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1.
Lupus Sci Med ; 7(1)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33051264

RESUMO

OBJECTIVE: Long-term extension (LTE) studies of belimumab in SLE do not include a comparator arm, preventing comparisons between belimumab plus standard therapy and standard therapy alone for organ damage accrual. Propensity score matching can be used to match belimumab-treated patients from LTE studies with standard therapy-treated patients from observational cohort studies. This analysis was designed to compare organ damage progression between treatment groups (belimumab plus standard therapy vs standard therapy alone) in patients with SLE with ≥5 years of follow-up, reproducing our previous study with more generalisable data. METHODS: This exploratory post hoc analysis used a heterogeneous population of US and non-US patients receiving monthly intravenous belimumab from pooled BLISS LTE trials (BEL112234/NCT00712933) and standard therapy-treated patients from the Toronto Lupus Cohort. Sixteen clinical variables were selected to calculate the propensity score. RESULTS: The 592 LTE and 381 Toronto Lupus Cohort patients were highly dissimilar across the 16 variables; an adequately balanced sample of 181 LTE and 181 matched Toronto Lupus Cohort patients (mean bias=3.7%) was created using propensity score matching. Belimumab treatment was associated with a smaller increase in Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) over 5 years than standard therapy alone (mean treatment difference=-0.453 (95% CI -0.646 to -0.260); p<0.001). Patients treated with belimumab were 60% less likely to progress to a higher SDI score over any given year of follow-up, compared with standard therapy alone (HR (95% CI) 0.397 (0.275 to 0.572); p<0.001). CONCLUSION: Using propensity score matching, this highly heterogeneous sample was sufficiently matched to the Toronto Lupus Cohort, suggesting that patients treated with intravenous belimumab may have reduced organ damage progression versus standard therapy alone. This analysis of a large and diverse pooled SLE population was consistent with our previously published US-focused study.

2.
J Patient Rep Outcomes ; 3(1): 2, 2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30645706

RESUMO

PURPOSE: To conduct qualitative interviews to evaluate and refine the Itch Diary (ID) and weekly version of the PBC-40 in patients with itching associated with primary biliary cholangitis (PBC). METHODS: Twenty adults with self-reported PBC diagnoses and recent/ongoing itching of at least moderate intensity participated in face-to-face qualitative combined concept elicitation (CE) interviews and cognitive interviews after completing the morning and evening versions of the ID and weekly version of the PBC-40. These questionnaires were evaluated to confirm saturation of concepts of interest and cognitively test the English language versions of the measures in patients with PBC in the US and Canada. Transcripts were organized into descriptions of PBC-related symptoms and symptom-related impacts using a structured coding framework. Two waves of interviews were conducted; revisions made after wave 1 were further tested in wave 2. RESULTS: Interview results confirmed the relevance of concepts presented in the PBC-40 and ID to patients' experiences. Saturation of concept was achieved. Itching-related signs and symptoms (46%) were the most commonly expressed symptom concept in the CE interviews followed by energy-related (14%) and additional signs/symptoms (13%). Several changes to the ID were made in response to cognitive interview results. Changes to the PBC-40 included adaptations from British to North American English, and the appropriateness of a 7-day recall period was confirmed. CONCLUSIONS: Relevance of the symptom and impact concepts in the ID to measure PBC-related itch were confirmed. Adaptation of the PBC-40 to a weekly recall period and for North American English was successful.

3.
J Med Econ ; 22(4): 319-327, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30580639

RESUMO

AIMS: Muscle weakness (MW)-attributable healthcare resource utilization (HCRU) and costs in patients with chronic obstructive pulmonary disease (COPD) have not been well-characterized in US insurance claims databases. The primary objective of this study was to estimate HCRU in patients with evidence of COPD with and without MW diagnosis codes. MATERIALS AND METHODS: This retrospective analysis used the MarketScan® Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits databases. Between January 2007 and March 2016, we identified patients aged ≥40 years with diagnosis codes for COPD (≥1 emergency department or inpatient claim or ≥2 outpatient claims within 1 year). The cohort was divided into patients with and without ≥1 MW diagnosis code. Propensity score matching was used to generate pairs of patients with and without MW (1:1). Multivariable regression analyses were used to estimate adjusted incremental costs and utilization attributable to the presence of MW diagnosis codes among patients with COPD. RESULTS: Of 427,131 patients who met the study inclusion criteria, 14% had evidence of MW. After matching, 107,420 unique patients remained equally distributed across MW status. Patients with MW diagnosis codes had greater predicted annual HCRU, $2,465 greater total predicted annual COPD-related costs, and $15,179 greater total all-cause costs than those without MW diagnosis codes. Overall, <1% of patients received COPD-related pulmonary rehabilitation services. LIMITATIONS: Study limitations include the potential for undercoding of MW and lack of information on severity of MW in claims data. CONCLUSION: The presence of MW diagnosis codes yielded higher HCRU in this COPD population and suggests that the burden of MW affects both all-cause and COPD-related care. However, utilization of pulmonary rehabilitation, a known effective treatment for MW, remains low. Future research should expand on our results by assessing data sources that allow for clinical confirmation of MW among patients with COPD.


Assuntos
Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Debilidade Muscular/etiologia , Doença Pulmonar Obstrutiva Crônica/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Gastos em Saúde , Humanos , Revisão da Utilização de Seguros , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Índice de Gravidade de Doença , Estados Unidos
4.
J Patient Rep Outcomes ; 2: 22, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30294708

RESUMO

Background: Ulcerative colitis (UC) is associated with lower health-related quality of life (HRQoL), and with disease activity predicting lower HRQoL and worse work-related outcomes. The current study examined the burden of UC on patients' HRQoL, as well as changes in patients' HRQoL and work-related outcomes following short-term and long-term treatment with multimatrix mesalamine, and their correspondence with changes in disease activity. Methods: Data were from an open-label, multinational, prospective trial (ClinicalTrials.gov identifier: NCT01124149) of 717 adults with active mild-to-moderate UC who were treated with 4.8 g/day multimatrix mesalamine tablets once daily for eight weeks (acute phase). Four-hundred sixty-one patients who achieved partial or complete clinical and endoscopic remission subsequently received treatment with daily 2.4 g/day multimatrix mesalamine for 12 months (maintenance phase). At baseline, Week 8, and Month 12, patients were administered patient-reported outcomes (PRO) measures of HRQoL (the SF-12v2® Health Survey [SF-12v2] and Short Inflammatory Bowel Disease Questionnaire) and work-related outcomes (Work Productivity and Activity Impairment questionnaire, UC-specific version). SF-12v2 scores were compared to the U.S. general population using Analysis of Variance models to assess burden of UC on HRQoL. Mixed-effects repeated-measures models compared PRO scores across visits to assess change in PRO scores over time. Correlations examined the correspondence of changes in PRO scores with changes on a modified UC disease activity index (UC-DAI). Results: Baseline burden of disease observed on all SF-12v2 domains was partially eliminated at Week 8 and completely eliminated at Month 12. Statistically significant improvements from baseline were observed at both Week 8 and Month 12 for all PRO scores (all P < 0.001). Decreases in UC-DAI scores significantly predicted improvements in PRO scores during the acute treatment phase. Conclusions: Patients with UC receiving daily multimatrix mesalamine treatment showed significant improvements in all measured domains of HRQoL and work-related outcomes. Patients who achieved partial or complete clinical and endoscopic remission maintained these improvements for most of these domains over 12 months with continued daily treatment. Changes in HRQoL and work-related outcomes were inversely related to changes in disease activity. Findings support the effectiveness of multimatrix mesalamine for improving, and sustaining improvements, in HRQoL and work-related outcomes.

5.
J Comp Eff Res ; 7(2): 89-100, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28814107

RESUMO

AIM: To compare medication adherence, discontinuation and glycemic control in patients receiving albiglutide versus liraglutide. PATIENTS & METHODS: Administrative claims data and glycated hemoglobin (HbA1c) results were analyzed from a sample of adult health plan members with Type 2 diabetes. RESULTS: Patients were matched 1:1 in the albiglutide (n = 2213) and liraglutide (n = 2213) overall cohorts and in 244 patients with HbA1c results from each treatment group. Mean HbA1c change from baseline was -1.0% for both groups. At 6 months, mean ± standard deviation adherence was 0.69 ± 0.29 versus 0.64 ± 0.29 (p < 0.001), and discontinuation was 33.2 versus 37.8% (p = 0.002) with albiglutide versus liraglutide, but these were not statistically or clinically different at 12 months. CONCLUSION: Similar treatment patterns and clinically meaningful reductions in HbA1c were observed for both treatments in this real-world comparison.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Peptídeo 1 Semelhante ao Glucagon/análogos & derivados , Hipoglicemiantes/uso terapêutico , Liraglutida/uso terapêutico , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Feminino , Peptídeo 1 Semelhante ao Glucagon/uso terapêutico , Hemoglobina A Glicada/metabolismo , Humanos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
6.
Pain Med ; 15(12): 2064-74, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24931057

RESUMO

OBJECTIVE: The objective of this study is to estimate the prevalence and impact of prescription opioid abuse and tampering among US adults. METHODS: Participants from the US National Health and Wellness Survey were invited to complete an online survey assessing use, misuse, and abuse of prescription opioid medications in the preceding 3 months. A total of 25,864 adults were screened for self-reported opioid abuse. Prevalence was calculated using weights based on age, gender, race, and education. Respondents reporting abuse or medical use of prescription opioid medication in the prior 3 months (N = 1,242) completed a questionnaire assessing health care resource use and the Work Productivity and Activity Impairment questionnaire. RESULTS: The prevalence of prescription opioid abuse in the 3 months prior to the survey was estimated at 1.31% of US adults, with approximately half (0.67%) tampering during that time. Opioid abuse increased with younger age, male sex, minority race, psychiatric illness, alcoholism, cigarette smoking, being employed, and higher household income. Respondents abusing opioid medications reported greater impairment in work and nonwork activities and more health care use than nonusers. Tampering with opioid medication was associated with greater productivity loss and increased use of health care (all P < 0.05). CONCLUSIONS: Tampering with opioid medications to get high is associated with substantial loss of productivity and health care use. Technologies that reduce users' ability to tamper may reduce the burden of opioid abuse on the health care system.


Assuntos
Transtornos Relacionados ao Uso de Opioides/epidemiologia , Adulto , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Prevalência , Autorrelato , Estados Unidos/epidemiologia
7.
J Manag Care Spec Pharm ; 20(6): 592-600, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24856597

RESUMO

BACKGROUND: Varenicline, a nicotinic acetylcholine receptor partial agonist, is a pharmacotherapy indicated for smoking cessation treatment. To date, no research has examined the relationship between out-of-pocket (OOP) expense and varenicline adherence among Medicare beneficiaries. OBJECTIVES: To (a) characterize medication utilization patterns of varenicline among Medicare members newly initiated on varenicline and (b) examine the relationship between member OOP expense and varenicline medication adherence. METHODS: In this retrospective cohort study, pharmacy claims data were used to identify Medicare Advantage Prescription Drug Plan (MAPD) members newly initiated on varenicline. Demographic and clinical characteristics, varenicline medication utilization patterns, and pharmacy costs (total and varenicline-specific) were determined for members included in the study. Varenicline adherence was measured by calculating the proportion of days covered (PDC) over a period of 84 days (12 weeks) after initiation. Multiple regression analysis was used to examine the relationship between varenicline OOP cost and varenicline medication utilization, while controlling for sociodemographic characteristics, clinical factors, and nonvarenicline pharmacy costs. RESULTS: A total of 15,452 MAPD members were included in the analysis. Mean (SD) subject age was 62.6 (10.0) years; 21.1% (n = 3,256) were dual eligible; and 33.0% (n = 5,106) received a low-income subsidy. Mean (SD) initial varenicline treatment episode duration was 50.8 (37.8) days, with a mean (SD) varenicline days' supply of 47.8 (32.6) obtained by members during the initial treatment episode. Mean (SD) PDC was 0.51 (0.24), and 14.9% (n = 2,302) of members were classified as adherent to treatment (PDC ≥ 0.80). Greater varenicline OOP expense was significantly associated with lower PDC (regression coefficient = -0.058, P less than 0.001) and significantly associated with lower odds of receiving a refill for varenicline (odds ratio 0.594, 95% CI: 0.540-0.655, P less than 0.001). CONCLUSIONS: Among Medicare beneficiaries newly initiated on varenicline, medication adherence was suboptimal, and greater OOP cost was associated with lower adherence and lower odds of refilling varenicline.


Assuntos
Benzazepinas/economia , Benzazepinas/uso terapêutico , Serviços Comunitários de Farmácia/economia , Custos de Medicamentos , Gastos em Saúde , Adesão à Medicação , Agonistas Nicotínicos/economia , Agonistas Nicotínicos/uso terapêutico , Quinoxalinas/economia , Quinoxalinas/uso terapêutico , Abandono do Hábito de Fumar/economia , Prevenção do Hábito de Fumar , Dispositivos para o Abandono do Uso de Tabaco/economia , Tabagismo/tratamento farmacológico , Idoso , Feminino , Humanos , Modelos Lineares , Modelos Logísticos , Masculino , Medicare , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Fumar/efeitos adversos , Fumar/economia , Fatores de Tempo , Tabagismo/economia , Resultado do Tratamento , Estados Unidos , Vareniclina
8.
Pain Med ; 15(1): 79-92, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24112715

RESUMO

OBJECTIVE: This study was conducted to compare safety and efficacy outcomes between opioids formulated with technologies designed to deter or resist tampering (i.e., abuse-deterrent formulations [ADFs]) and non-ADFs for commonly prescribed opioids for treatment of non-cancer pain in adults. METHODS: PubMed and Cochrane Library databases were searched for opioid publications between September 1, 2001 and August 31, 2011, and pivotal clinical trials from all years; abstracts from key pain conferences (2010-2011) were also reviewed. One hundred and ninety-one publications were initially identified, 68 of which met eligibility criteria and were systematically reviewed; a subset of 16 involved a placebo group (13 non-ADFs vs placebo, 3 ADFs vs placebo) and reported both efficacy and safety outcomes, and were included for a meta-analysis. Summary estimates of standardized difference in mean change of pain intensity (DMCPI), standardized difference in sum of pain intensity difference (DSPID), and odds ratios (ORs) of each adverse event (AE) were computed through random-effects estimates for ADFs (and non-ADFs) vs placebo. Indirect treatment comparisons were conducted to compare ADFs and non-ADFs. RESULTS: Summary estimates for standardized DMCPI and for standardized DSPID indicated that ADFs and non-ADFs showed significantly greater efficacy than placebo in reducing pain intensity. Indirect analyses assessing the efficacy outcomes between ADFs and non-ADFs indicated that they were not significantly different (standardized DMCPI [0.39 {95% confidence interval (CI) 0.00-0.76}]; standardized DSPID [-0.22 {95% CI -0.74 to 0.30}]). ADFs and non-ADFs both were associated with higher odds of AEs than placebo. Odds ratios from indirect analyses comparing AEs for ADFs vs non-ADFs were not significant (nausea, 0.87 [0.24-3.12]; vomiting, 1.54 [0.40-5.97]; dizziness/vertigo, 0.61 [0.21-1.76]; headache, 1.42 [0.57-3.53]; somnolence/drowsiness, 0.47 [0.09-2.58]; constipation, 0.64 [0.28-1.49]; pruritus 0.41 [0.05-3.51]). CONCLUSION: ADFs and non-ADFs had comparable efficacy and safety profiles, while both were more efficacious than placebo in reducing pain intensity.


Assuntos
Entorpecentes/efeitos adversos , Manejo da Dor , Adulto , Química Farmacêutica , Ensaios Clínicos como Assunto , Constipação Intestinal/induzido quimicamente , Preparações de Ação Retardada , Transtornos da Cefaleia Secundários/etiologia , Humanos , Entorpecentes/uso terapêutico , Náusea/induzido quimicamente , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Dor Pós-Operatória/tratamento farmacológico , Transtornos Relacionados ao Uso de Substâncias/etiologia , Resultado do Tratamento
9.
Pain Pract ; 14(3): E106-15, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24289539

RESUMO

PURPOSE: To measure the prevalence of diagnosed opioid abuse and prescription opioid use in a multistate managed care organization. METHODS: This retrospective claims data analysis reviewed the prevalence of diagnosed opioid abuse and the parallel prevalence of prescription opioid use in half-year intervals for commercial and Medicare members enrolled with Humana Inc., from January 1, 2008 to June 30, 2010. Diagnosis of opioid abuse was defined by ≥ 1 medical claim with any of the following ICD-9-CM codes: 304.0 ×, 304.7 ×, 305.5 ×, 965.0 ×, excluding 965.01, and opioid use was defined by ≥ 1 filled prescription for an opioid. The prevalence of opioid abuse was defined by the number of members with an opioid abuse diagnosis, divided by the number of members enrolled in each 6-month interval. RESULTS: The 6-month prevalence of diagnosed opioid abuse increased from 0.84 to 1.15 among commercial and from 3.17 to 6.35 among Medicare members, per 1,000. In contrast, there was no marked increase in prescription opioid use during the same time period (118.0 to 114.8 for commercial members, 240.6 to 256.9 for Medicare members, per 1,000). The prevalence of diagnosed opioid abuse was highest among members younger than 65 years for both genders in commercial (18- to 34-year-olds) and Medicare (35- to 54-year-olds) populations. CONCLUSIONS: Despite a stable rate of prescription opioid use among the observed population, the prevalence of diagnosed opioid abuse is increasing, particularly in the Medicare population.


Assuntos
Medicare/economia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Analgésicos Opioides/economia , Bases de Dados Factuais , Humanos , Revisão da Utilização de Seguros/economia , Programas de Assistência Gerenciada , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/economia , Prevalência , Estudos Retrospectivos , Estados Unidos
10.
Pain Pract ; 14(3): E116-25, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24268019

RESUMO

OBJECTIVE: Growth in the number of patients with pain conditions, and the subsequent rise in prescription opioid use for treatment, has been accompanied by an increase in diagnosed opioid abuse. Understanding what drives the incremental healthcare costs of members diagnosed with prescription opioid abuse may assist in developing better screening techniques for abuse. DESIGN: This retrospective analysis examined costs, resource use, and comorbidities 365 days pre- and postdiagnosis in prescription opioid users diagnosed with abuse (cases) vs. their matched nondiagnosed controls. Inclusion criteria for cases were diagnosis of opioid abuse (ICD-9-CM: 304.0x, 304.7x, 305.5x, 965.0x). Multivariate analysis used generalized linear modeling with log-transformed cost as dependent variable, controlling for comorbidities. RESULTS: Final sample sizes were 8,390 cases and 16,780 matched controls. Postindex abuse-related costs were $2,099 for commercial members, $539 for Medicare members aged < 65, and $170 for Medicare members aged ≥ 65. A higher percentage of cases had pain conditions (82.0% vs. 57.4% commercial, 95.9% vs. 87.5% Medicare members aged < 65, 92.9% vs. 82.4% Medicare members aged ≥ 65, P < 0.0001), and a higher numbers of cases had multiple opioid prescribers (3.7 vs. 1.4 commercial, 3.3 vs. 2.2 Medicare < 65, 2.2 vs. 1.6 Medicare ≥ 65, P < 0.0001) than controls preindex. Cases had higher rates of substance abuse and psychiatric diagnoses pre- and postindex (P < 0.0001, all comparisons). Adjusted costs were 28% higher for cases than for controls (P < 0.0001). CONCLUSION: Costs of members diagnosed with prescription opioid abuse are driven by higher pain and psychiatric comorbidities relative to nonabuse controls.


Assuntos
Analgésicos Opioides/economia , Custos de Cuidados de Saúde , Medicare/economia , Transtornos Relacionados ao Uso de Opioides/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
11.
Pain Pract ; 14(5): 419-26, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23701733

RESUMO

BACKGROUND: Managed healthcare organizations often utilize formulary management strategies such as prior authorization and step therapy to guide appropriate medication use and to control medication expenditures. The objective of this study was to examine clinical and economic outcomes associated with implementation of a pregabalin step therapy (ST) policy among Medicare Advantage Prescription Drug (MAPD) members. METHODS: Pharmacy and medical claims data from Humana (restricted cohort; ST policy implemented 01/01/2009) and Thomson Reuters MarketScan(®) (unrestricted cohort) were analyzed for MAPD members aged 65 to 89 years receiving treatment for painful diabetic peripheral neuropathy (pDPN), postherpetic neuralgia (PHN) or fibromyalgia (FM). Difference-in-differences (DID) was used to examine year-over-year changes in disease-related and all-cause utilization and costs. Regression analyses examined medication utilization and healthcare expenditures after controlling for between-group compositional differences. RESULTS: We identified 13,911 members in the restricted cohort and matched to members from unrestricted health plans. FM (51.0%) and pDPN (41.8%) were the most common diagnoses. Members in the unrestricted cohort were older and had a greater level of comorbidity than members in the restricted cohort. The restricted cohort demonstrated greater year-over-year decrease in pregabalin utilization and increase in year-over-year gabapentin utilization compared with the unrestricted cohort. ST restriction was associated with an increase in disease-related pharmacy costs and a decrease in total medical costs for the restricted cohort compared with the unrestricted cohort. There was no difference between cohorts in total healthcare cost. CONCLUSION: After controlling for differences in age and comorbidity burden between the groups, implementation of a pregabalin ST restriction was associated with increased disease-related pharmacy costs and decreased total medical costs; however, there was no net difference in total healthcare cost or total pharmacy cost.


Assuntos
Medicare Part C/economia , Dor/tratamento farmacológico , Dor/economia , Ácido gama-Aminobutírico/análogos & derivados , Idoso , Idoso de 80 Anos ou mais , Analgésicos/administração & dosagem , Analgésicos/economia , Estudos de Coortes , Esquema de Medicação , Revisão de Uso de Medicamentos , Feminino , Humanos , Masculino , Dor/epidemiologia , Pregabalina , Estudos Retrospectivos , Estados Unidos/epidemiologia , Ácido gama-Aminobutírico/administração & dosagem , Ácido gama-Aminobutírico/economia
12.
Pain Pract ; 14(2): 117-31, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23601620

RESUMO

Healthcare resource utilization (HCRU) and associated costs specific to pain are a growing concern, as increasing dollar amounts are spent on pain-related conditions. Understanding which pain conditions drive the highest utilization and cost burden to the healthcare system would enable providers and payers to better target conditions to manage pain adequately and efficiently. The current study focused on 36 noncancer chronic and 14 noncancer acute pain conditions and measured the HCRU and costs per member over 365 days. These conditions were ranked by per-member costs and total adjusted healthcare costs to determine the most expensive conditions to a national health plan. The top 5 conditions for the commercial line of business were back pain, osteoarthritis (OA), childbirth, injuries, and non-hip, non-spine fractures (adjusted annual total costs for the commercial members were $119 million, $98 million, $69 million, $61 million, and $48 million, respectively). The top 5 conditions for Medicare members were OA, back pain, hip fractures, injuries, and non-hip, non-spine fractures (adjusted annual costs for the Medicare members were $327 million, $218 million, $117 million, $82 million, and $67 million, respectively). The conditions ranked highest for both per-member and total healthcare costs were hip fractures, childbirth, and non-hip, non-spine fractures. Among these, hip fractures in the Medicare member population had the highest mean cost per member (adjusted per-member cost was $21,058). Further examination specific to how pain is managed in these high-cost conditions will enable providers and payers to develop strategies to improve patient outcomes through appropriate pain management.


Assuntos
Custos de Cuidados de Saúde , Seguro Saúde/economia , Manejo da Dor , Dor/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor nas Costas/economia , Dor Crônica/economia , Dor Crônica/etiologia , Feminino , Fraturas Ósseas/economia , Fraturas Ósseas/fisiopatologia , Fraturas do Quadril/economia , Fraturas do Quadril/fisiopatologia , Humanos , Revisão da Utilização de Seguros , Masculino , Medicare/economia , Pessoa de Meia-Idade , Osteoartrite/economia , Osteoartrite/fisiopatologia , Dor/etiologia , Manejo da Dor/economia , Parto , Estados Unidos , Ferimentos e Lesões/economia , Ferimentos e Lesões/fisiopatologia
13.
Pain Pract ; 14(5): 437-45, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23809020

RESUMO

OBJECTIVE: Evaluate prevalence and risk-adjusted healthcare costs of diagnosed opioid abuse in the national Veterans Health Administration (VHA). Costs were compared between patients with and without diagnosed opioid abuse. DESIGN: Medical and pharmacy claims analysis of VHA data (10/01/2006 to 09/30/2010) were retrospectively analyzed. Prevalence was calculated as the percent of patients with diagnosed opioid abuse for the entire VHA membership and those with noncancer pain diagnoses, compared between patients prescribed opioids prior to abuse diagnosis and those not prescribed opioids through the VHA system. Healthcare utilization and costs were estimated using matching techniques and generalized linear models to control for clinical and demographic differences between patients with and without diagnosed opioid abuse. Separate comparisons were made (with diagnosed abuse vs. without) for each cohort: patients with/without opioid prescriptions. RESULTS: Five-year diagnosed opioid abuse was 1.11%. Among patients prescribed opioids, 5-year abuse prevalence was 3.04%. Pain patients prescribed opioids had the highest abuse rate at 3.26%. Adjusted annual healthcare costs for diagnosed opioid abuse patients were higher than for those without diagnosed abuse, (prescribed opioids overall healthcare costs: $28,882, with diagnosed abuse vs. $13,605 for those without; not prescribed opioids: $25,197 vs. $6350, P-value< 0.0001; opioid-specific healthcare costs for patients prescribed opioids: $8956 vs. $218; patients not prescribed opioids: $8733 vs. $20). CONCLUSIONS: Diagnosed opioid abuse prevalence is almost 7-fold higher in the veteran's administration population than in commercial health plans and translates to a significant economic burden. Appropriate interventions should be considered to prevent and reduce opioid abuse.


Assuntos
Efeitos Psicossociais da Doença , Transtornos Relacionados ao Uso de Opioides/economia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , United States Department of Veterans Affairs/economia , Saúde dos Veteranos/economia , Adolescente , Adulto , Idoso , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Prevalência , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
14.
Pain Pract ; 14(5): 446-56, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23809064

RESUMO

OBJECTIVES: Compare healthcare resource utilization (HCRU) and costs between patients prescribed opioids (RxOP) and those who were not (NoRxOP) during an emergency department (ED) or inpatient visit. METHODS: Retrospective cohort analysis was performed (January 2006 to September 2010). Continuously eligible RxOP patients in ED/inpatient settings (January 2007 to September 2009) were included if age was ≥ 12 years by initial prescription date (or random date between first ED/inpatient admission and September 30, 2009 [NoRxOP patients]). Healthcare resource utilization and costs for 12 months after initial prescription were compared. Univariate descriptive analyses were performed for baseline and outcome variables and compared using appropriate tests. Risk adjustment compared HCRU between RxOP and NoRxOP cohorts for the postindex period. RESULTS: Of 27,599 eligible patients, RxOP patients (n = 18,819) were younger, less likely to be male, more likely to reside in southern United States and to have Preferred Provider Organization health plans, and had lower comorbidity index scores, compared with NoRxOP patients (n = 8,780). RxOP patients were less likely to have nonpain-related comorbidities and more frequently diagnosed with pain-related comorbidities. Unmatched and propensity-matched RxOP patients experienced higher HCRU and costs in all subcategories (total, inpatient, outpatient ED, physician, pharmacy, other outpatient settings). Opioid abuse frequency was low in patients with common diagnoses/procedures within 3 months before initial prescription (0.48%). Average time to abuse was < 1 year (201 days). CONCLUSION: Most patients were prescribed opioids initially during ED/inpatient visits and incurred higher HCRU than those not prescribed opioids. Among those with diagnosed opioid abuse after initiating opioids, time to diagnosis was rapid (range: 14 to 260 days) for patients with common diseases and procedures.


Assuntos
Analgésicos Opioides/economia , Prescrições de Medicamentos/economia , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Custos de Cuidados de Saúde , Hospitalização/economia , Adolescente , Adulto , Idoso , Analgésicos Opioides/uso terapêutico , Criança , Estudos de Coortes , Serviço Hospitalar de Emergência/tendências , Feminino , Custos de Cuidados de Saúde/tendências , Hospitalização/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/economia , Estudos Retrospectivos , Adulto Jovem
15.
Am J Manag Care ; 19(10): 816-23, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24304160

RESUMO

OBJECTIVE: To identify inefficiencies in drug and medical service utilization related to pain management in patients with osteoarthritis and chronic low back pain. STUDY DESIGN: This retrospective cohort study applied revised measures of pain management inefficiencies to Humana Medicare members with osteoarthritis and/or chronic low back pain. METHODS: Subjects had either 2 or more claims for osteoarthritis on different days or 2 or more claims for low back pain 90 or more days apart, from January 1, 2008, to June 30, 2010, with the first occurrence assigned the index date. Inefficiencies were identified for 365 days postindex.Pain-related healthcare costs postindex were compared between members with and without inefficiencies. A generalized linear model calculated adjusted costs per member controlling for age, sex, and comorbidities. RESULTS: Most members diagnosed with osteoarthritis, chronic low back pain, or both (N = 68,453) had at least 1 inefficiency measure (n = 37,863) during the postindex period. High per member costs were for repeated surgical procedures ($26,451) and inpatient admissions ($19,372) compared with members without inefficiencies ($781; P < .0001). High total costs (prevalence times per member cost) were for repeated diagnostic testing and excessive office visits. Members with an inefficiency had adjusted pain-related costs 5.42 times higher than those of members without an inefficiency (P <.0001). CONCLUSIONS: Pain management inefficiencies are common and costly among Humana Medicare members with osteoarthritis and/or chronic low back pain. Further work by providers and payers is needed to determine benefits of member identification and early intervention for these inefficiencies.


Assuntos
Dor Lombar/terapia , Osteoartrite/terapia , Manejo da Dor/economia , Adolescente , Adulto , Dor Crônica/economia , Dor Crônica/terapia , Humanos , Revisão da Utilização de Seguros , Dor Lombar/economia , Pessoa de Meia-Idade , Osteoartrite/economia , Avaliação de Resultados em Cuidados de Saúde , Manejo da Dor/normas , Qualidade da Assistência à Saúde , Estudos Retrospectivos , Adulto Jovem
16.
J Opioid Manag ; 9(3): 161-75, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23771567

RESUMO

OBJECTIVE: To evaluate the prevalence, characteristics, associated healthcare resource utilization (HRU), and costs of diagnosed prescription opioid abusers (abusers) in a managed care population. METHODS: Patients aged ≥12 years with a claim for opioid abuse were identified in the Thomson MarketScan Commercial and Medicare Supplemental research databases between January 1, 2005 and September 30, 2010. HRU and costs (per patient per month) were calculated for all patients with an index date (date of opioid abuse diagnosis) from October 1, 2008 to September 30, 2009 and continuous eligibility through 6 months prior to (preindex) and 12 months after (postindex) date. Abusers were matched 1:3 on demographics to nonabusers. RESULTS: The overall prevalence of diagnosed opioid abuse was 0.195 percent during 2005-2010, with a twofold increase from 2005 to 2010. Diagnosed abuse was more prevalent in males (0.220 percent), those aged 18-25 years (0.271 percent), those from the Northeast region (0.231 percent), those with a comorbidity of pain (0.462 percent), and those with an opioid prescription (0.924 percent). A total of 15,398 abusers were matched to 46,194 nonabusers. Medical comorbidities were significantly higher (all p < 0.0001) in abusers versus nonabusers in the preindex and postindex periods. Each healthcare resource measured was significantly higher for abusers than nonabusers in the preindex and postindex periods (p < 0.0001). Total all-cause costs were higher for abusers than nonabusers in the preindex ($1,856 vs $372, respectively) and postindex ($2,138 vs $408) periods (p < 0.0001). CONCLUSIONS: Opioid abuse increased over time and abusers were associated with significantly greater HRU and costs compared with nonabusers before and after the diagnosis of abuse.


Assuntos
Efeitos Psicossociais da Doença , Recursos em Saúde/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Adulto , Estudos de Coortes , Feminino , Recursos em Saúde/economia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/economia , Prevalência , Estudos Retrospectivos , Estados Unidos/epidemiologia
17.
Am J Alzheimers Dis Other Demen ; 28(4): 384-92, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23687180

RESUMO

BACKGROUND/RATIONALE: Alzheimer's disease (AD) represents a serious public health issue affecting approximately 5.4 million individuals in the United States and is projected to affect up to 16 million by 2050. This study examined health care resource utilization (HCRU), costs, and comorbidity burden immediately preceding new diagnosis of AD and 2 years after diagnosis. METHODS: This study utilized a claims-based, retrospective cohort design. Medicare Advantage members newly diagnosed with AD (n = 3374) were compared to matched non-AD controls (n = 6748). All patients with AD were required to have 12 months of continuous enrollment prior to AD diagnosis (International Classification of Diseases, Clinical Modification [ICD-9] 331.0), during which time no diagnosis of AD, a related dementia, or an AD medication was observed. Non-AD controls demonstrated no diagnosis of AD, a related dementia, or a prescription claim for an AD medication treatment during their health plan enrollment. Medical and pharmacy claims data were used to measure HCRU, costs, and comorbidity burden over a period of 36 months (12 months pre-diagnosis and 24 months post-diagnosis). RESULTS: The HCRU and costs were greater for AD members during the year prior to diagnosis and during postdiagnosis years 1 and 2 compared to controls. The AD members also displayed greater comorbidity than their non-AD counterparts during postdiagnosis years 1 and 2, as measured by 2 different comorbidity indices. CONCLUSIONS: Members newly diagnosed with AD demonstrated greater HCRU, health care costs, and comorbidity burden compared to matched non-AD controls.


Assuntos
Doença de Alzheimer/economia , Doença de Alzheimer/epidemiologia , Custos de Cuidados de Saúde/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Medicare Part C/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/diagnóstico , Comorbidade , Efeitos Psicossociais da Doença , Feminino , Gastos em Saúde/estatística & dados numéricos , Serviços de Saúde/economia , Humanos , Revisão da Utilização de Seguros/economia , Revisão da Utilização de Seguros/estatística & dados numéricos , Estudos Longitudinais , Masculino , Medicare Part C/economia , Estudos Retrospectivos , Estados Unidos/epidemiologia
18.
J Med Econ ; 16(6): 784-92, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23565813

RESUMO

OBJECTIVE: To compare changes in healthcare resource utilization and costs among members with painful diabetic peripheral neuropathy (pDPN), postherpetic neuralgia (PHN), or fibromyalgia (FM) in a commercial health plan implementing pregabalin step-therapy with members in unrestricted plans. METHODS: Retrospective study of outcomes associated with implementation of a pregabalin step-therapy protocol using claims data from Humana ('restricted' cohort) and Thomson Reuters MarketScan ('unrestricted' cohort). Members aged 18-65 years receiving treatment for pDPN, PHN, or FM during 2008 or 2009 were identified; cohorts were matched on diagnosis and geographic region. Baseline to follow-up changes in healthcare resource utilization and costs were determined using difference-in-differences (DID) analysis. Statistical models adjusting for covariates explored relationships between restricted access and outcomes. RESULTS: A total of 3876 restricted cohort members were identified and matched to 3876 unrestricted cohort members. FM was the predominant diagnosis (84.7%). The unrestricted cohort was older (mean = 49.0 (SD = 10.4) years vs 47.6 (SD = 10.5) years; p < 0.001), and had greater comorbidity (RxRisk-V score = 5.4 (SD = 3.2) vs 4.4 (SD = 2.9), p < 0.001) than the restricted cohort. Compared with the unrestricted cohort, the restricted cohort demonstrated a greater year-over-year decrease in pregabalin utilization (-2.6%, p = 0.008), and greater increases in physical therapy and disease-related outpatient utilization (3.7%, p = 0.010 and 3.6%, p = 0.022, respectively). There were no statistically significant net differences in all-cause or disease-related total healthcare, medical, or pharmacy costs between cohorts. After adjusting for baseline compositional differences between cohorts, restricted plan membership was associated with a net increase in all-cause medical ($1222; p = 0.016) and disease-related healthcare costs ($859; p = 0.002). Limitations include use of a combined analysis for pDPN, PHN, and FM, especially since the observed results were likely driven by FM; an inability to link the prescribing of a medication with the condition of interest, which is common to claims analyses; and lack of pain severity information. CONCLUSIONS: Implementation of a pregabalin step-therapy protocol resulted in lower pregabalin utilization, but this restriction was not associated with reductions in total healthcare costs, medical costs, or pharmacy costs.


Assuntos
Analgésicos/economia , Neuropatias Diabéticas/tratamento farmacológico , Fibromialgia/tratamento farmacológico , Controle de Acesso/economia , Neuralgia Pós-Herpética/tratamento farmacológico , Assistência Farmacêutica/economia , Ácido gama-Aminobutírico/análogos & derivados , Adolescente , Adulto , Idoso , Analgésicos/uso terapêutico , Controle de Custos , Bases de Dados Factuais , Feminino , Gastos em Saúde , Humanos , Seguro de Serviços Farmacêuticos/economia , Masculino , Pessoa de Meia-Idade , Assistência Farmacêutica/estatística & dados numéricos , Pregabalina , Estudos Retrospectivos , Adulto Jovem , Ácido gama-Aminobutírico/economia , Ácido gama-Aminobutírico/uso terapêutico
19.
Curr Med Res Opin ; 29(5): 421-33, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23444970

RESUMO

OBJECTIVE: The prevalence of non-steroidal anti-inflammatory drug (NSAID) and concurrent gastroprotective agent (GPA) use in the US is not known. As such, the prevalence of GPA use among arthritis patients taking NSAIDs was examined. METHODS: Men and women aged ≥ 40 with self-reported arthritis and members of a web-based community panel were invited via e-mail to participate in a web survey. Interested panelists consented and completed the survey. Participants using NSAIDs in the last 30 days were eligible. Questions regarding NSAID and GPA use were asked, likewise adherence to GPA (Morisky scale), comorbid conditions, gastrointestinal (GI) history, and other risk factors. Descriptive analyses and logistic regressions were performed to assess associations with GPA use and adherence. RESULTS: Invitations were sent to 7605 adults; 4108 (54%) responded; 2208 completed. Final sample was 1525 (76%) with osteoarthritis (OA), 354 (18%) with rheumatoid arthritis (RA), and 121 (6%) with both OA and RA. Mean age was 62.0; 64% were female; 83% white; 25% worked full-time, and 39% were retired. Mean duration with arthritis was 13.0 years; 47% and 19% experienced arthritis symptoms 'daily' and 'almost always', respectively. Nearly 43% reported using a GPA and 39% of daily NSAID users reported taking a GPA. Fifty-eight participants (2.9%) were classified as low GI risk, 342 (17.1%) were moderate risk, and 1600 (80.0%) were high risk. Variables significantly associated with GPA use included older age; male gender; being white (vs. Hispanic); taking an NSAID at least daily; taking fewer NSAIDs; taking a Cox-2 inhibitor or prescription NSAID; history of GI conditions; prescription antiplatelet use; and having GI symptoms. Similar variables were associated with GPA adherence. CONCLUSION: Less than half of adult men and women in the US taking a daily NSAID used GPAs and only 37% of high-risk participants were taking GPAs.


Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Artrite Reumatoide/tratamento farmacológico , Gastroenteropatias/prevenção & controle , Osteoartrite/tratamento farmacológico , Inibidores da Bomba de Prótons/administração & dosagem , Inquéritos e Questionários , Adulto , Idoso , Anti-Inflamatórios não Esteroides/efeitos adversos , Artrite Reumatoide/epidemiologia , Feminino , Gastroenteropatias/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Medicamentos sem Prescrição/administração & dosagem , Osteoartrite/epidemiologia , Estados Unidos/epidemiologia
20.
Pain Pract ; 12(3): 209-18, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21676163

RESUMO

BACKGROUND: Pregabalin and duloxetine are two FDA-approved medications for the treatment of pain associated with diabetic peripheral neuropathy (pDPN). The objective of this study was to compare changes in all-cause and pDPN-related health care costs in patients with pDPN initiated on pregabalin or duloxetine. METHODS: Patients at least 18 years of age initiating pregabalin or duloxetine between March 1, 2006 and December 31, 2008 were identified from a large U.S. managed care plan database. The date of the first pregabalin or duloxetine prescription was defined as the index date. Patients with claims-based evidence of pDPN and who had continuous enrollment for 6-month pre- and post-index periods were selected for study inclusion. Duloxetine patients with depression or generalized anxiety disorder (GAD) were excluded. All-cause and pDPN-related total health care costs (over 6 month pre-index and post-index periods) were analyzed with difference-in-differences (DiD) models. RESULTS: A total of 2,136 patients (1,785 pregabalin and 351 duloxetine) were identified. No significant differences in gender, age, or pre-index Quan-Charlson comorbidity score were observed between the two cohorts. No significant differences (pregabalin vs. duloxetine) in pre-index to post-index change in mean all-cause health care costs ($1,411 vs. $1,560, P = 0.93) or mean pDPN-related health care costs ($704 vs. -$240, P = 0.22) were found. The DiD models showed no significant difference in all-cause (mean) costs attributable to pregabalin vs. duloxetine therapy between pre-index and post-index periods (mean cost ratio = 0.97, 95% CI: 0.75 to 1.26), but showed that patients receiving pregabalin had a significantly higher increase in pDPN-related costs compared with patients receiving duloxetine (mean cost ratio = 2.35, 95% CI: 1.01 to 5.46). However, the difference (pre- to post-index) in pDPN-related costs attributable to pregabalin vs. duloxetine therapy was nonsignificant (mean cost ratio = 2.30, 95% CI: 0.93 to 5.68) in a sensitivity analysis in which patients with depression and GAD were excluded from both cohorts. CONCLUSION: No differences were noted in all-cause costs attributable to pregabalin or duloxetine. Although patients receiving pregabalin had a significantly greater pre- to post-index increase in pDPN-related health care costs compared with patients receiving duloxetine, this may have been due to an imbalance in patient exclusion criteria between cohorts.


Assuntos
Analgésicos/economia , Neuropatias Diabéticas/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Tiofenos/economia , Ácido gama-Aminobutírico/análogos & derivados , Adolescente , Adulto , Idoso , Analgésicos/uso terapêutico , Estudos de Coortes , Neuropatias Diabéticas/tratamento farmacológico , Cloridrato de Duloxetina , Feminino , Serviços de Saúde/economia , Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Programas de Assistência Gerenciada/estatística & dados numéricos , Pessoa de Meia-Idade , Pregabalina , Tiofenos/uso terapêutico , Estados Unidos , Ácido gama-Aminobutírico/economia , Ácido gama-Aminobutírico/uso terapêutico
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