Jonathan Bouchard

Novo Nordisk, København, Capital Region, Denmark

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Publications (42)123.95 Total impact

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    ABSTRACT: This retrospective cross-sectional study utilized medical, pharmacy and laboratory claims from a large Medicare Advantage with Prescription Drug Coverage (MAPD) payer. MAPD members (mean age 72 years) diagnosed with T2DM between 2009 and 2011 were eligible for inclusion. A 12-month baseline period before the first A1c value (the index date) was evaluated for demographic and clinical differences.
    09/2015; 11(3):97-97. DOI:10.1007/s12467-013-0051-5
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    ABSTRACT: Diabetes-related healthcare costs are increasing in the United States, with inpatient hospitalization the largest component of medical expenditures. The aims of this study were to characterize hospitalized type 2 diabetes mellitus (T2DM) patients, understand the relationship between hospitalization and healthcare costs, and explore treatment modification after inpatient hospitalization. A retrospective cohort analysis of Humana Medicare Advantage and commercial members with T2DM was conducted. T2DM members were identified and assigned to three groups: (1) inpatient hospitalization (IPH) without a 30-day readmit (IPH group); (2) IPH with a 30-day readmission (IPH readmission group); and, (3) matched non-IPH group. Demographics, clinical characteristics, comorbidities and healthcare costs were measured based on enrollment data and claims. Descriptive statistics were used and the relationship between IPH and costs was assessed using generalized linear models. A total of 15,555 IPH patients, 1757 IPH readmission patients, and 17,312 matched non-IPH patients were included in the study. The IPH readmission group had the highest adjusted mean all-cause total costs ($76,806), followed by the IPH group ($42,011), and the non-IPH group ($9624). A similar trend was observed for adjusted all-cause mean medical and pharmacy costs. DM-related total healthcare costs were highest for the IPH readmission group ($13,714), followed by the IPH group ($7477), and non-IPH group ($1620). While overall therapy modification (discontinuation, addition, switch) was low, T2DM patients with an IPH (with or without a readmission) had greater rates of therapy modification relative to the non-IPH patients. Adjusted all-cause and DM-related total costs were greatest for IPH readmission patients. Rates of treatment modification within 10 days of discharge after IPH were generally low. Identifying T2DM patients at high risk of readmission and employing methods to decrease that risk during the index hospitalization could have a significant impact on health system costs. Novo Nordisk.
    Advances in Therapy 07/2015; 32(7). DOI:10.1007/s12325-015-0223-3 · 2.27 Impact Factor
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    ABSTRACT: Describe treatment regimen changes of patients with type 2 diabetes mellitus (T2DM) initiating metformin monotherapy, and assess factors associated with those changes 12 months post-initiation. Retrospective cohort analysis of medical, pharmacy and laboratory claims of 17,527 Medicare Advantage (MAPD) Humana members aged 18-89, who had ≥1 medical claim with primary diagnosis or ≥2 medical claims with secondary diagnosis of T2DM (ICD-9-CM code 250.x0 or 250.x2) who filled an initial prescription for metformin (GPI code 2725) between 1/1/2008 and 9/30/2011. The main outcome measure was change in metformin monotherapy during the 12 months following initiation. Factors associated with treatment changes during follow-up were examined using Cox proportional hazards regression models. Fifty-nine percent of patients (mean age 69.6 years) remained on metformin monotherapy with no changes. Discontinuation was the most common treatment change (33%), followed by addition (5%), and switching (2%) to other antidiabetics. Of patients who discontinued treatment (median time to discontinuation=90 days), 61% did not reinitiate any diabetic treatment during the follow-up period. Among patients who added or switched to other antidiabetics, sulfonylureas were the most common addition or replacement agent. Predictors of discontinuation were being female, Black or Hispanic, low-income subsidy-eligible, having higher initial out-of-pocket metformin costs, or a diagnosis of depression. Discontinuation was less likely during follow-up if patients had higher pre-index pill burdens or records of a pre-index A1C screening test. A higher risk of discontinuation was observed for patients with low baseline A1C. One study limitation was that exact discontinuation dates could not be determined using claims. The findings suggest that gender, race, ethnicity, depression, and low income status were contributory factors to metformin discontinuation. More intensive monitoring and treatment adjustments may be warranted for patients newly initiated on metformin. This could ultimately improve morbidity, mortality, and costs associated with poor glycemic control.
    Current Medical Research and Opinion 07/2015; 31(9):1-43. DOI:10.1185/03007995.2015.1067194 · 2.65 Impact Factor
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    ABSTRACT: Objectives This study evaluated the usefulness of the Diabetes Complications Severity Index (DCSI) in assessing healthcare resource utilization (HRU) and costs among Medicare Advantage plan members diagnosed with type 2 diabetes mellitus (T2DM). Study Design A retrospective cohort study of medical and pharmacy claims of 333,576 Medicare members aged 18 to 89 years with ≥1 medical claim with primary diagnosis or ≥2 medical claims with secondary diagnosis, of T2DM (International Classification of Diseases, Ninth Revision, Clinical Modification code 250.x0 or 250.x2) during the period of January 1, 2010, to December 31, 2011. Methods - See more at:
    The American journal of managed care 02/2015; · 2.26 Impact Factor
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    ABSTRACT: Published guidelines for treatment of type 2 diabetes mellitus (T2DM) agree on initial pharmacotherapy. However, few specific recommendations on second-line agents are provided. The objective of this study was to describe antidiabetic treatment patterns in Medicare Advantage patients with T2DM within 6 months of measurement of the glycosylated hemoglobin (HbA1c) level. This retrospective cross-sectional study utilized medical, pharmacy, and laboratory claims from a large Medicare Advantage with Prescription Drug (MAPD) coverage payer. MAPD members between 65 and 89 years old identified as having T2DM between 2009 and 2011 were eligible for inclusion. A 12-month baseline period before the first HbA1c value (index date) was evaluated for demographic and clinical differences. Antidiabetic therapy was evaluated for 6 months post-index. The study population was stratified into three cohorts based on index HbA1c value: controlled (<8 %, 64 mmoL/mol), uncontrolled (≥8 %, 64 mmoL/mol and <10 %, 86 mmoL/mol), and severely uncontrolled (≥10 %, 86 mmoL/mol). Despite elevated HbA1c values (≥8 %, 64 mmoL/mol), 7-8 % of patients did not receive antidiabetic therapy during the post-index period. Metformin and sulfonylureas were the oral antidiabetics (OADs) most frequently used as monotherapy. The majority of patients on combination therapy were on two or more OADs and higher injectable use was observed in the severely uncontrolled cohort. Metformin was included in >60 % of the combination regimens with metformin + sulfonylurea being the most common. This study suggests suboptimal treatment of those not in glycemic control (HbA1c ≥8 %, 64 mmoL/mol). Many patients classified as severely uncontrolled based on HbA1c received only monotherapy. Opportunities exist for treatment modification within this population to achieve tighter glycemic control.
    Drugs & Aging 01/2015; 32(2). DOI:10.1007/s40266-014-0235-8 · 2.84 Impact Factor
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    Mary E Costantino · Jane N Stacy · Frank Song · Yihua Xu · Jonathan R Bouchard
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    ABSTRACT: Abstract The objective was to estimate health care costs and utilization for Medicare beneficiaries with type 1 (T1DM) or type 2 (T2DM) diabetes and their respective matched control cohorts. A retrospective claims cohort analysis was used to assess direct health care cost and utilization of health services in 2009 for patients aged 65-89 who were enrolled in a Medicare Advantage Plus prescription drug plan. Patients were matched 1:1 with patients without diabetes. All-cause health care costs for 2009 were calculated as the sum of all medical and pharmacy claims. The analysis included 6562 patients with T1DM and an equal number of matched controls, and 194,775 patients with T2DM and an equal number of matched controls. There were no significant demographic differences between cohorts for matched variables. Patients with T2DM had significantly higher mean Deyo/Charlson Comorbidity Index scores compared with their controls (2.47 versus 0.77; P<0.001), although all groups reported a high rate of costly comorbidities such as hypertension and heart disease. Mean all-cause health care costs per patient per year were significantly higher for patients with T1DM and T2DM versus controls for inpatient hospitalizations; outpatient, office, and emergency room visits; pharmacy expenditures; and total health care costs for 2009 (T1DM group: $20,701±$30,201; T1DM-matched control group: $6,537±$10,441; T2DM group: $10,437±$18,518; T2DM-matched control group: $6,505±$11,140). Diabetes escalates health care costs for Medicare Advantage Plus patients compared with patients in the same plan without diabetes, regardless of comorbidities. (Population Health Management 2014;xx:xxx-xxx).
    Population Health Management 05/2014; 17(5). DOI:10.1089/pop.2013.0097 · 1.51 Impact Factor
  • J.J. Ellis · J.R. Bouchard · V. Saundankar · K. Moll · J. Baltz · Y. Meah · C. Moretz
    Value in Health 05/2014; 17(3):A264. DOI:10.1016/j.jval.2014.03.1538 · 3.28 Impact Factor
  • J.J. Ellis · J.R. Bouchard · V. Saundankar · J. Baltz · Y. Meah · C. Moretz
    Value in Health 05/2014; 17(3):A153-A154. DOI:10.1016/j.jval.2014.03.894 · 3.28 Impact Factor
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    L Hazel-Fernandez · Y. Xu · C. Moretz · Y. Meah · J. Baltz · J. Lian · J.R. Bouchard
    Value in Health 05/2014; 17(3):A258-A259. DOI:10.1016/j.jval.2014.03.1506 · 3.28 Impact Factor
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    P. Schwab · V. Saundankar · J.R. Bouchard · C. Moretz · J. Baltz
    Value in Health 05/2014; 17(3):A264. DOI:10.1016/j.jval.2014.03.1540 · 3.28 Impact Factor
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    Value in Health 05/2014; 17(3):A125. DOI:10.1016/j.jval.2014.03.727 · 3.28 Impact Factor
  • Wei Shao · Rabia Ahmad · Naum Khutoryansky · Mark Aagren · Jonathan Bouchard
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    ABSTRACT: Abstract Objectives: This retrospective study investigated the association between hypoglycemic events (HEs) and depression events (DEs) in patients with diabetes mellitus (type 1 and type 2). Methods: Analyzed data were from health care claims for individuals with employer-sponsored primary or Medicare supplemental insurance from the Thomson Reuters Market Scan database during the years 2008 and 2009. A baseline period (January 2008 to December 2008) was used to identify eligible patients and collect baseline clinical and demographic characteristics. Eligible patients were aged ≥18 years with diabetes (ICD-9-CM codes: 250.00, 250.01, 250.02, 250.03) who had not experienced any HEs or DEs and were not on antidepressant therapy during the baseline period. We studied the relationships between the DEs and HEs before and after adjusting for the covariates. Results: Of the 923,024 patients meeting the inclusion criteria, 22,735 (2.46%) patients had HEs (ICD-9-CM coded: 251.0, 251.1, 251.2, 250.8) and 6164 (0.67%) patients had DEs (ICD-9-CM: 311) during the evaluation period. Patients reporting HEs had 78% higher odds of experiencing depression than patients without HEs before adjusting for the covariates. Similarly, after adjusting for the covariates, data indicated that patients with HEs had higher odds of experiencing depression (OR=1.726; 95% CI=1.52-1.96). Similar analyses in different age categories showed that the OR monotonically increases with age regardless of whether the other covariates are included in the model. Conclusions: ICD-9-CM-coded HEs were independently associated with an increased risk of DEs in patients with diabetes, and this incidence increased with the patients' age. Key limitations: A key limitation to this study is that only those HEs that resulted in health care provider contact and subsequent claims coding indicative of hypoglycemia were included. It is likely that many cases of mild hypoglycemia, particularly those not severe enough to warrant medical attention, were not captured in this study.
    Current Medical Research and Opinion 07/2013; 29(12). DOI:10.1185/03007995.2013.830599 · 2.65 Impact Factor
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    T. Young · W. Shao · W. Weng · J.R. Bouchard
    Value in Health 11/2012; 15(7):A507. DOI:10.1016/j.jval.2012.08.1718 · 3.28 Impact Factor
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    ABSTRACT: To determine the impact on insulin acquisition cost of a pharmacy program to convert insulin utilization from multidose vials to pen-delivery systems for long-term care residents covered by Medicare Part A, and managed care plans. Retrospective cost comparison. Long-term care facilities. Residents covered by Medicare Part A and managed care plans. Policy to replace insulin vials with pen devices, effective July 2009. Mean insulin cost-per-patient day (total insulin purchases divided by patient admission days) and pen utilization (pen purchases as a percent of total insulin purchases). Insulin purchase data covered 2,405 admissions in 75 facilities over the 12-month period ending June 2010. Pen device purchases increased from less than 1% to almost 35% of total insulin purchases over the study period during which insulin cost per patient-day declined from $10.29 to $4.08. For Medicare Part A patients with admissions of 30 days or fewer, the most frequent visit type, mean cost per patient-day decreased from $13.73 to $9.19 as pen purchases increased from less than 1% to about 32%. For these same patients, mean cost per patient-day for admissions using only pen devices was $7.04, compared with $11.79 for admissions using only vials (P < 0.001). Significant differences in mean cost per patient-day were also found for residents covered by managed care and for longer admissions. Total insulin costs can be reduced through higher utilization of pen devices by patients in long-term care facilities.
    The Consultant pharmacist: the journal of the American Society of Consultant Pharmacists 06/2012; 27(6):411-20. DOI:10.4140/TCP.n.2012.411
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    W. Shao · R. Ahmad · N. Khutoryansky · M. Aagren · J.R. Bouchard
    Value in Health 06/2012; 15(4):A174. DOI:10.1016/j.jval.2012.03.943 · 3.28 Impact Factor
  • S S Johnston · C Conner · M Aagren · K Ruiz · J Bouchard
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    ABSTRACT: This retrospective observational study examined the association between International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)-coded outpatient hypoglycaemic events and fall-related fractures in Medicare-covered patients with type 2 diabetes. Data were derived from healthcare claims for individuals with employer-sponsored Medicare supplemental insurance. The study period consisted of two consecutive 1-year periods; the baseline period (1 April 2008 to 31 March 2009) and the evaluation period (1 April 2009 to 31 March 2010). Patients selected for study were at least 65 years of age with evidence of type 2 diabetes during the baseline period, as identified using a Healthcare Effectiveness Data and Information Set algorithm or by at least two prescription claims for oral antidiabetic drugs. The baseline period was used to collect information on the patients' demographics and clinical characteristics. The evaluation period was used to identify the presence of hypoglycaemic events and fall-related fractures. Logistic regression was employed to examine the association between hypoglycaemic events and fall-related fractures occurring during the evaluation period, adjusting for patients' demographics and clinical characteristics. Of 361 210 included patients, 16 936 had hypoglycaemic events during the evaluation period. Patients with hypoglycaemic events had 70% higher regression-adjusted odds (hypoglycaemic events odds ratio = 1.70; 95% confidence interval = 1.58-1.83) of fall-related fractures than patients without hypoglycaemic events. Multiple sensitivity analyses also yielded results suggesting increased odds of fall-related fractures in patients with hypoglycaemic events. ICD-9-CM-coded outpatient hypoglycaemic events were independently associated with an increased risk of fall-related fractures. Further studies of the relationship between hypoglycaemia and the risk of fall-related fractures are warranted.
    Diabetes Obesity and Metabolism 02/2012; 14(7):634-43. DOI:10.1111/j.1463-1326.2012.01583.x · 6.36 Impact Factor
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    E. Buysman · C. Conner · F. Liu · M. Aagren · J. Bouchard
    Value in Health 11/2011; 14(3). DOI:10.1016/j.jval.2011.02.546 · 3.28 Impact Factor
  • Erin Buysman · Christopher Conner · Mark Aagren · Jonathan Bouchard · Fang Liu
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    ABSTRACT: This study was conducted to compare adherence and persistence of patients initiating basal insulin therapy with Levemir FlexPen versus those initiating basal insulin therapy with NPH via vial and syringe. Data were gathered from a large US retrospective claims database, and included patients with type 2 diabetes that initiated basal insulin therapy with either Levemir FlexPen or NPH in vials. Patients were defined as adherent to therapy if they had a medication possession ratio (MPR) of ≥80% in the 12-month follow-up period and were defined as persistent with therapy if they had no gaps in insulin therapy in the follow-up period. After controlling for confounders using logistic regression, patients initiating therapy with Levemir FlexPen had 39% higher adjusted odds of achieving an MPR ≥80% versus patients initiating therapy with NPH vial (OR 1.39; 95% CI: 1.04-1.85). Analysis of persistence using a Cox proportional hazards model indicated that patients initiating Levemir FlexPen had a 38% lower hazard of discontinuation compared to NPH vial (HR 0.62, 95% CI: 0.55-0.70). Claims-based studies are limited to the extent that they accurately capture medical and pharmacy use. Also, relying on claims-based data limits the generalizability of the findings to similar populations and treatments. These results suggest that persistence and adherence with insulin may be improved for patients initiating basal insulin therapy with Levemir FlexPen versus NPH vial.
    Current Medical Research and Opinion 09/2011; 27(9):1709-17. DOI:10.1185/03007995.2011.598500 · 2.65 Impact Factor
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    G. Bazalo · R. C. Weiss · J. Bouchard · R. Perry · F. Wendt
    Value in Health 05/2011; 14(3). DOI:10.1016/j.jval.2011.02.527 · 3.28 Impact Factor
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    ABSTRACT: Insulin pump users discard unused medication and infusion sets according to labeling and manufacturer's instructions. The stability labeling for insulin aspart (rDNA origin] (Novolog) was increased from two days to six. The associated savings was modeled from the perspective of a hypothetical one-million member health plan and the total United States population. The discarded insulin volume and the number of infusion sets used under a two-day stability scenario versus six were modeled. A mix of insulin pumps of various reservoir capacities with a range of daily insulin dosages was used. Average daily insulin dose was 65 units ranging from 10 to 150 units. Costs of discarded insulin aspart [rDNA origin] were calculated using WAC (Average Wholesale Price minus 16.67%). The cost of pump supplies was computed for the two-day scenario assuming a complete infusion set change, including reservoirs, every two days. Under the six-day scenario complete infusion sets were discarded every six days while cannulas at the insertion site were changed midway between complete changes. AWP of least expensive supplies was used to compute their costs. For the hypothetical health plan (1,182 pump users) the annual reduction in discarded insulin volume between scenarios was 19.8 million units. The corresponding cost reduction for the plan due to drug and supply savings was $3.4 million. From the U.S. population perspective, savings of over $1 billion were estimated. Using insulin that is stable for six days in pump reservoirs can yield substantial savings to health plans and other payers, including patients.
    Managed care (Langhorne, Pa.) 05/2011; 20(5):42-7.