Howard Lee

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

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Publications (3)5.73 Total impact

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    ABSTRACT: Anemia is one of the most common hematologic complications of cancer and cytotoxic treatment. The economic burden associated with anemia in patients with malignancy has not yet been extensively studied. Patients receiving chemotherapy within 6 months of initial cancer diagnosis were identified in a database of commercial health-care service claims and encounters. Patients with anemia were identified through a coded diagnosis of anemia, transfusion, or erythropoietin treatment. Exponential conditional mean models and a decomposition analysis were used to analyze mean 6-month health-care expenditures. Twenty-six percent (26%) of 2760 cancer patients with recently diagnosed invasive cancer treated with chemotherapy had anemia. Mean (SD) 6-month unadjusted total expenditures were 62,499 dollars (78,016 dollars) for anemic patients and 36,871 dollars (52,308 dollars) for nonanemic patients (P < 0.0001), with inpatient services representing the largest cost differential between the groups. The adjusted mean 6-month expenditure for the average anemic patient receiving chemotherapy was 57,209 dollars. If anemic patients had the same average health status as nonanemic patients, their predicted 6-month expenditures would have been 19% lower (46,237 dollars). Alternatively, if anemic patients had the same expenditure structure or parameter estimates as nonanemic patients, their predicted expenditures would have been 51% lower (27,847 dollars). Thus, for any given health status, treating a patient who is anemic is associated with considerably higher expenditures. Anemia among cancer patients receiving chemotherapy is associated with a substantial burden in terms of direct medical costs. Implications for the treatment of anemia are suggested by this research and should be confirmed in prospective studies.
    Full-text · Article · Mar 2005 · Value in Health
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    ABSTRACT: Cancer-related anaemia is associated with fatigue that adversely affects patients' everyday functioning and wellbeing. We explore the impact of fatigue on patient productivity and caregiver burden. The analyses are based on data from a randomised, open-label, active-controlled, dose-finding trial of darbepoetin alfa among solid-tumour cancer patients with anaemia, who are receiving chemotherapy. Fatigue is assessed with the Functional Assessment of Cancer Therapy (FACT)-Fatigue subscale score. Productivity and caregiver outcomes include time (hours) missed from usual activities, amount of assistance (hours) needed from others, overall ability to perform desired activities and ability to perform family responsibilities. These outcomes are assessed at baseline and the end of the 12-week treatment period. ANOVA and linear regression models are used to evaluate associations. Patients (n=300) were aged 61 years on average, with a mean (SD) baseline haemoglobin of 9.9 (0.9) g/dL. FACT-Fatigue subscale score improvements were significantly (p=0.003) associated with haemoglobin improvements. Over a 2-week period, after controlling for age, sex and disease progression, one-point improvements in FACT-Fatigue subscale scores corresponded to a 1-hour (95% CI 0.5, 1.5) gain in productive time, 0.7-hour (95% CI 0.4, 1.0) reduction in caregiver time and 1.6% (95% CI 1.4, 1.7) improvement in overall activity. Reducing fatigue is associated with gains in productive time, reductions in caregiver burden and enhanced ability to perform activities. These outcomes may have broader implications for patients' wellbeing and for the societal impact of cancer-related fatigue and anaemia.
    No preview · Article · Feb 2005 · PharmacoEconomics
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    ABSTRACT: Background Quality of life may be affected by daily injections of supportive hematopoietic growth factor medication, which is frequently required by patients with cancer undergoing chemotherapy. The objective of the study was to identify areas where long-acting derivatives of current proteins, which require less frequent administration, may provide advantages over existing therapies that require more frequent administration. Methods An observational study was conducted to assess the impact of daily injections of Filgrastim (Neupogen®; Amgen Inc.) on patients' quality of life. A Subject Outcome Questionnaire was administered to patients after chemotherapy on 2 consecutive cycles. Time spent for treatment and patient attitude towards injection frequency were measured. The effect on patients' daily activities, including their ability to work, was analyzed. Results Thirty patients completed the first, and 24 the second, administration of the Questionnaire across 3 participating sites in the United States. The average patient time commitment for each daily injection was 78 minutes. Forty-five percent of patients were moderately to extremely bothered by travel during the first chemotherapy cycle, which increased to 59% during the second cycle. Forty-four percent and 18% of patients reported having to rearrange their daily schedules and take time off from work to accommodate each injection at least some of the time, respectively. Eighty-nine percent of the patients reported a preference for a longer-acting drug that required fewer injections. Conclusion Results indicate that frequent injections represent a significant burden on patients' lives and that the majority would prefer longer-acting medications that require less frequent administration and potentially fewer clinic visits.
    Full-text · Article · Oct 2003 · BMC Nursing

Publication Stats

102 Citations
5.73 Total Impact Points

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  • 2003-2005
    • University of California, Los Angeles
      • • Department of Medicine
      • • Division of Hematology and Medical Oncology
      Los Angeles, California, United States