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Ankara, Turkey

Oztaner S.M.,Central Bank of Turkey | Temizel T.T.,Middle East Technical University | Remzi Erdem S.,Baskent University | Ozer M.,Scientific and Technological Research Council of Turkey
IEEE Journal of Biomedical and Health Informatics

The incorporation of pharmacogenomics information into the drug dosing estimation formulations has been shown to increase the accuracy in drug dosing and decrease the frequency of adverse drug effects in many studies in the literature. In this paper, an estimation framework based on the Bayesian structural equation modeling, which is driven by pharmacogenomics, is proposed. The results show that the model compares favorably with the linear models in terms of prediction and explaining the variations in warfarin dosing. © 2013 IEEE. Source

Ozorhan M.O.,Central Bank of Turkey | Cicekli N.K.,Middle East Technical University
Computer and Information Sciences II - 26th International Symposium on Computer and Information Sciences, ISCIS 2011

This paper discusses automated methods to achieve web service advertisement and discovery, and presents efficient search and matching techniques based on OWL-S. The service discovery and matchmaking is performed via a centralized peer-to-peer web service repository. The repository has the ability to run on a software cloud, which improves the availability and scalability of the service discovery. An OWL-S based unified ontology - Suggested Upper Merged Ontology - is used in web service annotation. User-agents generate query specification using the system ontology, to provide semantic unification between the client and the system during service discovery. Query matching is performed via complex Hilbert Spaces composed of conceptual planes and categorical similarities for each web service. © 2012 Springer-Verlag London Limited. Source

Baser O.,University of Michigan | Baser O.,STATinMED Research | Burkan A.,Social Security Institution | Baser E.,Central Bank of Turkey | And 3 more authors.
International Journal of Rheumatology

Objectives. To explore health care costs associated with ankylosing spondylitis (AS) in Turkey. Methods. Research-identified data from a system that processes claims for all Turkish health insurance funds were analyzed. Adult prevalent and incident AS patients with two AS visits at least 60 days apart, identified between June 1, 2010 and December 31, 2010, with at least 1 year of continuous health plan enrollment for the baseline and follow-up years were included in the study. Pharmacy, outpatient, and inpatient claims were compiled over the study period for the selected patients. Generalized linear models were used to estimate the expected annual costs, controlling for baseline demographic and clinical characteristics. Results. A total of 2.986 patients were identified, of which 603 were incident cases and 2.383 prevalent cases. The mean ages were 39 and 41 years, respectively, and 44% and 38% were women for incident and prevalent cases. Prevalent patients had higher comorbidity scores (5.01 versus 2.24, P < 0.001) and were more likely to be prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) (77% versus 72%, P < 0.001) or biologics (35% versus 8%, P < 0.006) relative to incident patients. Seventy-seven percent of prevalent patients were prescribed NSAIDs, followed by biologic and disease-modifying antirheumatic drugs (DMARDs). Total annual medical costs for incident AS patients were 2.253 and 4.233 for prevalent patients. Pharmacy costs accounted for a significant portion of total costs (88% for prevalent patient, 77% for incident patient), followed by physician office visit costs. Prior comorbidities and treatment type also significantly contributed to overall costs. Conclusion. Annual expenditures for AS patients in Turkey were comparable relative to European countries. Pharmaceutical expenditures cover a significant portion of the overall costs. Comparative effectiveness studies are necessary to further decrease health care costs of AS treatment. © 2013 Onur Baser et al. Source

Baser O.,University of Michigan | Baser O.,STATinMED Research | Burkan A.,Social Security Institution | Baser E.,Central Bank of Turkey | And 3 more authors.
Health Policy

Objective: Encourage quality improvements and assess high expenditures for patients with coronary artery bypass graft (CABG) surgery and hospital quality in Turkey. Methods: Using the Turkish National Health Insurance Database (2009-2011), CABG surgery patients were identified using International Classification of Diseases Tenth Revision Clinical Modification codes. High-cost cardiac surgery patients had annual healthcare costs in the top 20% post-surgery. The empirical Bayes approach was used to combine mortality rates with hospital volume for quality index, weighing observed mortality according to estimation reliability, with the remaining weight placed on hospital volume. The relationship between hospital quality and high-cost payments was assessed using chi-square tests. Results: Total annual healthcare payments for 20,126 identified CABG patients were approximately €70 million. High-cost patients incurred 31% of the total expenditures. Although disease severity did not differ for patients across hospitals, those in the lowest quartile, in terms of quality, cared for 25% of high-costs surgery patients, compared with only 18% in the highest quality hospitals (p<0.0001) €4M in associated cost savings was calculated for patients shifting from low- to high-quality hospitals. Conclusions: Results imply that hospital quality improvements can reduce costs and improve morbidity and mortality rates in Turkey. © 2012 Elsevier Ireland Ltd. Source

Baser O.,University of Michigan | Baser O.,STATinMED Research | Burkan A.,Social Security Institution | Baser E.,Central Bank of Turkey | And 3 more authors.
Rheumatology International

This study aimed to estimate and identify determinants of direct medical costs associated with rheumatoid arthritis (RA) in Turkey using nationwide real-world data. Using the Turkish National Health Insurance Database (2009-2011), RA patients (ages 18-99) were identified using International Classification of Disease Tenth Revision Clinical Modification (ICD-10-CM) codes. Patients were required to have two RA diagnoses at least 60 days apart and were grouped as prevalent and incident cases. The date of the first RA claim was identified for each patient and designated as the index date. Total healthcare costs were examined over the 12-month period following the index date. Descriptive and multivariate analyses are provided. Generalized linear models were used to calculate expected annual costs for incident and prevalent RA patients after controlling for age, gender, region, comorbid conditions and medication. A total of 2,613 patients met all inclusion criteria (693 incident; 1,920 prevalent patients). Prevalent patients were older, less likely to reside in the Marmara region, had higher comorbidity index scores and were more likely to use non-steroidal anti-inflammatory drugs, biologics and disease-modifying anti-rheumatic drugs relative to incident patients. Average direct annual costs were €2,000 [(€1,750, €2,247) 95 % CI] for incident cases and €2,385 [(€2,224, €2,545) 95 % CI] for prevalent cases, most due to pharmacy costs (73 % for incident cases, 60 % for prevalent cases). For incident and prevalent cases, a significant portion of inpatient and outpatient costs were due to physician costs (31 % for incident cases, 40 % for prevalent cases). Although the costs were not significantly different in terms of age or region, prior comorbid conditions and medication use significantly affected the cost estimation. RA total annual costs were found to be lower in Turkey, relative to estimates in Europe. The significant portion of the annual costs was due to pharmaceutical expenditures. Comparative effectiveness analysis may be useful to decrease RA-related pharmacy costs. © 2013 Springer-Verlag Berlin Heidelberg. Source

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