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Offord S.,University of America | Lin J.,Novosys Health | Mirski D.,University of America | Wong B.,University of Pennsylvania
Advances in Therapy | Year: 2013

Introduction: To quantify early nonadherence to antipsychotic medications in patients with schizophrenia and its impact on short-term antipsychotic adherence, healthcare utilization, and costs. Methods: Patients who initiated oral antipsychotic treatment between January 1, 2006 to September 30, 2009 were identified from the MarketScan® Commercial Claims and Encounters (CCE) database (Truven Health Analytics, Ann Arbor, Michigan, USA). Patients were required to have a diagnosis of schizophrenia determined by the International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) code 295.x, be 13-65 years of age, and have 12 months of continuous coverage prior to and after (follow-up) the earliest antipsychotic usage (index event). Medication discontinuation was defined as a gap of 30 days in available therapy; early nonadherence was defined as having the gap 90 days from the index event. During the follow-up period, medication adherence was estimated with quarterly medication possession ratios (MPR), and all-cause and schizophreniarelated healthcare resource utilization and costs were determined. Results: The mean time to discontinuation (TTD) was 39.5 ± 20.1 days for early nonadherence patients (n = 873) and 250.7 ± 103.3 days for patients who were adherent early (n = 589). Early nonadherence resulted in more hospitalizations (0.57 vs. 0.38; P = 0.0006) with longer length of stay (LOS, 5.0 vs. 3.0 days; P = 0.0013) and higher costs ($5,850 vs. $4,211; P = 0.0244); schizophrenia-related hospitalizations, LOS, and costs were also greater. Patients that were adherent used more schizophrenia-related medications (10.4 vs. 4.7; P ≤ 0.0001), increasing pharmacy costs ($3,684 vs. $1,549; P ≤ 0.0001). Early nonadherence was correlated with lower drug adherence at each quarter of the follow-up period. Conclusion: Approximately 60% of patients with schizophrenia are nonadherent to antipsychotic medication early in treatment and are less likely to be adherent later. Early nonadherence resulted in more all-cause and schizophreniarelated hospitalizations with a greater LOS and cost of care. © Springer Healthcare 2013.

Higgins P.D.R.,University of Michigan | Skup M.,Abbvie Inc. | Mulani P.M.,Abbvie Inc. | Lin J.,Novosys Health | Chao J.,Abbvie Inc.
Clinical Gastroenterology and Hepatology | Year: 2015

Background and Aims: We investigated whether treatment of active inflammatory bowel disease with biologic agents is associated with a reduced risk of venous thromboembolic events (VTEs) compared with corticosteroid therapy. Methods: We performed a retrospective analysis of 15,100 adults with inflammatory bowel disease who were identified from the Truven Health MarketScan databases. We analyzed data from patients who received 6 months of continuous medical and prescription coverage before and 12 months after their first diagnosis and had no VTE during the 6 months before they first received biologic or corticosteroid therapy. The outcome assessed was any VTE that occurred during the 12-month follow-up period. A multivariate logistic regression model was used to evaluate the effects of biologic, corticosteroid, and combination therapies (biologics and corticosteroids) on VTE risk. Results: Three hundred twenty-five VTEs occurred during the study period (in 2.25% of patients receiving only corticosteroids, in 0.44% of patients receiving biologics, and in 2.49% of patients receiving combination therapy). Compared with patients receiving only corticosteroids, the odds ratio for VTE in patients receiving only biologics was 0.21 (95% confidence interval, 0.05-0.87) in the multivariate model, and the odds ratio for VTE in patients on combination therapy was 1.01. Conclusions: Compared with treatment with only a biologic agent, corticosteroid therapy is associated with a nearly 5-fold increase in risk for VTE. Combination therapy with corticosteroids and biologic agents was associated with the same risk for VTE as that of corticosteroids alone. Corticosteroids therefore appear to increase risk for VTE. © 2015 AGA Institute.

Khorana A.A.,University of Rochester | Dalal M.,Sanofi S.A. | Lin J.,Novosys Health | Connolly G.C.,University of Rochester
Cancer | Year: 2013

Background: Recent studies suggest that thromboprophylaxis is beneficial in preventing venous thromboembolism (VTE) in cancer outpatients, but this is not widely adopted because of incomplete understanding of the contemporary incidence of VTE and concerns about bleeding. Therefore, the authors examined the incidence and predictors of VTE in ambulatory patients with bladder, colorectal, lung, ovary, pancreas, or gastric cancers. Methods: Data were extracted from a large health care claims database of commercially insured patients in the United States between 2004 and 2009. Demographic and clinical characteristics of the cancer cohort (N = 17,284) and an age/sex-matched, noncancer control cohort were evaluated. VTE incidence was recorded during a 3-month to 12-month follow-up period after the initiation of chemotherapy. Multivariate analyses were conducted to identify independent predictors of VTE and bleeding. Results: The mean age of the study population was 64 years, and 51% of patients were women. VTE occurred in 12.6% of the cancer cohort (n = 2170) over 12 months after the initiation of chemotherapy versus 1.4% of controls (n = 237; P <.0001); incidence ranged by cancer type from 19.2% (pancreatic cancer) to 8.2% (bladder cancer). Predictors of VTE included type of cancer, comorbidities (Charlson Comorbidity Index score or obesity), and commonly used specific antineoplastic or supportive care agents (cisplatin, bevacizumab, and erythropoietin). Conclusions: This large, contemporary, real-world analysis confirmed high rates of VTE in select patients with solid tumors and suggested that the incidence of VTE is high in the real-world setting. Awareness of the benefits of targeted thromboprophylaxis may result in a clinically significant reduction in the burden of VTE in this population. Cancer 2013. © 2012 American Cancer Society.

Connolly G.C.,University of Rochester | Dalal M.,Sanofi S.A. | Lin J.,Novosys Health | Khorana A.A.,University of Rochester
Lung Cancer | Year: 2012

Background: The incidence and economic impact of lung cancer-associated venous thromboembolic (VTE) events in a contemporary ambulatory setting is unknown. Patients and methods: We conducted a retrospective cohort analysis utilizing the IMS Patient-Centric database of US healthcare claims and recorded VTE events occurring 3-12 months after chemotherapy initiation. Results: Lung cancer (n= 6732) and control (n= 17 284) cohorts had 51% women, with a mean age of 64 years. VTE occurred in 13.9% of the lung cancer cohort (odds ratio [OR], 3.15; 95% confidence interval [CI] 2.55, 3.89), and 1.4% of the control cohort (P< 0.0001). Charlson Comorbidity Index ≥5 (CCI; OR, 2.56; 95% CI 1.02, 6.39; P= 0.045), the use of erythropoiesis-stimulating agents (ESAs; OR, 1.63; 95% CI 1.40, 1.89; P< 0.0001), and congestive heart failure (CHF; OR, 1.29; 95% CI 1.01, 1.66; P= 0.045) were associated with VTE. Bleeding occurred in 22.1% of the lung cancer cohort and 7.0% of the control cohort (P< 0.0001). Among lung cancer patients the average total healthcare payment was $84,187 in patients with VTE compared to $56,818 in patients without VTE (P< 0.0001). Conclusions: VTE is common among lung cancer patients receiving chemotherapy and is associated with increased healthcare utilization. © 2012 Elsevier Ireland Ltd.

Khorana A.A.,University of Rochester | Dalal M.R.,Sanofi S.A. | Lin J.,Novosys Health | Connolly G.C.,University of Rochester
ClinicoEconomics and Outcomes Research | Year: 2013

Background: This study examines venous thromboembolism (VTE)-associated resource utilization and real-world costs in ambulatory patients initiating chemotherapy for selected common high-risk solid tumors. Methods: Health care claims data (2004-2009) from the IMS/PharMetrics® Patient-Centric database were collected for propensity score-matched adult cancer (lung, colorectal, pancreatic, gastric, bladder, or ovarian) patients initiating chemotherapy with VTE (n = 912) and without VTE (n = 2736). Health care resource utilization (inpatient, outpatient, and outpatient prescription drug claims) and costs were compared between the two cohorts during the 12-month follow-up period after the index VTE event. Incremental costs were adjusted for demographic and clinical covariates. Results: Cancer patients with VTE had approximately three times as many all-cause hospitalizations (mean 1.38 versus 0.55 per patient) and days in hospital (10.19 versus 3.37), and more outpatient claims (331 versus 206) than cancer patients without VTE (all P< 0.0001). Cancer patients with VTE incurred higher overall all-cause inpatient costs (mean USD 21,299 versus USD 7459 per patient), outpatient costs (USD 53,660 versus USD 34,232 per patient), and total health care costs (USD 74,959 versus USD 41,691 per patient) than cancer patients without VTE (all P< 0.0001). Total mean VTE-related health care costs were USD 9247 per patient over 12 months. Adjusted mean incremental all-cause health care costs of VTE were USD 30,538 per patient for cancer overall, ranging from USD 11,946 for gastric to USD 38,983 for pancreatic cancer. Conclusion: VTE is associated with significant inpatient and outpatient resource utilization, and increased all-cause (in addition to VTE-related) health care costs among ambulatory cancer patients. Measures to prevent outpatient cancer-associated VTE may reduce health care utilization and costs in this population. © 2013 Khorana et al, publisher and licensee Dove Medical Press Ltd.

Amin A.N.,University of California at Irvine | Jhaveri M.,Sanofi S.A. | Lin J.,Novosys Health
Advances in Therapy | Year: 2011

Introduction: Atrial fibrillation (AF) and atrial flutter (AFL) patients often have cardiovascular (CV) comorbidities, and have an increased risk of hospitalization and death. Little is known about the real-world cost burden of AF/AFL patients with additional risk factors (ARF). We evaluated the medical resource use and cost burden of AF/AFL patients with >1 ARF (other than heart failure [HF]), in comparison with non-AF/AFL controls. Methods: This retrospective cohort study included patients from the MarketScan Medicare database who had >1 inpatient or >2 outpatient AF/AFL claims. Patients were (1) >75 years of age or (2) 70-74 years of age with >1 ARF (hypertension, diabetes, systemic embolism, or stroke/transient ischemic attack), but without HF. The AF/AFL patients were matched on age, gender, region, and enrollment status with non-AF/AFL patients. Hospital resource use and costs over the 12-month post-index period were compared across cohorts. The impacts of comorbidity were seen by subcategorizing hospitalization as all-cause, CV-related, and AF/AFL-related. Results: AF/AFL patients with >1 ARF had a higher prevalence of comorbidity than non-AF/AFL patients (n=58,555/cohort). Hospitalizations (all-causality) were more than three times more frequent and of longer duration in AF/AFL patients with >1 ARF than in non-AF/AFL controls (mean [SD]: 0.72 [0.87] vs. 0.21 [0.51] hospitalizations per patient per year and 3.85 [9.30] and 1.03 [4.53] days, respectively; both P<0.0001). Overall mean (SD) costs over the 12-month post-index period were higher in AF/AFL patients with >1 ARF versus the non-AF/AFL control patients for inpatient (9613 [25,407] vs. 2625 [11,597]; P<0.0001; incremental cost 6988), outpatient (9447 [15,062] vs. 4906 [11,715]; P<0.0001; incremental cost 4541), and prescription drug costs (3430 [3637] vs. 2618 [3374]; P<0.0001; incremental cost 812). Conclusion: AF/AFL patients with >1 ARF had significantly greater levels of comorbidity, hospitalizations, prescription, and outpatient claims than non-AF/AFL patients. The incremental costs of AF/AFL patients with >1 ARF are largely due to higher CV-related inpatient costs. © 2011 Springer Healthcare.

Amin A.N.,University of California at Irvine | Jhaveri M.,Sanofi S.A. | Lin J.,Novosys Health
Journal of Medical Economics | Year: 2012

Objectives: The ATHENA study showed that use of dronedarone reduced rates of first cardiovascular (CV) hospitalization in atrial fibrillation/flutter (AF/AFL) patients. AF is associated with high costs to payers, which are driven by high rates of hospitalization. This retrospective cohort study examined readmission patterns and costs to US payers in real-world AF/AFL patients with ≥1 additional risk factor (ARF). Methods: Patients hospitalized (January 2005March 2008) with AF/AFL as primary diagnosis and having ≥1 year of health coverage, before and after their first (index) admission, were identified in the PharMetrics Patient-Centric database. As in the ATHENA study, patients had to be ≥75 years of age or ≥70 years, with ≥1 ARF. Rehospitalization patterns (all-cause, all CV-related [including AF/AFL] and AF/AFL-related alone) were examined over 1 year post-index, and costs of index vs later AF/AFL admissions compared. Results: The study included 3498 patients (mean 80 [SD 7.6] years; 42.4% men). Over 1 year, 1389 patients (39.7%) were rehospitalized for any cause (mean 1.7 [SD 1.3] events/patient), with 1223 patients (35.0%) undergoing CV-related (mean 1.6 [SD 1.0] events/patient) and 935 (26.7%) undergoing AF-related rehospitalization (mean 1.4 [SD 0.8] events/patient). Common causes of CV-related readmissions (primary diagnosis) were AF/AFL (47.5%), congestive heart failure (CHF) (9.9%), coronary artery disease (7.4%), and stroke/transient ischemic attack (6.2%). Readmission rates at 3 months were 16.2% (all-cause), 14.3% (all CV-related including AF/AFL), and 10.5% (AF/AFL-related alone). AF/AFL readmissions (primary diagnosis) were longer than initial hospitalizations (mean total 6.9 [SD 12.9] vs 4.3 [SD 5.1] days, p<0.0001) and more costly (median $1819 [25th percentile $1066, 75th percentile $5623] vs $1707 [25th percentile $1102, 75th percentile $4749]). Limitations: This study excluded patients with pre-existing CHF, did not require electrocardiogram confirmation of AF/AFL diagnosis, and did not distinguish between paroxysmal, persistent, and permanent AF. Conclusions: AF/AFL patients with ≥1 ARF have high readmission rates. AF/AFL-related readmissions incur higher costs than the initial AF/AFL admissions. © 2012 Informa UK Ltd All rights reserved.

Amin A.,University of California at Irvine | Deitelzweig S.,Ochsner Clinic Foundation | Jing Y.,Bristol Myers Squibb | Makenbaeva D.,Bristol Myers Squibb | And 3 more authors.
Journal of Thrombosis and Thrombolysis | Year: 2014

Warfarin's time-in-therapeutic range (TTR) is highly variable among patients with nonvalvular atrial fibrillation (NVAF). The objective of this study was to estimate the impact of variations in wafarin's TTR on rates of stroke/systemic embolism (SSE) and major bleedings among NVAF patients in the ARISTOTLE, ROCKET-AF, and RE-LY trials. Additionally, differences in medical costs for clinical endpoints when novel oral anticoagulants (NOACs) were used instead of warfarin at different TTR values were estimated. Quartile ranges of TTR values and corresponding event rates (%/patient - year = %/py) of SSE and major bleedings among NVAF patients treated with warfarin were estimated from published literature and FDA documents. The associations of SSE and major bleeding rates with TTR values were evaluated by regression analysis and then the calculated regression coefficients were used in analysis of medical cost differences associated with use of each NOAC versus warfarin (2010 costs; US payer perspective) at different TTRs. Each 10 % increase in warfarin's TTR correlated with a -0.32 %/py decrease in SSE rate (R2 = 0.61; p < 0.001). Although, the rate of major bleedings decreased as TTR increased, it was not significant (-0.035 %/py, p = 0.63). As warfarin's TTR increased from 30 to 90 % the estimated medical cost decreased from -$902 to -$83 for apixaban, from -$506 to +$314 for rivaroxaban, and from -$596 to +$223 for dabigatran. Among NVAF patients there is a significant negative correlation between warfarin's TTR and SSE rate, but not major bleedings. The variations in warfarin's TTR impacted the economic comparison of use of individual NOACs versus warfarin. © 2014 Springer Science+Business Media.

Amin A.,University of California at Irvine | Bruno A.,Bristol Myers Squibb | Trocio J.,Pfizer | Lin J.,Novosys Health | Lingohr-Smith M.,Novosys Health
Journal of Medical Economics | Year: 2015

Objective: Medical costs that may be avoided when any of the four new oral anticoagulants (NOACs), dabigatran, rivaroxaban, apixaban, and edoxaban, are used instead of warfarin for the treatment of non-valvular atrial fibrillation (NVAF) were estimated and compared. Additionally, the overall differences in medical costs were estimated for NVAF and venous thromboembolism (VTE) patient populations combined. Methods: Medical cost differences associated with NOAC use vs warfarin or placebo among NVAF and VTE patients were estimated based on clinical event rates obtained from the published trial data. The clinical event rates were calculated as the percentage of patients with each of the clinical events during the trial periods. Univariate and multivariate sensitivity analyses were conducted for the medical-cost differences determined for NVAF patients. A hypothetical health plan population of 1 million members was used to estimate and compare the combined medical-cost differences of the NVAF and VTE populations and were projected in the years 2015-2018. Results: In a year, the medical-cost differences associated with NOAC use instead of warfarin were estimated at -$204, -$140, -$495, and -$340 per patient for dabigatran, rivaroxaban, apixaban, and edoxaban, respectively. In 2014, among the hypothetical population, the medical-cost differences were -$3.7, -$4.2, -$11.5, and -$6.6 million for NVAF and acute VTE patients treated with dabigatran, rivaroxaban, apixaban, and edoxaban, respectively. In 2014, for the combined NVAF, acute VTE, and extended VTE patient populations, medical-cost differences were -$10.0, -$10.9, -$21.0, and -$21.0 million for dabigatran, rivaroxaban, 2.5mg apixaban, and 5mg apixaban, respectively. Medical-cost differences associated with use of NOACs were projected to steadily increase from 2014 to 2018. Conclusions: Medical costs are reduced when NOACs are used instead of warfarin/placebo for the treatment of NVAF or VTE, with apixaban being associated with the greatest reduction in medical costs. © 2015 All rights reserved: reproduction in whole or part not permitted.

Lin J.,Novosys Health | Preblick R.,Daiichi Sankyo | Lingohr-Smith M.,Novosys Health | Kwong W.J.,Daiichi Sankyo
Journal of Managed Care Pharmacy | Year: 2014

BACKGROUND: The third leading cause of cardiovascular-associated death, venous thromboembolism (VTE), represents a significant health care and economic burden. Although the burden of a one-time VTE event has been assessed, there are limited data regarding the burden of VTE recurrence. OBJECTIVE: To assess the rate and predictors of VTE recurrence within 1 year in the United States and evaluate the incremental health care resource utilization and costs associated with such VTE recurrences. METHODS: Patients (≥ 18 years) diagnosed with deep vein thrombosis and/or pulmonary embolism between January 1, 2008, and December 31, 2010, were identified from the Truven Health Analytics MarketScan Commercial and Medicare databases. The earliest VTE diagnosis was defined as the index VTE event. Patients were required to have 12 months of continuous insurance coverage before (baseline period) and after (follow-up period) the index event. Patients were further required to have initiated anticoagulant usage within 30 days of the index VTE event and have at least 30 days of treatment. The incidence of recurrent VTE, defined as a hospitalization or emergency room (ER) visit with a VTE diagnosis in the follow-up period, was determined for the commercially insured and Medicare populations separately. A proportional hazards model was used to assess the predictors of time to VTE recurrences. All cause and VTE-related health care resource utilization including hospitalizations, length of stay, outpatient medical service claims, and outpatient pharmacy claims were assessed along with the associated costs incurred during the 30-day and 12-month post-index event periods. Commercially insured and Medicare patients with and without recurrent VTE were evaluated and compared separately. Generalized linear models were used to further assess the incremental cost burden of recurrent VTE. RESULTS: Among the commercially insured population, 29,275 patients were diagnosed with VTE and received anticoagulant therapy. A recurrence of VTE associated with a hospitalization or ER visit occurred within 12 months of the index VTE in 15.4% of patients with a mean time to recurrence of 74.1 days. Among the Medicare insured population (n = 14,509), 11.4% of patients experienced another VTE with a mean time to recurrence of 115.6 days. A consistent predictor of VTE recurrence across both populations was greater comorbidity as indicated by Charlson Comorbidity Index scores. Among commercially insured VTE patients, total payments for health care resource utilization for all causes, including inpatient, outpatient medical services, and outpatient pharmacy use were higher for patients with a recurrent VTE relative to those without a recurrent VTE ($82,110 [$106,918] vs. $36,918 [$54,852], P < 0.001). The primary driver for the higher health care payments was greater use of inpatient care. Total payments for VTE-related resource use was also greater for patients with a VTE recurrence ($38,591 [$51,479] vs. $15,123 [$22,186], P < 0.001) with the majority (62.9%) attributed to care that took place within 30 days of the index VTE. After adjustment for key patient characteristics, VTE recurrence was associated with 2.2-fold and 3.0-fold higher post-index health care payments for all causes and for VTE-related claims, respectively. Similar results were observed for the Medicare population. CONCLUSIONS: VTE recurrence associated with a hospitalization or ER visit is associated with substantial health care resource utilization, which is primarily inpatient care undergone within the first 30 days following an initial VTE event. Thus, a sizeable portion of the economic burden of recurrent VTE is also incurred during this short period of time following an initial VTE event. Given that rates of VTE recurrence were high among patients identified as having received anticoagulant treatment, strategies to improve anticoagulation therapy among VTE patients in addition to other preventative measures are needed to lessen the health care and economic burdens of VTE. © 2014, Academy of Managed Care Pharmacy.

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