[Show abstract][Hide abstract] ABSTRACT: For most gout patients, excruciatingly painful gout attacks are the major clinical burden of the disease. The goal of this study was to assess the association of frequent gout flares with healthcare burden, and to quantify how much lower gout-related costs and resource use are for those with infrequent flares compared to frequent gout flares.
Retrospective cohort study.
Administrative claims data from a large US health plan.
Patients aged 18 years or above, and with evidence of gout based on medical and pharmacy claims between January 2009 and April 2012 were eligible for inclusion. Patient characteristics were assessed during a 12-month baseline period.
Frequency of gout flares, healthcare costs and resource utilisation were assessed in the 12 months following the first qualifying gout claim. Generalised linear models were employed to assess the impact of flare frequency on cost outcomes after adjusting for covariates.
102 703 patients with gout met study inclusion criteria; 89 201 had 0-1 gout flares, 9714 had 2 flares, and 3788 had 3+ flares. Average counts of gout-related inpatient stays, emergency room visits and ambulatory visits were higher among patients with 2 or 3+ flares, compared to those with 0-1 flares (all p<0.001). Adjusted annual gout-related costs were $1804, $3014 and $4363 in those with 0-1, 2 and 3+ gout flares, respectively (p<0.001 comparing 0-1 flares to 2 or 3+ flares).
Gout-related costs and resource use were lower for those with infrequent flares, suggesting significant cost benefit to a gout management plan that has a goal of reducing flare frequency.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
BMJ Open 06/2015; 5(6):e007214. DOI:10.1136/bmjopen-2014-007214 · 2.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction:
Adherence to diabetes medication has been linked to improved glycemic levels and lower costs, but previous research on adherence has typically involved oral antidiabetic medication or insulin. This study examines how adherence and persistence to once-daily liraglutide impact glycemic control and economic outcomes in a real-world population of adult type 2 diabetes (T2D) patients.
A retrospective cohort study using administrative claims data from July 2009 through September 2013. Patients aged ≥18 years with T2D treated with liraglutide were identified (index date = first liraglutide prescription). Adherence was based on the proportion of days covered (PDC); with PDC ≥0.80 classified as adherent. Non-persistent patients were those with a gap in therapy of >90 days. Lab results for glycated hemoglobin (A1C) were used to identify whether patients achieved target levels of <7.0% and ≤ 6.5%, or experienced a reduction of ≥1.0% in A1C from pre-index (baseline) to post-index (follow-up). Logistic regression was used to estimate the likelihood of achieving the A1C goals, adjusted for baseline characteristics. Diabetes-related medical, pharmacy, and total costs were modeled and estimated for the adherence and persistence cohorts.
A total of 1321 patients were identified. The mean PDC was 0.59 and 34% of patients were classified as adherent, while 60% were persistent over 12 months of follow-up. Adherent and persistent patients were more likely to achieve each of the A1C goals than their non-adherent and non-persistent counterparts after adjusting for patient characteristics. Adherence and persistence were associated with higher adjusted diabetes-related pharmacy and total healthcare costs during follow-up; whereas persistent patients had significantly lower diabetes-related medical costs than non-persistent patients.
Adherence and persistence to liraglutide are associated with improved A1C outcomes. Persistent patients showed significantly lower medical costs versus those discontinuing liraglutide. Total healthcare costs were higher for adherent and persistent cohorts driven by higher pharmacy costs.
Advances in Therapy 04/2015; 32(4). DOI:10.1007/s12325-015-0199-z · 2.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
Diabetes accounts for almost 15% of all direct healthcare expenditures. Managed care organizations try to reduce costs and improve patient outcomes. Increasing patient persistence with antidiabetes treatment could help achieve these goals.
Subjects and methods:
A retrospective study was conducted using the Optum Research Database (Optum, Eden Prairie, MN) to analyze clinical and economic outcomes associated with initiation of insulin glargine via a disposable pen (GLA-P) or vial and syringe (GLA-V) among adult, insulin-naive patients with type 2 diabetes mellitus (T2DM). Propensity-matched patient cohorts were assessed for persistence with insulin therapy, glycated hemoglobin (A1C), hypoglycemic events (based on diagnosis codes), and healthcare costs (total paid amount of adjudicated claims) after follow-up at 1 year.
In 1,308 matched patients, persistence was significantly higher (P=0.011) and longer (P=0.001) with GLA-P. Follow-up A1C values were significantly lower (P=0.038), and decreases in A1C from baseline significantly larger (P=0.043), in GLA-P than in GLA-V. Significantly fewer hypoglycemic events (P=0.042) were experienced, and a lower rate of diabetes-related inpatient admissions (P=0.008) was reported in GLA-P than GLA-V. Despite higher study drug costs with GLA-P than GLA-V, all-cause and diabetes-related healthcare costs were similar.
In insulin-naive patients with T2DM, initiation of insulin glargine using the disposable pen rather than the vial and syringe is associated with higher persistence, better A1C control, and lower rates of hypoglycemia. The higher study drug costs associated with pen use do not increase total all-cause or diabetes-related healthcare costs. This may help treatment selection for patients with T2DM in a managed care setting.
[Show abstract][Hide abstract] ABSTRACT: Type 2 diabetes mellitus (T2DM) progression often results in treatment intensification with injectable therapy to maintain glycemic control. Using pilot data from the Initiation of New Injectable Treatment Introduced after Anti-diabetic Therapy with Oral-only Regimens study, real-world treatment patterns among T2DM patients initiating injectable therapy with insulin glargine or liraglutide were assessed.
This was a retrospective analysis of claims from the OptumInsight™ (OI; January 1, 2010 to July 30, 2010) and HealthCore(®) (HC; January 1, 2010 to June 1, 2010) health insurance databases. Baseline characteristics, health care resource utilization, and costs were compared between adults with T2DM initiating injectable therapy with insulin glargine pen versus liraglutide. Follow-up outcomes, including glycated hemoglobin A1c (A1C), hypoglycemia, health care utilization, and costs, were assessed.
At baseline, almost one in three liraglutide patients (OI, n = 363; HC, n = 521) had A1C <7.0%, while insulin glargine patients (OI, n = 498; HC, n = 1,188) had poorer health status, higher A1C (insulin glargine: 9.8% and 9.1% versus liraglutide: 7.9% and 7.7%, OI and HC, respectively, both P < 0.001), and were less likely to be obese (insulin glargine: 10.8% and 9.2% versus liraglutide: 17.4% and 18.8%, OI and HC, respectively, both P < 0.01). The percentage of patients experiencing a hypoglycemic event was numerically higher for insulin pen use for both cohorts (OI 4.4% versus 3.0%; HC 6.2% versus 2.3%). During follow-up, in the insulin glargine cohort, annualized diabetes-related costs remained unchanged ($8,344 versus $7,749 OI, and $7,094 versus $7,731 HC), despite a significant increase in pharmacy costs, due to non-significant decreases in medical costs, while the liraglutide cohort had a significant increase in annualized diabetes-related costs ($4,510 versus $7,731 OI, and $4,136 versus $7,111 HC; both P < 0.001) due to a non-significant increase in medical costs coupled with a significant increase in pharmacy costs.
These descriptive data identified differences in demographic and baseline clinical characteristics among patients initiating injectable therapies. The different health care utilization and cost patterns warrant further cost-effectiveness analysis.
Advances in Therapy 11/2013; 30(12). DOI:10.1007/s12325-013-0074-8 · 2.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background / Purpose:
Patients with type 2 diabetes mellitus (T2DM) uncontrolled on oral antidiabetic drugs (OADs) alone, often progress to treatment with an injectable therapy with insulin or a GLP-1 agonist. The I nitiation of N ew I njectable T reatment I ntroduced after A nti-diabetic T herapy with O ral-only R egimens (INITIATOR) study, is an retrospective observational study of US patients initiating injectable therapy with insulin glargine (GLA-P) or liraglutide (LIRA). The INITIATOR study is focused on investigating treatment patterns and associated outcomes using information from healthcare claims databases.Here, we describe pilot real-world data from two US administrative claims databases on the comparative effectiveness of GLA-P and LIRA, in T2DM patients.
In this study of patients uncontrolled on OADs alone, similar A1C reductions with no statistically significant differences in rates of hypoglycemia were found for patients initiating GLA-P and LIRA. Patients initiating GLA-P were identified as having higher treatment persistence and with a lower treatment cost in comparison to those initiating LIRA.
95th Endocrine Society (ENDO) Annual Meeting 2013; 10/2013
[Show abstract][Hide abstract] ABSTRACT: Patients with nonvalvular atrial fibrillation (NVAF) are at increased risk for stroke and bleeding events, but bleeding as an outcome has not been extensively studied in this patient population.
The goal of this study was to estimate the incidence of bleeding events among patients with NVAF enrolled in managed care, investigate the relationships between bleeding incidence and bleeding and stroke risks, and estimate health care costs for patients who had a major bleeding event.
Adults with commercial insurance or Medicare Advantage coverage and health care claims related to AF between January 2005 and June 2009 but with no evidence of valvular disease were included in this retrospective claims data analysis. Baseline stroke risk (CHADS2 [Congestive Heart Failure, Hypertension, Age >75 Years, Diabetes Mellitus, and Prior Stroke or Transient Ischemic Attack]) and bleeding risk (HAS-BLED [Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile International Normalized Ratios, Elderly, Drugs/Alcohol]) were estimated. Bleeding events were identified during the variable follow-up period, which lasted from the date of the first qualifying AF visit until the earlier of death, disenrollment from the health plan, or June 30, 2010. Bleeding events were classified as major, serious nonmajor, or minor. Health care costs for patients with major bleeding events were calculated.
Among 48,260 patients with NVAF (mean age, 67 years), 34% had an incident bleeding event during a mean (SD) follow-up period of 802 (540) days. Incidence rates for bleeding events of any severity and major events were 29.6 and 10.4 per 100 patient-years, respectively. Bleeding incidence rates increased with greater CHADS2 and HAS-BLED risk scores. All-cause health care costs for patients during a major bleeding event averaged $16,830. Average costs per patient with a major event increased from approximately $52 per day in the prebleeding period to approximately $63 per day in the postbleeding period. Costs for patients who did not experience a major bleeding event averaged approximately $38 per day.
Bleeding incidence among patients with NVAF in a real-world setting was high and increased with greater stroke and bleeding risk scores. Health care costs for patients with major bleeding events were elevated. All rights reserved.
[Show abstract][Hide abstract] ABSTRACT: Stroke prevention is a goal of atrial fibrillation (AF) management, but discontinuation of warfarin anticoagulation therapy is common.
To investigate the association between warfarin discontinuation and hospitalization for stroke among nonvalvular AF (NVAF) patients enrolled in managed care.
Patients with NVAF who initiated warfarin therapy from January 2005 through June 2009 were included. Warfarin discontinuation was defined as a supply gap >60 days without evidence of International Normalized Ratio measurements. Follow-up, which was a variable time period from warfarin initiation until the earlier of death, disenrollment from the health plan, or June 30, 2010, was divided into periods of warfarin treatment and discontinuation. Stroke events were identified based on claims for inpatient stays with a primary diagnosis of stroke or transient ischemic attack. Cox proportional hazards models were constructed to assess the relationship between warfarin discontinuation and incident stroke while adjusting for baseline demographics, stroke and bleeding risk, and comorbidities, as well as time-dependent antiplatelet use, stroke, and bleeding events in the previous warfarin treatment period.
Among warfarin initiators with NVAF (N = 16,253), 51.4% discontinued warfarin therapy at least once during a mean follow-up of 668 days. Stroke risk was significantly greater during warfarin discontinuation periods compared with therapy periods (hazard ratio = 1.60; 95% CI, 1.35-1.90; P < 0.001).
More than half of patients on warfarin had treatment gaps or discontinued therapy. Therapy gaps were associated with increased stroke risk.
[Show abstract][Hide abstract] ABSTRACT: To compare outcomes of type 2 diabetes mellitus (T2DM) patients initiating therapy with FDC vs. those with loose-dose combination (LDC) or step therapy (ST) in a managed care population.
A retrospective claims database analysis.
Treatment-naive T2DM patients who were continuously enrolled in a health plan during 2006-2009 were studied. Eligible patients were assigned to FDC, LDC, or ST cohorts. Glycated hemoglobin goal attainment (HbA1c < 7%) was assessed using the American Diabetes Association (ADA) treatment guidelines. Health care resources use and costs, including inpatient, emergency room (ER), and ambulatoryvisits, were measured during the 12 months after therapy initiation. All-cause and diabetes-related use and costs were assessed.
21,048 patients met study criteria (FDC n = 8,416, ST n = 8,407, LDC n = 4,225), and 1,926 of these patients had HbA1c results. FDC patients had lower rates of post-index all-cause inpatient stays and ER visits compared with the other cohorts. FDC patients had lower average counts of diabetes-related ambulatory visits (2.7) compared with ST (3.7; p < 0.001) and LDC (3.2; p < 0.001) and significantly lower average post-index all-cause and diabetes-related costs compared with the other cohorts, with average all-cause costs for FDC, ST, and LDC of $8,445, $10,515, and $9,688, respectively, and diabe-tes-related costs of $1,641, $2,099, and $1,900, respectively. FDC patients had higher rates of achieving HbA1c goal (61%) compared to ST (48%; p < 0.001) or LDC (52%; p = 0.015). Differences in outcomes remained following multivariate analyses.
Treatment with FDC was associated with lower health care resources use and costs and better likelihood of HbA1c goal attainment.
Managed care (Langhorne, Pa.) 07/2012; 21(7):40-8.
[Show abstract][Hide abstract] ABSTRACT: There are 10 million patients with angina in the United States (500,000 new diagnoses annually). Although clinical efficacy of angina treatments is understood, total costs of care and clinical outcomes for patients with chronic angina in different treatment protocols are unknown.
Our objective was to estimate total costs of care and revascularization rates for patients with poorly controlled angina who added either (1) long-acting nitrates, (2) beta blockers or calcium channel blockers, or (3) ranolazine to their therapy.
We performed retrospective claims analysis using an index event involving change of therapy in which a new antiangina drug was added.
Using a large commercial insurance claims database, 4545 patients with angina with an index event (ie, change of antiangina therapy) and 6 months of continuous enrollment pre- and postindex event were identified. Using total cost of care and revascularization rates, we first compared preindex disease burden, medical care use, and total cost of care and components of total cost. We then compared unadjusted use and cost of care across treatment groups. Finally, we estimated regression models to predict postindex event total costs of care and revascularization rates.
During the preindex period, the 3 comparison groups had similar health measures, medical care use, and total costs of care. During the postindex period, ranolazine users had lower revascularization rates (9.9%) than comparison patient groups (15.4%-20.4%, both Ps < 0.001). Ranolazine users had lower total costs of care ($13,961) than the nitrate group ($18,166, 30.0% higher; P < 0.001) and the beta blockers/calcium channel blockers group ($17,612, 26.6% higher; P = 0.002).
Adding ranolazine to the treatment regimen of patients with poorly controlled angina was associated with lower rates of revascularization and lower total costs of care than for comparable patients, differences both statistically and clinically relevant.
[Show abstract][Hide abstract] 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
[Show abstract][Hide abstract] ABSTRACT: Angina is often a first symptom of coronary artery disease (CAD); however, the specific burden of illness for patients with CAD-associated angina in managed care has not been reported.
American Health and Drug Benefits 09/2011; 4(6):353-61.
[Show abstract][Hide abstract] ABSTRACT: Respiratory syncytial virus (RSV) lower respiratory tract infection (LRI) in early life has been associated with sustained airway hyperreactivity during childhood; however, corresponding data in premature infants are sparse.
The objective of this study was to determine whether RSV-LRI during early infancy of preterm infants was associated with an increased risk for serious early childhood wheezing (SECW) by age 3 years.
A retrospective cohort study was conducted using data from a large (∼14 million members) US health plan database. The study population included infants ≤ 6 months of age born at ≤ 36 weeks' gestational age or weighing <2500 g, or both. Preterm infants with any medically attended RSV-LRI from May 2001 through April 2004 with 3 years of continuous eligibility were selected and propensity matched with ≤ 3 control infants. SECW was defined as >3 office, outpatient, or emergency department (ED) visits with asthma or wheezing; ≥ 1 office, outpatient, or ED visit with asthma or wheezing plus treatment with systemic corticosteroids within 7 days; ≥ 1 inpatient stay with asthma or wheezing; or ≥ 150 days' supply of asthma-control medications. The presence of SECW between ages 2 and 3 years was compared between infants with and without RSV-LRI using univariate and multivariate methods. Health care costs for patients with SECW were explored.
A total of 378 infants with RSV were matched to 606 controls. The prevalence of SECW between ages 2 and 3 years was 16.7% in the RSV-LRI group versus 8.6% in the control group (P < 0.001). Logistic regression showed that preterm infants with RSV in early life were 2.52-fold (95% CI,1.65-3.85) more likely to present with SECW between ages 2 and 3 years (P < 0.001). Patients with SECW had a mean SECW-related cost of US $1378 (95% CI, $939-$1816) and total health care cost of $7138 (95% CI, $5087-$9189) compared with $37 (95% CI, $24-$51) and $2521 (95% CI, $1789-$3253), respectively, for patients without SECW. After adjusting for possible confounders, patients with SECW had a significantly higher total health care cost than did patients without evidence of SECW (P < 0.001).
The development of RSV-LRI in infancy in preterm infants was associated with an increased prevalence of SECW between ages 2 and 3 years. Patients with SECW had higher total health care costs than those who did not have SECW.