CONCLUSIONS: The economic value of knowing BRCA status for all low-risk localized PCa patients in the US provides short-term and long-term evidence for BRCA testing to screen early and optimize treatment.

The economic value of knowing BRCA status: universal BRCA testing for breast cancer prevention.

BACKGROUND: This study aimed to estimate the incremental lifetime effects, costs, and net monetary benefit (NMB) of knowing BRCA information by universal genetic testing of all US women without breast cancer turning 40 in a given year, and the cumulative savings or losses of yearly cohort testing over 16 years. We compared two strategies: (1) 'with BRCA information' and (2) 'without BRCA information.' METHODS: Incremental NMB (INMB) was calculated as the monetized benefit per person of knowing BRCA status. The net monetized value (cumulated INMB) of knowing BRCA information was estimated by multiplying the INMB with the eligible population or the year 2020 cohort of US women age 40 and extended for a total of 16 yearly cohorts. RESULTS: Universal testing of the female population at the age of 40 in a given year provided aan INMB of $663/person (payer) and $1,006/person (society).Escalated to the U.S. population of women age 40 , knowing BRCA status resulted in lifetime cumulated INMB of $1.3 billion (payer) and $2.0 billion (society) for the 2020 cohort; and yielded accumulated monetized value of $18.3 billion (payer) and $27.6 billion (society) over 16 yearly cohorts of 40-year-old women. CONCLUSIONS: The universal testing for BRCA status of all US women at age 40 provides compelling short-term and long-term economic value.

The economic value of knowing BRCA status: BRCA testing for optimizing treatment in recurrent epithelial ovarian cancer.

BACKGROUND: This study aimed to estimate the incremental lifetime effects, costs, and net monetary benefit (NMB) of knowing BRCA information for recurrent ovarian cancer (ROC) patients in a given year and the cumulative savings of yearly hypothetical cohort testing over 16 years. We compared two strategies: (1) 'with BRCA information' and (2) 'without BRCA information.' METHODS: Incremental NMB (INMB) was calculated as the average net monetized benefit of knowing BRCA status. The net monetized value (cumulative INMB) of knowing BRCA information was estimated by multiplying the INMB with the eligible ROC patients in year 2020 and extended for potential ROC patients over 16 yearly hypothetical cohorts of ROC patients. RESULTS: Knowing BRCA information for ROC patients provided an additional monetized value of $3,528 in (payer) and $3,194 (society). Escalated to all ROC patients in the U.S. and future incidence ROC estimates, knowing BRCA information resulted in a lifetime cumulative INMB of $35.6 million (payer) and $32.2 million (society) for the 2020 cohort; and yielded an accumulated value of $97.3 million (payer) and $88.0 million (society) over 16 yearly hypothetical cohorts of ROC patients. CONCLUSIONS: The economic value of knowing BRCA status of all U.S. ROC patients provides short-term and long-term evidence for optimizing treatment.

Identifying Student Research Project Impact Using the Buxton and Hanney Payback Framework.

Objectives. To determine whether evidence of the impact of student quality improvement projects and research projects on practice sites and the community can be identified using the Buxton and Hanney Payback Framework (BHPF).Methods. The BHPF was used to identify the broader impact of quality improvement projects and research projects conducted by the Doctor of Pharmacy (PharmD) class of 2020. The BHPF includes five domains of community impact: knowledge production, benefits to health or the health sector, benefits to future research, economic benefits, and policy and product development. Data were collected by having project preceptors complete a questionnaire and by reviewing student project posters. Data were analyzed by calculating frequencies and percentages for each domain.Results. Projects (N=73) were completed by 107 pharmacy students at health-system sites, community sites, academic sites, and other sites, and most often involved clinical care and pharmacy services (49%). Thirty-three preceptors (55%) responded to the questionnaire, and 73 project posters were reviewed. The most frequently identified impact types were knowledge production (n=43 for questionnaire, n=24 for posters) and health/health sector benefits (n=46 for questionnaire, n=8 for posters). Less frequently identified were economic benefits (total n=19), benefits to future research (total n=13), and policy and product development (total n=10).Conclusions. This study provides evidence that the impact of PharmD student quality improvement and research projects on practice sites and communities can be identified using the BHPF framework, and this impact extends beyond the usual academic outcomes of poster presentations and publications to include benefits related to improving quality of services, improving workflow, and providing opportunity for personal development.

Use of Pharmacological and Non-Pharmacological Strategies by Community-Dwelling Adults to Manage Migraine: A Systematic Review.

Migraine is a prevalent disease associated with high levels of disability and is often underdiagnosed and undertreated. This systematic literature review aimed to identify the types of pharmacological and non-pharmacological strategies that community-dwelling adults report using to manage migraine. A systematic literature review of relevant databases, grey literature, websites, and journals was conducted from 1 January 1989 to 21 December 2021. Study selection, data extraction, and risk of bias assessment were completed independently by multiple reviewers. Data were extracted on migraine management strategies and categorized as opioid and non-opioid medications and medical, physical, psychological, or self-initiated strategies. A total of 20 studies were included. The sample sizes ranged from 138 to 46,941, with a mean age of 34.7 to 79.9 years. The data were typically collected using self-administered questionnaires (nine studies), interviews (five studies), online surveys (three studies), paper-based surveys (two studies), and a retrospective database (one study). Community-dwelling adults with migraine reported they primarily used medications, specifically triptans (range 9-73%) and non-steroidal anti-inflammatory drugs (NSAIDs) (range 13-85%) to manage migraine. Except for medical strategies, the use of other non-pharmacological strategies was low. Common non-pharmacological strategies included consulting physicians (range 14-79%) and heat or cold therapy (35%).

Features of Cancer mHealth Apps and Evidence for Patient Preferences: Scoping Literature Review.

BACKGROUND: Cancer is increasingly being treated as a chronic disease rather than an acute one-time illness. Additionally, oral anticancer therapies, as opposed to intravenous chemotherapy, are now available for an increasing number of cancer indications. Mobile health (mHealth) apps for use on mobile devices (eg, smartphones or tablets) are designed to help patients with medication adherence, symptom tracking, and disease management. Several previous literature reviews have been conducted regarding mHealth apps for cancer. However, these studies did not address patient preferences for the features of cancer mHealth apps. OBJECTIVE: The primary aim was to review the scientific literature that describes the features and functions of mHealth apps designed for cancer self-management. METHODS: As the purpose of this review was to explore the depth and breadth of research on mHealth app features for cancer self-management, a scoping review methodology was adopted. Four databases were used for this review: PubMed/MEDLINE, Embase, CINAHL, and PsycINFO. Citation and reference searches were conducted for manuscripts meeting the inclusion criteria. A gray literature search was also conducted. Data extracted from manuscripts included author, title, publication date, study type, sampling type, cancer type, treatment, age of participants, features, availability (free or subscription), design input, and patient preferences. Finally, the features listed for each app were compared, highlighting similarities across platforms as well as features unique to each app. RESULTS: After the removal of duplicates, 522 manuscripts remained for the title and abstract review, with 51 undergoing full-text review. A total of 7 manuscripts (referred to as studies hereafter) were included in the final scoping review. App features described in each study varied from 2 to 11, with a median of 4 features per app. The most reported feature was a symptom or side effect tracker, which was reported in 6 studies. Two apps specified the inclusion of patients and health care providers during the design, while 1 app noted that IT and communications experts provided design input. The utility of the apps for end users was measured in several ways, including acceptability (measuring the end users' experience), usability (assessing the functionality and performance by observing real users completing tasks), or qualitative data (reports from end users collected from interviews or focus groups). CONCLUSIONS: This review explored the literature on cancer mHealth apps. Popular features within these mHealth apps include symptom trackers, cancer education, and medication trackers. However, these apps and features are often developed with little input from patients. Additionally, there is little information regarding patient preferences for the features of existing apps. While the number of cancer-related apps available for download continues to increase, further exploration of patient preferences for app features could result in apps that better meet patient disease self-management needs.

Cost-effectiveness analysis of nivolumab-chemotherapy as first-line therapy for locally advanced/metastatic gastric cancer: a United States payer perspective.

OBJECTIVES: Nivolumab, an immune checkpoint inhibitor, was approved by the United States (US) Food and Drug administration as a first-line systemic therapy for locally advanced/metastatic gastric cancer patients. The current study aimed to investigate the cost-effectiveness of nivolumab-chemotherapy combination versus chemotherapy alone as a first-line therapy from a US payer perspective. METHODS: An economic evaluation was conducted using a partitioned survival model in Microsoft Excel® using data from the CheckMate 649 trial. Three discrete mutually exclusive health states (progression-free, post-progression, and death) were included in the model. The health state occupancy was calculated using the overall survival and progression-free survival curves derived from the CheckMate 649 trial. Cost, resource use, and health utility estimates were estimated from a US payer perspective. Deterministic and probabilistic sensitivity analyses assessed the uncertainty of the model parameters. RESULTS: Nivolumab-chemotherapy provided additional 0.25 life years compared to chemotherapy alone and the quality-adjusted life years (QALYs) were 0.701 and 0.561, respectively, producing a gain of 0.140 QALYs and an incremental cost-effectiveness ratio of $574,072/QALY. CONCLUSION: From the US payer perspective, at a willingness to pay threshold of $US150,000/QALY, nivolumab-chemotherapy was not found to be cost-effective as a first-line therapy for locally advanced/metastatic gastric cancer.