Abstract:
OBJECTIVE:To assess predictors and costs of multiple sclerosis (MS) relapse, a potential outcome measure in payer-manufacturer risk-sharing agreements for disease-modifying drugs (DMDs). METHODS:A retrospective cohort analysis of medical/pharmacy claims was used. Study patients had ≥1 DMD (interferon beta, glatiramer, natalizumab) claim, without DMD claims in a 6-month pre-period before DMD initiation; were aged 18-64 years and continuously enrolled from the pre-period through a 24-month post-period; and had ≥2 MS medical claims during the 30-month study period. Post-period relapse cohorts included: (1) severe (hospitalization with MS diagnosis); (2) moderate (outpatient services including intravenous methylprednisolone); and (3) none. Poisson regression modeled severe relapse frequency, logistic regression modeled ≥1 severe relapse, and generalized linear modeling predicted healthcare costs. Tested predictors included demographics, insurance type, index DMD, pre-period health status, and DMD medication possession ratio (MPR). RESULTS:Severe relapse was experienced by 14.5% and moderate relapse by 13.8% of 2291 patients. In logistic regression, severe relapse was predicted by plan type; age (odds ratio [OR] = 1.018, 95% confidence interval [CI] = 1.005-1.031); pre-period Charlson Comorbidity Index (OR = 1.307, 95% CI = 1.166-1.464); pre-period proxy measure indicating impaired activities of daily living (OR = 1.470, 95% CI = 1.134-1.905); pre-period MS hospitalization (OR = 2.174, 95% CI = 1.537-3.074); and DMD non-adherence (MPR OR = 0.101, 95% CI = 0.068-0.151). Poisson regression results were similar. Predicted mean [standard deviation] all-cause healthcare expenditures were tripled for patients with severe compared with moderate relapse ($48,173 [$8665] and $13,334 [$1929], respectively). LIMITATIONS:Commercially insured patients from a single payer; use may have been inconsistent with approved indications; proxy relapse measure may have misclassified patients. CONCLUSIONS:Severe MS relapses requiring hospitalization, although affecting less than 15% of patients initiating DMD treatment, are associated with high medical costs. The only actionable predictor of severe relapse identified in observational analysis was MPR, raising questions about the feasibility of using observational data to guide outcomes-based contracting.
journal_name
J Med Econjournal_title
Journal of medical economicsauthors
Lage MJ,Carroll CA,Fairman KAdoi
10.3111/13696998.2013.823868subject
Has Abstractpub_date
2013-09-01 00:00:00pages
1146-53issue
9eissn
1369-6998issn
1941-837Xjournal_volume
16pub_type
杂志文章abstract:OBJECTIVE:Duloxetine is indicated for treatment of major depressive disorders in the UK. While clinical trials have documented its clinical effectiveness, little is known regarding the relationship between duloxetine use and healthcare utilization in community practice. This study quantifies the impact of treatment wit...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.3111/13696998.2012.672941
更新日期:2012-01-01 00:00:00
abstract:OBJECTIVES:Two anti-cancer drugs are currently approved for the treatment of HER2-positive metastatic breast cancer (MBC): trastuzumab-based therapy (TBT) administered intravenously as first line therapy until disease progression and lapatinib, an oral self-administered dual therapy with capecitabine (L+C) as second in...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.3111/13696998.2012.729549
更新日期:2013-01-01 00:00:00
abstract::Aims: Allopurinol is the most common urate lowering therapy (ULT) used to treat gout but may cause life-threatening severe cutaneous adverse reactions (SCAR) in a small number of patients. Risk of SCAR is increased for patients with the HLA-B*58:01 genotype. When alternative ULT is required, febuxostat or probenecid a...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.1080/13696998.2020.1757456
更新日期:2020-08-01 00:00:00
abstract:BACKGROUND:Until recently, standard treatment of venous thromboembolism (VTE) concerned a combination of short-term low-molecular-weight heparin (LMWH) and long-term vitamin-K antagonist (VKA). Risk of bleeding and the requirement for regular anticoagulation monitoring are, however, limiting their use. Rivaroxaban is a...
journal_title:Journal of medical economics
pub_type: 杂志文章,随机对照试验
doi:10.1080/13696998.2017.1331912
更新日期:2017-08-01 00:00:00
abstract:OBJECTIVE:This study evaluated infection-related hospitalization risk and cost in tumor necrosis factor inhibitor (TNFi)-experienced and targeted DMARD (tDMARD) naïve rheumatoid arthritis (RA) patients that were treated with abatacept, TNFi, or other non-TNFi. METHODS:This retrospective study used 100% Medicare Fee-fo...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.1080/13696998.2021.1881525
更新日期:2021-01-27 00:00:00
abstract:AIM:This analysis assessed the direct medical costs of newly-diagnosed, temozolomide (TMZ)-treated glioblastoma (GBM) from the perspective of a US commercial setting. MATERIALS AND METHODS:The analysis included subjects identified from the IMS PharMetrics LifeLink Plus™ claims database from January 1, 2008 to August 3...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.1080/13696998.2017.1364258
更新日期:2017-12-01 00:00:00
abstract:INTRODUCTION:Switching drugs from prescription to non-prescription status (Rx-to-OTC) presents a unique set of challenges and opportunities to policy-makers and the industry in terms of managing health outcomes, pharmaceutical spending, and steering of consumer choices of therapy. Decision-analytic models are used to a...
journal_title:Journal of medical economics
pub_type: 杂志文章,评审
doi:10.3111/13696998.2013.793693
更新日期:2013-01-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to evaluate medication adherence and persistence of patients treated with Etanercept and Adalimumab for Rheumatoid Arthritis, also giving economic evaluations on therapy costs for Received Daily Dose (RDD). MATERIALS AND METHODS:This retrospective study took into account 6 years fro...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.3111/13696998.2014.902844
更新日期:2014-05-01 00:00:00
abstract::Background: Adults admitted to hospital with community-acquired pneumonia (CAP) impose significant burden upon limited hospital resources. To achieve early response and possibly early discharge, thus reducing hospital expenditure, the choice of initial antibiotic therapy is pivotal.Methods: A cost-consequences model w...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.1080/13696998.2019.1688819
更新日期:2020-02-01 00:00:00
abstract::Objectives: Aging populations are contributing to an increased volume of osteoporotic fractures. The goals of this study were to (1) develop a scorecard on epidemiological burden, policy framework, service provision, and service uptake for osteoporosis in Saudi Arabia and (2) estimate the direct costs of managing oste...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.1080/13696998.2020.1737536
更新日期:2020-07-01 00:00:00
abstract:OBJECTIVE:To estimate the cost-effectiveness of ipilimumab (3 mg/kg) compared with best supportive care (BSC) in pre-treated advanced melanoma patients. METHODS:The analysis was based on a US payer perspective and lifetime time horizon. A three-state Markov model was developed representing clinical outcomes, quality-o...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.3111/13696998.2012.739226
更新日期:2013-01-01 00:00:00
abstract::Background: IVF is now a wide spread procedure globally, and currently 65 countries report annually all or part of their IVF/ICSI cycles, from which the International Committee Monitoring progress in Assisted Reproduction Technology (ICMART) published its report. There is considerable variation in the utilization (num...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.1080/13696998.2019.1609484
更新日期:2019-09-01 00:00:00
abstract:OBJECTIVES:To assess the costs of severe hypoglycaemic events (SHEs) in diabetes patients in Germany, Spain and the UK. METHODS:Healthcare resource use was measured by surveying 639 patients aged ≥ 16 years, receiving insulin for type 1 (n=319) or type 2 diabetes (n=320), who experienced ≥ 1 SHE in the preceding year....
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.3111/13696990903336597
更新日期:2009-01-01 00:00:00
abstract:AIMS:In this pharmacoeconomic simulation, we: (1) modeled the cost-efficiency of converting patients from reference pegfilgrastim to biosimilar pegfilgrastim-cbqv for prophylaxis of chemotherapy-induced (febrile) neutropenia (CIN/FN) from the US payer perspective, (2) simulated how savings enable, on a budget-neutral b...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.1080/13696998.2020.1833339
更新日期:2020-10-24 00:00:00
abstract:OBJECTIVE:To estimate the economic implications of introducing dabigatran etexilate ('dabigatran') for anti-coagulation therapy in Danish patients with non-valvular atrial fibrillation based on results of the RE-LY trial. METHODS:The lifetime cost and outcomes of dabigatran and warfarin were estimated using a previous...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.3111/13696998.2012.673525
更新日期:2012-01-01 00:00:00
abstract:AIMS:Six Delta is a six-dimensional independent platform for outcome-based pricing/contracting. The six dimensions have been described separately: (δ1) cost-effectiveness analysis and cost-utility analysis-based pricing; (δ2) willingness-to-pay-based pricing; (δ3) reference-based pricing; (δ4) safety-based pricing; (δ5...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.1080/13696998.2020.1815031
更新日期:2020-11-01 00:00:00
abstract:BACKGROUND:In the last decade, the number of new agents, including monoclonal antibodies, being developed to treat metastatic colorectal cancer (mCRC) increased rapidly. While improving outcomes, these new treatments also have distinct and known safety profiles with toxicities that may require hospitalizations. However...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.3111/13696998.2011.610394
更新日期:2011-01-01 00:00:00
abstract:OBJECTIVE:To construct a value-based healthcare system for rural Chinese hypertensive patients through an increasing outpatient care reimbursement ratio. METHODS:This comparative study sampled two similar counties, Dangyang County and Zhijiang County, in Hubei Province of China, as the intervention group and the contr...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.1080/13696998.2018.1558864
更新日期:2019-03-01 00:00:00
abstract::Aims: To assess rates of surgical treatment, post-surgical complications, reoperations, and reimbursement in patients with clavicle fractures and acromioclavicular (AC) dislocations. Materials and methods: This US retrospective study used data from patients with ≥1 diagnosis of clavicle fracture or AC dislocation (ind...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.1080/13696998.2019.1620245
更新日期:2019-09-01 00:00:00
abstract:OBJECTIVE:Iso-osmolar Iodixanol is associated with a lower rate of contrast-induced acute kidney injury (CI-AKI) in patients at increased risk compared to low-osmolar contrast media (LOCM). The aim of this study was to assess the financial consequences of CI-AKI risk reduction in patients undergoing coronary angiograph...
journal_title:Journal of medical economics
pub_type: 杂志文章,meta分析,评审
doi:10.3111/13696998.2015.1105809
更新日期:2016-01-01 00:00:00
abstract:AIMS:Improvements in information technology have granted the recent development of rapid, cloud-enabled, onsite laboratory testing for rheumatoid arthritis (RA). This study aims to quantify the value to payers of such technologies. MATERIALS AND METHODS:To calculate the value of rapid, cloud-enabled, onsite laboratory...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.1080/13696998.2018.1502191
更新日期:2018-11-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to analyse hospital incidence of osteogenesis imperfecta (OI) in Spanish hospitals and the associated medical costs from a healthcare system perspective. METHODS:To this aim, a retrospective multicentre study was designed analysing admission records from patients admitted with...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.1080/13696998.2020.1834402
更新日期:2020-10-21 00:00:00
abstract:OBJECTIVE:Compare long-term costs and outcomes of lurasidone to aripiprazole among adults with schizophrenia in the US who previously failed ≥1 atypical antipsychotic (olanzapine, risperidone, quetiapine, or ziprasidone) based on an indirect comparison of outcomes data from clinical trials. METHODS:A 5-year Markov coh...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.3111/13696998.2013.807813
更新日期:2013-07-01 00:00:00
abstract:OBJECTIVES:The purpose of this study is to report on long-term treatment patterns in a back pain population and to consider whether these may be considered as reflective of under-treatment of pain or poor pain control. METHODS:Data are from a commissioned recontact SELECT survey of persons who had previously reported ...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.3111/13696998.2013.777346
更新日期:2013-01-01 00:00:00
abstract:AIMS:Tuberous sclerosis complex (TSC) is a multi-organ autosomal-dominant, genetic disorder with incomplete penetrance. The multiple manifestations of TSC and impacts to numerous organ systems represent significant disease, healthcare, and treatment burden. The economic and employment burden of the disease on individua...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.1080/13696998.2018.1487447
更新日期:2018-10-01 00:00:00
abstract:OBJECTIVE:To characterize patient and physician satisfaction with current standard-of-care botulinum toxin treatment regimens for symptom control in patients with post-stroke spasticity using structured interviews with patients and physicians. RESEARCH DESIGN AND METHODS:Two cross-sectional surveys were conducted in C...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.3111/13696998.2014.925462
更新日期:2014-09-01 00:00:00
abstract::Aims: To evaluate costs in patients with diabetes who experienced a macrovascular complication from a Brazilian public healthcare system perspective.Materials and methods: A retrospective, observational study that utilized the database of the Brazilian Unified Health System (DATASUS). Data for direct medical costs (ho...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.1080/13696998.2020.1764966
更新日期:2020-09-01 00:00:00
abstract:OBJECTIVE:To describe costs, healthcare resource utilization, and adherence of US patients receiving human regular U-500 insulin (U-500R), compared to patients receiving high-dose (>200 units/day) U-100 insulins (U-100) by subcutaneous injection for the treatment of diabetes. METHODS:A retrospective analysis of data f...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.3111/13696998.2013.772059
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND:Efficient use of government funding has been increasingly relevant for the success and sustainability of ongoing health-system reform in China; however, as there is no generic substitution policy, patients and basic health-insurance programs pay more for public-preferred brand originators. Such phenomenon is...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.1080/13696998.2016.1181641
更新日期:2016-09-01 00:00:00
abstract:PURPOSE:The purpose of this study was to describe the health-related quality-of-life (QoL) in patients after elective surgery for abdominal aortic aneurysm (AAA) compared to a normal population and to study the association between QoL and number of years since surgery. METHODS:All Danish men who underwent elective sur...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.3111/13696998.2011.626822
更新日期:2011-01-01 00:00:00