Darius Lakdawalla

University of Southern California, Los Angeles, California, United States

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Publications (119)333.57 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To explore the relationship between commercial health care prices and Medicare spending/utilization across U.S. regions. Claims from large employers and Medicare Parts A/B/D over 2007-2009. We compared prices paid by commercial health plans to Medicare spending and utilization, adjusted for beneficiary health and the cost of care, across 301 hospital referral regions. A 10 percent lower commercial price (around the average level) is associated with 3.0 percent higher Medicare spending per member per year, and 4.3 percent more specialist visits (p < .01). Commercial health care prices are negatively associated with Medicare spending across regions. Providers may respond to low commercial prices by shifting service volume into Medicare. Further investigation is needed to establish causality. © Health Research and Educational Trust.
    Health Services Research 11/2014; · 2.29 Impact Factor
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    ABSTRACT: Abstract: Background:Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability in the US. Patients with COPD are at high risk of nutritional deficiency, which is associated with declines in respiratory function, lean body mass and strength, and immune function. Although oral nutritional supplements (ONS) have been associated with improvements in some of these domains, the impact of hospital ONS on readmission risk, length of stay (LOS), and cost among hospitalized patients is unknown. Methods:We first identified Medicare patients aged 65+ hospitalized with a primary diagnosis of COPD in the Premier Research Database. We then identified hospitalizations in which ONS was provided and used propensity score matching to compare LOS, hospitalization cost and 30-day readmission rates in a 1-1 matched sample of ONS and non-ONS hospitalizations. To further address selection bias among patients prescribed ONS, we also utilized instrumental variables (IV) analysis to study the effects of ONS. Model covariates included patient and provider characteristics and a time trend. Results:Out of 10,322 ONS hospitalizations and 368,097 non-ONS hospitalizations, a one-to-one matched sample was created (N=14,326). IV analysis indicated that ONS use was associated with: a 1.88 day (21.5%) decrease in LOS, from 8.75 to 6.87 days (p<0.01); hospitalization cost reduction of $1,570 (12.5%), from $12,523 to $10,953 (p<0.01); and a 13.1% decrease in probability of 30-day readmission, from 0.335 to 0.291 (p<0.01). Conclusions:ONS may offer an inexpensive, effective means for reducing LOS, hospitalization cost, and readmission risk in hospitalized Medicare patients with COPD. Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability in the US. Patients with COPD are at high risk of nutritional deficiency, which is associated with declines in respiratory function, lean body mass and strength, and immune function. Although oral nutritional supplements (ONS) have been associated with improvements in some of these domains, the impact of hospital ONS on readmission risk, length of stay (LOS), and cost among hospitalized patients is unknown. Methods: We first identified Medicare patients aged 65+ hospitalized with a primary diagnosis of COPD in the Premier Research Database. We then identified hospitalizations in which ONS was provided and used propensity score matching to compare LOS, hospitalization cost and 30-day readmission rates in a 1-1 matched sample of ONS and non-ONS hospitalizations. To further address selection bias among patients prescribed ONS, we also utilized instrumental variables (IV) analysis to study the effects of ONS. Model covariates included patient and provider characteristics and a time trend. Results: Out of 10,322 ONS hospitalizations and 368,097 non-ONS hospitalizations, a one-to-one matched sample was created (N=14,326). IV analysis indicated that ONS use was associated with: a 1.88 day (21.5%) decrease in LOS, from 8.75 to 6.87 days (p<0.01); hospitalization cost reduction of $1,570 (12.5%), from $12,523 to $10,953 (p<0.01); and a 13.1% decrease in probability of 30-day readmission, from 0.335 to 0.291 (p<0.01). Conclusions: ONS may offer an inexpensive, effective means for reducing LOS, hospitalization cost, and readmission risk in hospitalized Medicare patients with COPD.
    Chest 10/2014; · 7.13 Impact Factor
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    ABSTRACT: Disease-associated malnutrition (DAM) is a well-recognized problem in many countries, but the extent of its burden on the Chinese population is unclear. This article reports the results of a burden-of-illness study on DAM in 15 diseases in China. Using data from the World Health Organization (WHO), the China Health and Nutrition Survey, and the published literature, mortality and disability-adjusted life years (DALYs) lost because of DAM were calculated; a financial value of this burden was calculated following WHO guidelines. DALYs lost annually to DAM in China varied across diseases, from a low of 2248 in malaria to a high of 1 315 276 in chronic obstructive pulmonary disease. The total burden was 6.1 million DALYs, for an economic burden of US$66 billion (Chinese ¥ 447 billion) annually. This burden is sufficiently large to warrant immediate attention from public health officials and medical providers, especially given that low-cost and effective interventions are available.
    Asia-Pacific journal of public health / Asia-Pacific Academic Consortium for Public Health. 10/2014;
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    ABSTRACT: Background: The burden imposed by disease-associated malnutrition (DAM) on patients and the healthcare system in food-abundant industrialized countries is often underappreciated. This study measured the economic burden of community-based DAM in the United States. Methods: The burden of DAM was quantified in terms of direct medical costs, quality-adjusted life years lost, and mortality across 8 diseases (breast cancer, chronic obstructive pulmonary disease [COPD], colorectal cancer [CRC], coronary heart disease [CHD], dementia, depression, musculoskeletal disorders, and stroke). To estimate the total economic burden, the morbidity and mortality burden was monetized using a standard value of a life year and combined with direct medical costs of treating DAM. Disease-specific prevalence and malnutrition estimates were taken from the National Health Interview Survey and the National Health and Nutrition Examination Survey. Deaths by disease were taken from the Center for Disease Control and Prevention. Estimates of costs and morbidity were taken from the literature. Results: The annual burden of DAM across the 8 diseases was $156.7 billion, or $508 per U.S. resident. Nearly 80% of this burden was derived from morbidity associated with DAM; around 16% derived from mortality and the remainder from direct medical costs of treating DAM. The total burden was highest in COPD and depression, while the burden per malnourished individual was highest in CRC and CHD. Conclusion: DAM exacts a large burden on American society. Therefore, improved diagnosis and management of community-based DAM to alleviate this burden are needed.
    JPEN. Journal of parenteral and enteral nutrition. 09/2014;
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    ABSTRACT: Background: Nutrition deficiency is common among hospitalized children. Although oral nutrition supplements (ONS) may improve malnutrition in this population, the benefits and healthcare costs associated with their use have not yet been fully explored. The objective of this study was to assess the effect of ONS use on inpatient length of stay (LOS) and episode cost in hospitalized children. Materials and Methods: Retrospective analysis of 557,348 hospitalizations of children aged 2-8 years in the Premier Research Database. The effect of ONS use on LOS and episode cost in a propensity score- matched sample was estimated in analyses with and without the use of instrumental variables (IVs) to reduce confounding from unobserved variables. Results: ONS were prescribed in 6066 of 557,348 inpatient episodes (1.09%). In an analysis that did not include instrumental variables to control for selection bias, ONS use was associated with a 2.9-day increase (95% confidence interval [CI], 2.32-3.39), or 51.6% increase in LOS, from 5.5 to 8.4 days. ONS use was also associated with increased episode cost of $8568 (95% CI, $8415-$8723), or 66.8%, from $12,833 to $21,401. However, in IV analysis, using a matched sample of 11,031 episodes, hospitalizations with ONS use had 14.8% shorter LOS (6.4 vs 7.5 days; 1.1 days [95% CI, 0.2-2.4]). Hospitalizations with ONS use had 9.7% lower cost ($16,552 vs $18,320; $1768 [95% CI, $1924-$1612]). Conclusions: ONS use was associated with lower LOS and episode cost among pediatric inpatients. ONS use in hospitalized pediatric patients may provide a cost-effective, evidence-based approach to improving pediatric hospital care.
    JPEN. Journal of parenteral and enteral nutrition. 09/2014;
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    ABSTRACT: Objective To demonstrate how expanding services covered by a “bundled payment” can also expand variation in the costs of treating patients under the bundle, using the Medicare dialysis program as an example.Data Sources/Study SettingObservational claims-based study of 197,332 Medicare hemodialysis beneficiaries enrolled for at least one quarter during 2006–2008.Study DesignWe estimated how resource utilization (all health services, dialysis-related services, and medications) changes with intensity of secondary hyperparathyroidism (sHPT) treatment.Data Extraction Methods Using Medicare claims, a patient-quarter level dataset was constructed, including a measure of sHPT treatment intensity.Principal FindingsUnder the existing, narrow dialysis bundle, utilization of covered services is relatively constant across treatment intensity groups; under a broader bundle, it rises more rapidly with treatment intensity.Conclusions The broader Medicare dialysis bundle reimburses providers uniformly, even though patients treated more intensively for sHPT cost more to treat. Absent any payment adjustments or efforts to ensure quality, this flat payment schedule may encourage providers to avoid high-intensity patients or reduce their treatment intensity. The first incentive harms efficiency. The second may improve or worsen efficiency, depending on whether it reduces appropriate or inappropriate treatment.
    Health Services Research 07/2014; · 2.29 Impact Factor
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    ABSTRACT: Objective To examine the impact of Medicaid prior authorization for atypical antipsychotics on the prevalence of schizophrenia among the prison population. Study Design We collected drug-level information on prior authorization restrictions from Medicaid programs in 30 states to determine which states had prior authorization requirements before 2004. We linked the regulatory data to a survey of prison inmates conducted in 2004. Methods We used a sample of 16,844 inmates from a nationally representative survey and analyzed the data using cross-sectional regression. To capture the impact of prior authorization, we estimated 2 models: the first included an indicator variable for states requiring prior authorization, and a second model used per capita atypical usage. Results Evidence indicated that prior authorization restrictions on atypical antipsychotics are associated with an increase in the odds of a schizophrenic resident being imprisoned in a state. State-level prior authorization requirements for atypical antipsychotics are associated with a 2.7% increase in the likelihood that an imprisoned inmate displays psychotic symptoms, and a 1.25 increase in the likelihood that an inmate was previously diagnosed with schizophrenia by a physician. Higher state-level atypical prescriptions per capita are also associated with lower likelihood of psychotic symptoms and of prior schizophrenia diagnosis among prisoners. Conclusions Prior authorization requirements for atypical antipsychotics, which are designed to reduce healthcare costs, are associated with greater prevalence of mental illness within the criminal justice system.This association raises important questions about whether increased costs to the criminal justice system might mitigate or offset prescription drug savings created by prior authorization requirements.
    The American journal of managed care. 07/2014; 20(7):577-586.
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    ABSTRACT: Background: Increasingly sedentary lifestyles and dietary changes associated with economic development in China, combined with progress in the treatment of infectious disease have resulted in a shift in the disease burden - the so-called epidemiological transition. Cardiovascular disease (CVD), including coronary heart disease (CHD) and other non-communicable diseases now play an increasingly important role in the disease burden faced by China. However, little is known about the future burden of CHD morbidity and mortality, as well as the cost-effectiveness of particular CHD-prevention policies in China. Objectives: To estimate the impact of aging and epidemiological transition on the burden of CHD morbidity and mortality over the next 15 years in China and to estimate the net value of effective lipid management. Methods: First, we estimate the prevalence of CHD and other risk factors based on the China Health and Nutrition Survey. Next, using prediction from the literature regarding trends in demographic and cardiovascular risk factors, such as elevated low-density lipoprotein cholesterol (LDL-C), we model how CHD risk will evolve between 2015 and 2030. We then estimate how expanded use of statins for lipid management over the next 15 years would alter the prevalence of elevated LDL-C as a risk factor, and determine how this would dampen the future growth in CHD burden. Accounting for the costs of statin use, we assess the net value of a policy that expands statin utilization for lipid management in China. Results: We find that - left unchecked - rising prevalence of CHD risk factors and the aging of the Chinese population will lead to the incidence of heart attacks rising from 4 million in 2015 to over 6 million in 2030. Similarly, the number of CHD deaths will rise from 1.3 million in 2015 to over 2 million in 2030. Treating all hyperlipidemia patients with statins would avert 10.5 million heart attacks and 3.5 million CHD deaths between 2015 and 2030. Based on current estimates of treatment costs in China and the cost of statins, we predict that such a policy would produce a net social value of $176 to $226 billion over the next 15 years. Conclusions: In light of its aging population and continued economic development, China faces near-certain increases in the incidence of CHD morbidity and mortality. Preventative measures such as effective lipid management may reduce the CVD burden substantially and also provide large social value to the society. At a time when the Chinese government is taking steps towards a more systematic approach to health care delivery, primary and secondary prevention of CVD should be high on the agenda.
    Circulation Cardiovascular Quality and Outcomes 06/2014; 7:A227-A. · 5.66 Impact Factor
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    ABSTRACT: Medical professional liability (MPL) remains a significant burden for physicians, in general, and cardiologists, in particular, as recent research has shown that average MPL defense costs are higher in cardiology than other specialties. Knowledge of the clinical characteristics and outcomes of lawsuits against cardiologists may improve quality of care and risk management. We analyzed closed MPL claims of 40,916 physicians and 781 cardiologists insured by a large nationwide insurer for ≥1 policy year between 1991 and 2005. The annual percentage of cardiologists facing an MPL claim was 8.6%, compared with 7.4% among physicians overall (P < .01). Among 530 claims, 72 (13.6%) resulted in an indemnity payment, with a median size of $164,988. Mean defense costs for claims resulting in payment were $83,593 (standard deviation (s.d.) $72,901). The time required to close MPL claims was longer for claims with indemnity payment than claims without (29.6 versus 18.9 months; P < .001). More than half of all claims involved a patient's death (304; 57.4%), were based on inpatient care (379; 71.5%), or involved a primary cardiovascular condition (416; 78.4%). Acute coronary syndrome was the most frequent condition (234; 44.2%). Medical professional liability claims involving noncardiovascular conditions were common (66; 12.5%) and included falls or mechanical injuries had while under a cardiologist's care and a failure to diagnose cancer. Rates of malpractice lawsuits are higher among cardiologists than physicians overall. A substantial portion of claims are noncardiovascular in nature.
    American heart journal 05/2014; 167(5):690-6. · 4.65 Impact Factor
  • Robert Kaestner, Michael Darden, Darius Lakdawalla
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    ABSTRACT: We obtain estimates of associations between statin use and health behaviors. Statin use is associated with a small increase in BMI and moderate (20-33%) increases in the probability of being obese. Statin use was also associated with a significant (e.g., 15% of mean) increase in moderate alcohol use among men. There was no consistent evidence of a decrease in smoking associated with statin use, and exercise worsened somewhat for females. Statin use was associated with increased physical activity among males. Finally, there was evidence that statin use increased the use of blood pressure medication and aspirin for both males and females, although estimates varied considerably in magnitude. These results are consistent with the hypothesis that healthy diet is a strong substitute for statins, but there is only uneven evidence for the hypothesis that investments in disease prevention are complementary.
    Journal of Health Economics 04/2014; 36C:151-163. · 1.60 Impact Factor
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    ABSTRACT: Objectives: To measure the impact of state Medicaid formulary policies on costs for patients with schizophrenia and bipolar disorder. Study Design: Retrospective analysis of medical and pharmacy claims for patients diagnosed with schizophrenia or bipolar disorder in 24 state Medicaid programs. Methods: We combined information on formulary restrictions in Medicaid with the medical and pharmacy claims of 117,908 patients with schizophrenia and 170,596 patients with bipolar disorder in Medicaid who were single-eligible, and newly prescribed a second-generation antipsychotic from 2001 to 2008. We tested the impact of formulary restrictions on the medical costs and utilization of patients in the 12 months after the index prescription. To capture social costs in addition to medical expenditures in Medicaid, we estimated the incremental costs of incarcerating patients with schizophrenia and bipolar disorder associated with formulary restrictions. Results: Patients with schizophrenia subject to formulary restrictions were more likely to be hospitalized (odds ratio 1.13, P <.001), had 23% higher inpatient costs (P <.001), and 16% higher total costs (P <.001). Similar effects were observed for patients with bipolar disorder. Our estimates suggest restrictive formulary policies in Medicaid increased the number of prisoners by 9920 and incarceration costs by $362 million nationwide in 2008. Conclusions: Applying formulary restrictions to atypical antipsychotics is associated with higher total medical expenditures for patients with schizophrenia and bipolar disorder in Medicaid. Combined with the other social costs such as an increase in incarceration rates, these formulary restrictions could increase state costs by $1 billion annually, enough to offset any savings in pharmacy costs.
    The American journal of managed care 01/2014; 20(2):e52-60. · 2.12 Impact Factor
  • Darius N Lakdawalla, Anupam B Jena, Jason N Doctor
    JAMA The Journal of the American Medical Association 01/2014; 311(1):25-6. · 29.98 Impact Factor
  • Darius Lakdawalla, Neeraj Sood, Qian Gu
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    ABSTRACT: We explore how and to what extent prescription drug insurance expansions affect incentives for pharmaceutical advertising. When insurance expansions make markets more profitable, firms respond by boosting advertising. Theory suggests this effect will be magnified in the least competitive drug classes, where firms internalize a larger share of the benefits from advertising. Empirically, we find that the implementation of Part D coincides with a 14-19% increase in total advertising expenditures. This effect is indeed concentrated in the least competitive drug classes. The additional advertising raised utilization among non-elderly patients outside the Part D program by about 3.6%. This is roughly half of the direct utilization effect of Part D on elderly beneficiaries. The results suggest the presence of considerable spillover effects from publicly subsidized prescription drug insurance on the utilization and welfare of consumers outside the program.
    Journal of Health Economics 12/2013; 32(6):1356-67. · 1.60 Impact Factor
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    ABSTRACT: Purpose: To assess the effect of oral nutrition supplements (ONS) on 30-day readmission rates, length of stay (LOS), and episode costs in hospitalized Medicare patients, aged 65 and over, with diagnoses affected by new Medicare reimbursement rules under the Affordable Care Act (ACA): acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia (PNA). Methods: Analyses were conducted using the Premier Perspectives Database over an eleven-year period (2000-2010) on Medicare patients aged 65+ and carrying a diagnosis of AMI, CHF, or PNA. One-to-one matched samples of ONS and non-ONS episodes were created using propensity score matching, producing samples of 20,870, 38,418, and 47,477 AMI, CHF, and PNA episodes, respectively. To eliminate bias from confounding, instrumental variables (IV) regression analysis was performed to quantify the effect of ONS on the probability of 30-day readmission, as well as on LOS and episode cost. For comparison, analyses were also conducted on elderly Medicare patients with any primary diagnosis, with a 1:1 matched sample of 667,684 episodes. Results: Use of ONS decreased the probability of 30-day readmission, LOS, and episode costs among hospitalized aged 65+ Medicare patients. Most notably, ONS use was associated with a statistically significant (p<0.01) reduction in the probability of readmission within 30 days of 12% for AMI episodes and 10.1% for CHF episodes. The effect on LOS and episode cost was greatest for the comparison population (all primary diagnoses), with decreases of 16.0% and 15.8% (p<0.01), respectively. Table: Percent change in outcome due to oral nutritional supplements Population 30-Day Readmission Probability Length of Stay Episode Cost 65+ Medicare patients with acute myocardial infarction -12.0%** -10.9%** -5.1%* 65+ Medicare patients with congestive heart failure -10.1%** -14.2%** -7.8%** 65+ Medicare patients with pneumonia -5.2% -8.5%** -10.6%** All 65+ Medicare patients -8.4%** -16.0%** -15.8%** Note: * indicates significance at the 5% level; ** indicates significance at the 1% level. Conclusions: In the aged 65+ Medicare patient population with AMI and CHF, ONS improves 30-day readmission, LOS, and episode cost outcomes. This also holds true for all aged 65+ Medicare patients. Among patients with PNA, ONS improves LOS and episode cost outcomes. ONS use in hospitalized Medicare patients aged 65+ may present an inexpensive, evidence-based solution for hospitals seeking to meet the quality targets established by the ACA.
    The 35th Annual Meeting of the Society for Medical Decision Making; 10/2013
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    ABSTRACT: To evaluate the risk from different insulin types on severe hypoglycaemia (SHG) events requiring inpatient (IP) or emergency department (ED) care in patients with type 2 diabetes. Type 2 diabetes patients newly started on insulin in a large commercial claims database were evaluated for SHG events. Patients were classified into an insulin group based on their most frequently used insulin type. Multivariable Cox models assessed the association between insulin type and the risk of SHG events. We identified 8626 patients (mean age 53.5 years; 55% female) with type 2 diabetes followed for an average of 4.0 years after insulin initiation. Of these, 161 (1.9%) had a SHG event at an average of 3.1y after insulin initiation. Patients with SHG events were slightly older (56.4 vs. 53.4 years), used a similar number of OADs (1.1 vs. 1.2) but had more co-morbidities compared with those without SHG events. In multivariate Cox models, premixed insulin (HR 2.12; p<0.01), isophane insulin (NPH) (HR 2.02; p<0.01), and rapid acting insulin (HR 2.75; p<0.01) had significantly higher risks of SHG events compared with glargine. No statistically significant difference in SHG events was seen with detemir (HR 1.20; p=0.73). Among patients with type 2 diabetes, the use of newer basal insulin analogues was associated with lower rates of SHG events requiring IP or ED care compared with users of other insulin formulations. Future research should examine the impact of hypoglycaemia events of different severity levels.
    Diabetes research and clinical practice 10/2013; · 2.74 Impact Factor
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    ABSTRACT: Limited data exist on the burden and relationship of cardiovascular (CV) hospitalization to mortality after newly diagnosed with atrial fibrillation (AF). Using a 20% sample of nationwide Medicare Part A and B claims data, we performed a retrospective cohort study of Medicare beneficiaries with newly diagnosed AF (2004-2008). Cox proportional hazards time-varying exposures were used to determine the risk of death among patients with CV hospitalization after AF diagnosis. Of 228,295 patients (mean age 79.6 ± 7.4 years, 56% female), 57% had a CV hospitalization after diagnosis of AF (41% in the first year). The most common primary CV hospitalization diagnoses were AF/supraventricular arrhythmias (21%), heart failure (19%), myocardial infarction (11%), and stroke/transient ischemic attack (7.7%). Incidence rates per 1,000 person-years among patients with and without CV hospitalization were 114 and 87, respectively, for all-cause mortality. After adjustment for covariates and time to CV hospitalization, the hazard of mortality among newly diagnosed AF patients with CV hospitalization, compared with those without CV hospitalization, was higher (hazard ratio 1.22, 95% CI 1.20-1.24). Cardiovascular hospitalization is common in the first year after AF diagnosis. Atrial fibrillation, heart failure, myocardial infarction, and stroke/transient ischemic attack account for half of primary hospitalization diagnosis. Cardiovascular hospitalization is independently associated with mortality, irrespective of time from diagnosis to first hospitalization, and represents a critical inflection point in survival trajectory. These findings highlight the importance of CV hospitalization as a marker of disease progression and poor outcomes. Efforts to clarify the determinants of hospitalization could inform interventions to reduce admissions and improve survival.
    American heart journal 09/2013; 166(3):573-80. · 4.65 Impact Factor
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    ABSTRACT: Aim: To assess, through a systematic review, evidence for the effects of antiarrhythmic drugs (AADs) on cardiovascular (CV) hospitalization and mortality. Materials & methods: English language articles were identified using MEDLINE, EMBASE and the Cochrane Clinical Trial Registry and were screened for study applicability and methodological quality. Results: Out of 3526 identified studies, 38 were selected for analysis (19 evaluated individual AADs, 13 compared rate- versus rhythm-control strategies, and 6 evaluated multiple AADs but did not report outcomes for individual agents). None of the studies examining individual AADs employed the CV hospitalization end point used in ATHENA (the reference trial). There were no head-to-head comparisons of individual AADs on CV hospitalization. Most high-quality studies used multidrug rate- versus rhythm-control strategies. Conclusion: Assessment of the comparative effectiveness of individual AADs on CV hospitalization and mortality end points is not possible with the current evidence.
    Journal of comparative effectiveness research. 05/2013; 2(3):301-12.
  • Value in Health 05/2013; 16(3):A173-4. · 2.19 Impact Factor
  • The American journal of managed care 02/2013; 19(2):93-6. · 2.12 Impact Factor
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    ABSTRACT: Objectives: To assess the effect of inpatient oral nutritional supplement (ONS) use on length of stay, episode cost, and 30-day readmission probability. Study Design: Eleven-year retrospective study (2000 to 2010). Methods: Analyses were conducted using the Premier Perspectives Database, which contained information on 44.0 million adult inpatient episodes. Using a matched sample of ONS and non-ONS episodes for any inpatient diagnosis, instrumental variables regression analysis was performed to quantify the effect of ONS use on length of stay, episode cost, and probability of approximate 30-day readmission. For the readmission outcome, the matched sample was restricted to episodes where the patient was known to be at risk of readmission. The fraction of a hospital's episodes in a given quarter involving ONS was used as an instrumental variable. Results: Within the database, 1.6% of 44.0 million adult inpatient episodes involved ONS use. Based on a matched sample of 1.2 million episodes, ONS patients had a shorter length of stay by 2.3 days (95% confidence interval [CI] - 2.42 to -2.16), from 10.9 to 8.6 days (21.0% decline), and decreased episode cost of $4734 (95% CI - $4754 to - $4714), from $21,950 to $17,216 (21.6% decline). Restricting the matched sample to the 862,960 episodes where patients were readmitted at some point, ONS patients had a reduced probability of early readmission (within 30 days) of 2.3 percentage points (95% CI - 0.027 to - 0.019), from 34.3% to 32.0% (6.7% decline). Conclusions: Use of ONS decreases length of stay, episode cost, and 30-day readmission risk in the inpatient population.
    The American journal of managed care 02/2013; 19(2):121-8. · 2.12 Impact Factor

Publication Stats

1k Citations
333.57 Total Impact Points

Institutions

  • 2006–2014
    • University of Southern California
      • Schaeffer Center for Health Policy and Economics
      Los Angeles, California, United States
    • University of Chicago
      • Department of Economics
      Chicago, Illinois, United States
  • 2013
    • Stanford Medicine
      Stanford, California, United States
    • Precision Health Economics
      San Francisco, California, United States
  • 2012
    • University of Illinois at Chicago
      Chicago, Illinois, United States
  • 1999–2012
    • The National Bureau of Economic Research
      Cambridge, Massachusetts, United States
  • 1998–2012
    • RAND Corporation
      Santa Monica, California, United States
  • 2011
    • Université du Québec à Montréal
      Montréal, Quebec, Canada
  • 2009
    • Santa Monica College
      Santa Monica, California, United States
    • Mathematica Policy Research
      Princeton, New Jersey, United States
  • 2004–2008
    • Stanford University
      • Department of Medicine
      Stanford, CA, United States
    • Federal Reserve Bank of New York
      New York City, New York, United States
    • Brooks Rand
      Seattle, Washington, United States
  • 2003
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States