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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. Source


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%. Source


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. Source


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. Source


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. Source

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