Publications (9)20.21 Total impact
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Article: Comorbid conditions in patients with erectile dysfunction in a community setting.
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ABSTRACT: The objective of this study was to assess the prevalence of chronic comorbidities and the use of concomitant medications in men diagnosed with erectile dysfunction (ED) in a community setting, using a large integrated database. All patients who experienced an episode of ED during a two-month period were identified from the database. Comorbid conditions were determined through outpatient management claims and prescription claims for concomitant conditions were also assessed during the study period.Managed care interface 01/2002; 14(12):36-8, 42. -
Article: A descriptive analysis of the use and cost of new-generation antihistamines in the treatment of allergic rhinitis: a retrospective database analysis.
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ABSTRACT: This retrospective database analysis was conducted to evaluate the use and cost of new-generation antihistamines (i.e., those that are nonsedating) in the treatment of allergic rhinitis in a managed care population. The study is a retrospective database review of medical and pharmacy-related claims linked by episodes of care. Patients who had been diagnosed as having allergic rhinitis and had at least 1 prescription claim were identified from a database containing patient-level medical and pharmacy-related claims. The treatment patterns of patients with allergic rhinitis who met the study criteria were documented for a 12-month period in which the use of nonsedating antihistamines was described and the associated costs of various medications were assessed. Subanalyses of patients categorized by comorbidity status were also performed. A total of 202,426 patients participated in the study. Nonsedating antihistamines were used by 71% of the patients; the most commonly prescribed drugs were loratadine and fexofenadine. The mean annual charges per patient for the treatment of allergic rhinitis in the study population were $465.21 (standard deviation [SD], 548). The greatest departmental cost was that of pharmacy-related charges (mean, $236.02; SD, 233); the next highest cost was that of outpatient charges (mean, $216.31; SD, 396). Comparisons of departmental charges indicated the use of loratadine was associated with significantly higher treatment costs than that of fexofenadine in a number of patient subgroups. In this analysis, loratadine was associated with significantly higher treatment charges than was fexofenadine. This result was observed consistently across different stratifications of patients, including the presence of comorbid respiratory infection, concomitant use of nasal steroids, and the presence of asthma and/or sinusitis. These results provided useful insights into the differential costs associated with the use of nonsedating antihistamines in the treatment of rhinitis.The American journal of managed care 06/2001; 7(4 Suppl):S103-12. · 2.46 Impact Factor -
Article: Cost associated with the treatment of influenza in a managed care setting.
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ABSTRACT: The purpose of this study was to assess the costs and treatments associated with influenza patients with and without secondary viral or bacterial infections in a managed care setting. Patients with influenza diagnoses (ICD-9 = 487) were identified in the PharMetrics database between January 1, 1997 and June 30, 1998. Patients were placed into 3 cohorts: influenza only (INF), influenza plus a secondary bacterial respiratory infection (BRI), and influenza plus a secondary viral respiratory infection (VRI). The index date was defined as the date of the first occurrence of an influenza diagnosis during the study period. Medical claims were assessed from the index date to the end of the influenza episode, which was defined as the date of the last claim for influenza followed by a 90-day "clean period" during which no influenza-related charges occurred. A total of 18,000 patients met the inclusion criteria. The mean age was 29 years, and 54% were female. Approximately 93% of patients were placed in the INF cohort, and 3% each in the BRI and VRI groups. The BRI cohort had the highest mean total cost ($5593* SD = 10,939), compared with the VRI cohort ($847 SD = 1782) and INF cohort ($602 SD = 2813) (P less than.0001 vs INF; P less than.0001 vs VRI). This total cost disparity was primarily driven by differences in inpatient costs: BRI ($3509, SD = 9474); VRI ($208, SD = 1327); INF ($138, SD = 2145). Patients in the BRI cohort averaged 0.5 hospitalizations per patient vs 0.06 in the VRI cohort and 0.03 in the INF cohort. Subjects in the BRI cohort were significantly more costly and had an increased risk of hospitalization as compared with subjects in the VRI or INF cohorts. Early intervention with antiviral agents and/or antibiotics, where appropriate, could result in significant cost savings for managed care organizations.MedGenMed: Medscape general medicine 11/2000; 2(4):E34. -
Article: Rates of hospitalization for asthma by insurance status.
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ABSTRACT: To compare utilization of emergency department (ED) and inpatient resources for asthmatics across insurance types. Retrospective cohort analysis consisting of patients over 18 years of age admitted to the ED of 27 hospitals located throughout the United States for asthma between October 1, 1996 and September 30, 1997. 2738 patients were identified who met all inclusion/exclusion criteria. Approximately 25% of the sample had traditional indemnity insurance, 22% were managed care enrollees, 35% were enrolled in Medicaid or Medicare, and 18% were self-pay. Cost of treatment varied by insurance type in the ED and for inpatient asthma care: Medicare patients tended to have higher ED costs than all other insurance types, while indemnity patients had higher costs than Medicaid and Medicare patients. No significant differences were observed between managed care or indemnity patients for ED or inpatient costs; however, indemnity patients were less likely to be hospitalized for asthma subsequent to visiting the ED than managed care patients (OR: 0.40, 95% CI: 0.31-0.52). Significant differences in types and costs of care were observed across differing insurance types, which may suggest an "insurance effect" on asthma-related treatment in the ED and/or hospital.MedGenMed: Medscape general medicine 02/2000; 2(1):E5. -
Article: The effect of fluticasone propionate on functional status and sleep in children with asthma and on the quality of life of their parents.
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ABSTRACT: Although in the past drug interventions were measured primarily on the basis of their efficacy and safety, today we are increasingly interested in what impact treatments have on the patient's day-to-day activities and quality of life. We sought to assess the effect of treatment with fluticasone propionate (FP) on functional status and sleep disturbances in children with asthma and to evaluate possible changes in the quality of life of the parents of these children after treatment. As part of a randomized, double-blind, parallel-group, placebo-controlled, multicenter study on the effects of FP powder (50 or 100 microg twice daily) on growth in children aged 4 to 11 years with mild-to-moderate asthma (n = 325), parents/caregivers completed the following questionnaires at baseline and at weeks 24 and 52 of treatment: Functional Status IIR (FSII), Sleep Scale-Children (SLP-C), and Quality of Life of Parents of Asthmatic Children (QOL-PAC). Change from baseline to weeks 24 and 52 within each treatment group was analyzed by using paired t-tests, and differences between treatment groups were analyzed by using analysis of covariance. Mean FSII and SLP-C scores improved significantly over baseline values with either 50 or 100 microg FP at weeks 24 and 52 (p < 0.05) and were significantly better than scores in the placebo group (p < 0.05). In contrast, FSII scores at week 52 and SLP-C scores at weeks 24 and 52 decreased significantly in the placebo group (p < 0.05). QOL-PAC results revealed that scores on the Burden scale were significantly improved in both FP groups at weeks 24 and 52. Subjective Norms and Social scales improved significantly only in the 100 microg FP group at week 52. The results of this study show that FP (either 50 or 100 microg twice a day) was associated with significant improvements in functional status and decreased sleep disturbances in children with asthma. In addition, treatment of children with FP was associated with a decreased burden on the parents of these children with asthma.Journal of Allergy and Clinical Immunology 07/1998; 102(1):19-23. · 11.00 Impact Factor -
Article: Importance of selected inhaler characteristics and acceptance of a new breath-actuated powder inhalation device.
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ABSTRACT: The degree of patient comfort and satisfaction with an inhaler can have an important effect on compliance with asthma treatment and, hence, therapeutic success. The objective of this study was to assess, from the patient's perspective, the importance of various inhaler characteristics and then evaluate patient satisfaction with a new breath-actuated powder inhaler (Diskhaler) based on those characteristics. Self-administered patient satisfaction questionnaires were completed as part of a randomized, double-blind, placebo-controlled study of fluticasone propionate powder in the treatment of asthma. At baseline, patients rated the importance of five inhaler characteristics (convenient to carry, durability, easy to load, easy to hold and operate, and easy to clean). Following exposure to the Diskhaler over a period of 8 weeks, patients rated the inhaler on those same characteristics. They also rated their comfort using the inhaler and their overall satisfaction with the inhaler. Data were available from 274 patients, the majority of whom expressed a high or very high level of satisfaction with the Diskhaler on each of the five characteristics. These ratings were congruent with their ratings of the importance of those same characteristics; 80-90% rated "convenient to carry," "durability," "easy to load," and "easy to hold and operate" as important or very important characteristics for an inhaler, while "easy to clean" was considered somewhat less important, with 63% rating this characteristic as important or very important. Following the initial exposure to the Diskhaler, 67% of patients were comfortable or very comfortable with the inhaler; that percentage increased to 79% after 8 weeks of use. Following 2 and 8 weeks of use, 61 and 62%, respectively, were satisfied or very satisfied with the Diskhaler. In general, satisfaction ratings were not affected by treatment, indicating that patients were evaluating only the inhaler and not the efficacy of the study drug they received. This study helped to identify which selected inhaler characteristics are most important to patients with asthma. The Diskhaler inhaler performed well on those characteristics deemed important to the patients. From their first exposure to the Diskhaler, patients were comfortable using the device, and this overall acceptance of the inhaler was maintained throughout the study.Journal of Asthma 02/1997; 34(3):249-53. · 1.52 Impact Factor -
Article: Patient satisfaction with the Diskhaler and the Diskus inhaler, a new multidose power delivery system for the treatment of asthma.
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ABSTRACT: To evaluate patient satisfaction with two breath-actuated powder inhalers (Diskhaler and Diskus), investigators asked patients to complete questionnaires as part of a randomized, double-masked, double-dummy, placebo-controlled study of fluticasone propionate powder (500 mg twice daily) in the treatment of chronic persistent asthma. At baseline, patients rated the importance of various inhaler attributes (i.e., ease of use, ease of loading with medication, ease of holding and operating, ease of cleaning, and ease of telling how many doses of medication are left). After 2 weeks of placebo and 6 and 12 weeks of active therapy, patients rated the inhalers on these same attributes. They also rated their general satisfaction with the inhalers and how comfortable they were using them. After 12 weeks, patients also rated the durability and convenience of carrying each device and were asked to indicate which they preferred. Data were available from 213 patients. All seven inhaler attributes measured were considered important by the majority of patients (71% to 91%), contributing to the validity of the patient-rated performance assessments. After 12 weeks of use, 57% to 88% of patients expressed a high level of satisfaction with the performance of the Diskhaler on all attributes; a high level of overall satisfaction (72%) and comfort (79%) was reported with this inhaler. Patients rated the performance of the Diskus inhaler very favorably, with 76% to 96% expressing a high level of satisfaction on all attributes; a high level of overall satisfaction (87%) and comfort (85%) was reported with this inhaler. At end point, 61.4% preferred the Diskus inhaler, 25.4% preferred the Diskhaler inhaler, and 13.2% expressed no preference. These breath-actuated powder inhalers may be acceptable alternatives to traditional metered-dose inhalers for the treatment of patients with asthma.Clinical Therapeutics 19(5):1126-34. · 2.32 Impact Factor -
Article: A cost comparison of beta 2-agonist bronchodilators is not a cost-effectiveness comparison.
Pharmacotherapy 16(3):484-5; discussion 486-7. · 2.90 Impact Factor -
Article: A075: Amlodipine VS angiotensin converting enzyme inhibitors or angiotensin recepter blockers in hypertension in the elderly
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2002
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Pfizer Inc.
New York City, NY, USA
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