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Ivanova J.I.,Analysis Group Inc. | Bergman R.,Analysis Group Inc. | Birnbaum H.G.,Analysis Group Inc. | Colice G.L.,Washington Hospital Center | And 2 more authors.
Journal of Allergy and Clinical Immunology | Year: 2012

Background: Health care costs increase in patients with more severe asthma, but the effect of asthma exacerbations on costs among patients with more severe asthma has not been quantified. Objective: This study compared direct health care costs between patients with moderate/severe persistent asthma with and without exacerbations. Methods: Patients who had an asthma diagnosis (International Classification of Diseases-ninth revision-Clinical Modification code 493.x), were 12 to 64 years old, and were receiving controller therapy were identified from a large administrative claims database. Patients were categorized as having moderate/severe persistent asthma and were further evaluated for exacerbations during a 12-month exacerbation identification period. Patients with 1 or more exacerbations (asthma-related inpatient or emergency department visit or corticosteroid prescription) were matched to patients without exacerbations on demographic characteristics and asthma severity. Total and asthma-related health care costs during the 1-year study period after the exacerbation index date were calculated. Results: Patients with exacerbations had significantly higher total health care costs ($9223 vs $5011, P <.0001) and asthma-related costs ($1740 vs $847, P <.0001). The cost differences remained significant after controlling for patient differences by using multivariate models. Patients with exacerbations (n = 3830) had higher rates of sinusitis, allergy-related diagnoses or medications, pneumonia, and mental disorders and higher average Charlson Comorbidity Index scores at baseline. Patients with exacerbations filled their prescriptions for controllers more often and had higher asthma-related drug costs. Conclusions: Patients with moderate/severe persistent asthma who had exacerbations had higher total and asthma-related health care costs than those without exacerbations. Moreover, controller medication use was higher in patients with exacerbations. © 2011 American Academy of Allergy, Asthma & Immunology.


Switzer J.A.,University of Georgia | Demaerschalk B.M.,Mayo Medical School | Xie J.,Analysis Group Inc. | Fan L.,Analysis Group Inc. | And 3 more authors.
Circulation: Cardiovascular Quality and Outcomes | Year: 2013

Background-A hub-and-spoke telestroke network is an effective way to extend quality acute stroke care to remote hospitals and to improve patient outcomes. This study assessed the cost-effectiveness of a telestroke network in the management of acute ischemic stroke from the perspectives of a network, a hub hospital, and a spoke hospital. Methods and Results-A model was developed to compare costs and effectiveness with and without a telestroke network over a 5-year time horizon. The model considered differences in rates of teleconsultations, intravenous thrombolysis, endovascular stroke therapies, and spoke-to-hub transfers. These inputs were estimated through the use of data from Georgia Health Sciences University and Mayo Clinic telestroke networks. A network model with 1 hub and 7 spokes predicted that 45 more patients would be treated with intravenous thrombolysis and 20 more with endovascular stroke therapies per year compared with no network, leading to an estimate of 6.11 more home discharges. Each year, a telestroke network was associated with 358 435 in cost savings; each spoke had 109 080 in cost savings, whereas the hub had positive costs of 405 121. However, cost sharing can be arranged so that each hospital could achieve an equal amount of cost savings (44 804/y). Results were sensitive to the number of spokes, marginal treatment costs in spokes and rates of transfer, and endovascular stroke therapies. Conclusions-The results of this study suggest that a telestroke network may increase the number of patients discharged home and reduce the costs borne by the network hospitals. Hospitals should consider their available resources and the network features when deciding whether to join or set up a network. © 2013 American Heart Association, Inc.


Hyperglycemia in hospitalized patients is associated with adverse outcomes; treatment of hyperglycemia in the hospital improves outcomes. We investigated clinical outcomes and hospital readmissions associated with insulin continuation and discontinuation post-discharge in patients with type 2 diabetes mellitus (T2DM) who initiated insulin therapy during hospitalization. This observational retrospective database analysis was performed using medical records obtained from a US coordinated health system. Patients with T2DM, glycated hemoglobin (HbA1c) levels ≥ 8.0%, naïve to insulin, and initiating insulin during hospitalization were included. Clinical outcomes and hospital readmissions were compared between patients who continued and discontinued insulin post-discharge. Of 732 patients initiating insulin during hospitalization, 180 (24.6%) continued and 552 (75.4%) discontinued insulin. Higher mean baseline HbA1c levels were observed in patients continuing insulin compared with those discontinuing insulin (11.1% vs 9.5%; P < 0.001). A significantly higher percentage of patients continuing insulin achieved target HbA1c levels (< 7.0%) compared with those discontinuing insulin (P = 0.023), with no difference in hypoglycemia rates. In patients with a baseline HbA1c of ≥ 9.0%, insulin continuation was significantly associated with lower risks of all-cause (adjusted hazard ratio, 0.58; 95% CI, 0.36-0.93; P = 0.0276) and diabetes-related (adjusted hazard ratio, 0.46; 95% CI, 0.23-0.87; P = 0.0204) hospital readmissions. Continuation of insulin post-discharge in insulin-naïve patients with T2DM is associated with better HbA1c target level achievement, no difference in hypoglycemia rates, and a reduced risk of hospital readmission in patients with baseline HbA1c levels ≥ 9.0%.


To estimate the budget impact of everolimus as the first and second treatment option after letrozole or anastrozole (L/A) failure for post-menopausal women with hormone receptor positive (HR+), human epidermal growth factor receptor-2 negative (HER2-) advanced breast cancer (ABC). Pharmacy and medical budget impacts (2011 USD) were estimated over the first year of everolimus use in HR+, HER2- ABC from a US payer perspective. Epidemiology data were used to estimate target population size. Pre-everolimus entry treatment options included exemestane, fulvestrant, and tamoxifen. Pre- and post-everolimus entry market shares were estimated based on market research and assumptions. Drug costs were based on wholesale acquisition cost. Patients were assumed to be on treatment until progression or death. Annual medical costs were calculated as the average of pre- and post-progression medical costs weighted by the time in each period, adjusted for survival. One-way and two-way sensitivity analyses were conducted to assess the model robustness. In a hypothetical 1,000,000 member plan, 72 and 159 patients were expected to be candidates for everolimus treatment as first and second treatment option, respectively, after L/A failure. The total budget impact for the first year post-everolimus entry was $0.044 per member per month [PMPM] (pharmacy budget: $0.058 PMPM; medical budget: -$0.014 PMPM), assuming 10% of the target population would receive everolimus. The total budget impacts for the first and second treatment options after L/A failure were $0.014 PMPM (pharmacy budget: $0.018; medical budget: -$0.004) and $0.030 PMPM (pharmacy budget: $0.040; medical budget: -$0.010), respectively. Results remained robust in sensitivity analyses. Assumptions about some model input parameters were necessary and may impact results. Increased pharmacy costs for HR+, HER2- ABC following everolimus entry are expected to be partially offset by reduced medical service costs. Pharmacy and total budget increases were modest.


Greenberg P.E.,Analysis Group Inc. | Fournier A.-A.,Analysis Group Inc. | Sisitsky T.,Analysis Group Inc. | Pike C.T.,Analysis Group Inc. | Kessler R.C.,Harvard University
Journal of Clinical Psychiatry | Year: 2015

Background: The economic burden of depression in the United States-including major depressive disorder (MDD), bipolar disorder, and dysthymia-was estimated at $83.1 billion in 2000. We update these findings using recent data, focusing on MDD alone and accounting for comorbid physical and psychiatric disorders. Method: Using national survey (DSM-IV criteria) and administrative claims data (ICD-9 codes), we estimate the incremental economic burden of individuals with MDD as well as the share of these costs attributable to MDD, with attention to any changes that occurred between 2005 and 2010. Results: The incremental economic burden of individuals with MDD increased by 21.5% (from $173.2 billion to $210.5 billion, inflation-adjusted dollars). The composition of these costs remained stable, with approximately 45% attributable to direct costs, 5% to suicide-related costs, and 50% to workplace costs. Only 38% of the total costs were due to MDD itself as opposed to comorbid conditions. Conclusions: Comorbid conditions account for the largest portion of the growing economic burden of MDD. Future research should analyze further these comorbidities as well as the relative importance of factors contributing to that growing burden. These include population growth, increase in MDD prevalence, increase in treatment cost per individual with MDD, changes in employment and treatment rates, as well as changes in the composition and quality of MDD treatment services. © Copyright 2015 Physicians Postgraduate Press, Inc.


Fontaine R.,Analysis Group Inc.
IEEE Transactions on Semiconductor Manufacturing | Year: 2013

Materials integration in semiconductors, wafer fabrication process development, and device packaging have seemingly evolved at an exponential pace over the last decade. While microprocessor and memory chip manufacturers are the leading drivers of innovation, several other technology sectors benefit from the technologies that enable Moore's law scaling. Image sensor manufacturers, in particular, have realized many advancements from the selective use of advanced wafer fabrication and packaging developments. The motivations for the imaging industry to pursue advanced technology generation scaling are comparable to that of the broader semiconductor industry. In addition, image sensor companies seek a reduction of the camera module form factor, an increase in camera resolution, and an increase in pixel array performance. The pixel size of recent camera phone sensors has shrunk to 1.12 $\mu{\rm m}$. This is about half the pixel size of leading edge devices of six years prior, and yet mobile imaging sensors have dramatically increased in performance. Design innovation continues to have an increasing contribution to the performance of leading edge pixels; however, to date, it has been fabrication process development that has substantially enabled the continuous breakthroughs in digital imaging. Current image sensor fabrication process flows mark a significant departure from conventional CMOS logic processes. Beyond silicon foundry processes, digital imaging companies must also concern themselves with the optical systems, packaging solutions, and image processing chips required to integrate their silicon devices with the consumer electronics supply chain. Chipworks, as a supplier of competitive intelligence to the semiconductor and electronics industries, monitors the evolution of image sensor technologies as they come into production. Chipworks has obtained charge-coupled devices and CMOS image sensor chips from leading manufacturers and performed structural, compositional, and design analyses to benchmark the successful technologies employed by the market leaders. © 1988-2012 IEEE.


Gradman A.H.,Temple University | Parise H.,Groupe dAnalyse | Lefebvre P.,Groupe dAnalyse | Falvey H.,Novartis | And 2 more authors.
Hypertension | Year: 2013

This study evaluated the effects of initial versus delayed treatment with a drug combination on blood pressure (BP) control and the risk of cardiovascular (CV) events in hypertensive patients. Clinical trials suggest that the time to BP control is an important determinant of long-term outcomes, but real-world evidence is scarce. Using electronic medical charts (2005-2009), we retrospectively analyzed 1762 adult patients with BP elevation initiating combination therapy matched 1:1 with similar patients initiating monotherapy and later switched to combination therapy. Incidence rate ratios of CV events (myocardial infarction, stroke/transient ischemic attack, or hospitalization for heart failure) or all-cause death and Kaplan-Meier analyses of time to BP control were compared between cohorts. Hazard ratios indicating the effects of initial treatment on CV events and BP control were estimated using time-varying Cox proportional hazard models. Initial combination therapy was associated with a significant reduction in the risk of CV events or death (incidence rate ratio, 0.66 [95% confidence interval, 0.52-0.84]; P=0.0008). After 6 months of therapy, 40.3% and 32.6% of patients with initial versus delayed combination treatment reached BP control, respectively. Achieving target BP was associated with a statistically significant risk reduction of 23% for CV events or death (hazard ratio, 0.77 [95% confidence interval, 0.61-0.96]; P=0.0223); the residual effect of initial combination therapy did not reach statistical significance (hazard ratio, 0.84 [95% confidence interval, 0.68-1.03]; P=0.0935). Initial combination therapy was associated with a significant risk reduction of cardiovascular events. More rapid achievement of target BP was found to be the main contributor to the estimated risk reduction. © 2012 American Heart Association, Inc.


Grabowski H.,Duke University | Long G.,Analysis Group Inc. | Mortimer R.,Analysis Group Inc.
Journal of Medical Economics | Year: 2014

Objective: To provide evidence on recent trends in: (1) market exclusivity periods (MEPs, the time between launch of a brand-name drug and its first generic competitor) for new molecular entities (NMEs); (2) the likelihood and timing of patent challenges under Paragraph IV of the Hatch-Waxman Act; and (3) generic drug penetration. Methods: IMS Health National Sales Perspectives data were used to calculate MEPs for the 257 NMEs experiencing initial generic entry between January 1995 and September 2012 and the number of generic competitors for 12 months afterwards, by level of annual sales prior to generic entry and time period. The likelihood and timing of Paragraph IV challenge were calculated using data from Abbreviated New Drug Approval (ANDA) approval letters, the FDA website, and public information searches to identify drugs experiencing Paragraph IV filings, and the first filing date. Results: For drugs experiencing initial generic entry in 2011-2012, the MEP was 12.6 years for drugs with sales greater than $100 million (in 2008 dollars) in the year prior to generic entry, 12.9 years overall. After generic entry, the brand rapidly lost sales, with average brand unit share of 16% at 1 year; 11% for NMEs with pre-generic entry sales of at least $250 million (in 2008 dollars). Over 80% of NMEs experiencing 2011-2012 initial generic entry had faced at least one Paragraph IV challenge from a generic manufacturer. These challenges were filed relatively early in the brand-name drug life cycle: within 7 years after brand launch, on average. Limitations: Analyses, including Paragraph IV calculations, were restricted to NMEs where generic entry had occurred. Conclusion: Pharmaceutical competition continues to evolve; while the average MEP below 13 years for 2011-2012 remains consistent with prior research, Paragraph IV challenges are increasingly frequent and occur earlier, and generic share erosion has intensified. © 2014 All rights reserved.


Rice J.B.,Analysis Group Inc. | Desai U.,Analysis Group Inc. | Cummings A.K.G.,Analysis Group Inc. | Birnbaum H.G.,Analysis Group Inc. | And 2 more authors.
Diabetes Care | Year: 2014

OBJECTIVE To estimate the annual, per-patient incremental burden of diabetic foot ulcers (DFUs). RESEARCH DESIGN AND METHODS DFU patients and non-DFU patients with diabetes (controls) were selected using two deidentified databases: ages 65+ years froma 5%randomsample ofMedicare beneficiaries (Standard Analytical Files, January 2007-December 2010) and ages 18-64 years from a privately insured population (OptumInsight, January 2007- September 2011). Demographics, comorbidities, resource use, and costs from the payer perspective incurred during the 12 months prior to a DFU episode were identified. DFU patients were matched to controls with similar pre-DFU characteristics using a propensity score methodology. Per-patient incremental clinical outcomes (e.g., amputation and medical resource utilization) and health care costs (2012 U.S. dollars) during the 12-month follow-up period were measured among the matched cohorts. RESULTS Data for 27,878 matched pairs of Medicare and 4,536 matched pairs of privately insured patients were analyzed. During the 12-month follow-up period, DFU patients had more days hospitalized (+138.2% Medicare, +173.5% private), days requiring home health care (+85.4% Medicare, +230.0% private), emergency department visits (+40.6% Medicare, +109.0% private), and outpatient/physician office visits (+35.1% Medicare, +42.5% private) than matched controls. Among matched patients, 3.8% of Medicare and 5.0% of privately insured DFU patients received lower limb amputations. Increased utilization resulted in DFU patients having 11,710 in incremental annual health care costs for Medicare, and 16,883 for private insurance, compared with matched controls. Privately insured matched DFU patients incurred excess work-loss costs of 3,259. CONCLUSIONS These findings document that DFU imposes substantial burden on public and private payers, ranging from 9-13 billion in addition to the costs associated with diabetes itself. © 2014 by the American Diabetes Association.


Rice J.B.,Analysis Group Inc. | White A.G.,Analysis Group Inc. | Birnbaum H.G.,Analysis Group Inc. | Schiller M.,Analysis Group Inc. | And 2 more authors.
Pain Medicine (United States) | Year: 2012

Objective. The objective of this study was to use administrative claims data to identify and analyze patient characteristics and behavior associated with diagnosed opioid abuse. Design. Patients, aged 12-64 years, with at least one prescription opioid claim during 2007-2009 (n=821,916) were selected from a de-identified administrative claims database of privately insured members (n=8,316,665). Patients were divided into two mutually exclusive groups: those diagnosed with opioid abuse during 1999-2009 (n=6,380) and those without a diagnosis for opioid abuse (n= 815,536). A logistic regression model was developed to estimate the association between an opioid abuse diagnosis and patient characteristics, including patient demographics, prescription drug use and filling behavior, comorbidities, medical resource use, and family member characteristics. Sensitivity analyses were conducted on the model's predictive power. Results. In addition to demographic factors associated with abuse (e.g., male gender), the following were identified as "key characteristics" (i.e., odds ratio [OR]>2): prior opioid prescriptions (OR=2.23 for 1-5 prior Rxs; OR=6.85 for 6+ prior Rxs); at least one prior prescription of buprenorphine (OR=51.75) or methadone (OR=2.97); at least one diagnosis of non-opioid drug abuse (OR=9.89), mental illness (OR=2.45), or hepatitis (OR=2.36); and having a family member diagnosed with opioid abuse (OR=3.01). Conclusions. Using medical as well as drug claims data, it is feasible to develop models that could assist payers in identifying patients who exhibit characteristics associated with increased risk for opioid abuse. These models incorporate medical information beyond that available to prescription drug monitoring programs that are reliant on drug claims data and can be an important tool to identify potentially inappropriate opioid use. © Wiley Periodicals, Inc.

Loading Analysis Group Inc. collaborators
Loading Analysis Group Inc. collaborators