Stockholm, Sweden
Stockholm, Sweden

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Wimo A.,Karolinska Institutet | Jonsson L.,OptumInsight | Bond J.,Northumbria University | Prince M.,King's College London | Winblad B.,Karolinska Institutet
Alzheimer's and Dementia | Year: 2013

Objective: To acquire an understanding of the societal costs of dementia and how they affect families, health and social care services, and governments to improve the lives of people with dementia and their caregivers. Methods: The basic design of this study was a societal, prevalence-based, gross cost-of-illness study in which costs were aggregated to World Health Organization regions and World Bank income groupings. Results: The total estimated worldwide costs of dementia were US$604 billion in 2010. About 70% of the costs occurred in western Europe and North America. In such high-income regions, costs of informal care and the direct costs of social care contribute similar proportions of total costs, whereas the direct medical costs were much lower. In low- and middle-income countries, informal care accounts for the majority of total costs; direct social care costs are negligible. Conclusions: Worldwide costs of dementia are enormous and distributed inequitably. There is considerable potential for cost increases in coming years as the diagnosis and treatment gap is reduced. There is also likely to be a trend in low- and middle-income countries for social care costs to shift from the informal to the formal sector, with important implications for future aggregated costs and the financing of long-term care. Only by investing now in research and the development of cost-effective approaches to early diagnosis and care can future societal costs be anticipated and managed. © 2013 The Alzheimer's Association. All rights reserved.

Svedbom A.,OptumInsight | Alvares L.,Medtronic | Cooper C.,University of Southampton | Cooper C.,University of Oxford | And 2 more authors.
Osteoporosis International | Year: 2013

The purpose of the study was to estimate the cost-effectiveness of balloon kyphoplasty compared to nonsurgical management and vertebroplasty for the treatment of hospitalised osteoporotic vertebral compression fractures in the UK. A cost-effectiveness model was constructed and used for analysis. Balloon kyphoplasty may be cost-effective compared to relevant alternatives. Introduction: The objective of this study was to estimate the cost-effectiveness of balloon kyphoplasty (BKP) for the treatment of patients hospitalised with acute osteoporotic vertebral compression fracture (OVCF) compared to percutaneous vertebroplasty (PVP) and nonsurgical management (NSM) in the UK. Methods: A Markov simulation model was developed to evaluate treatment with BKP, NSM and PVP in patients with symptomatic OVCF. Data on health-related quality of life (HRQoL) with acute OVCF were derived from the FREE and VERTOS II randomised clinical trials (RCTs) and normalised to the NSM arm in the FREE trial. Estimated differences in mortality among the treatments and costs for NSM were obtained from the literature whereas procedure costs for BKP and PVP were obtained from three National Health Service hospitals. It was assumed that BKP and PVP reduced hospital length of stay by 6 days compared to NSM. Results: The incremental cost-effectiveness ratio was estimated at Great Britain Pound Sterling (GBP) 2,706 per quality-adjusted life year (QALY) and GBP 15,982 per QALY compared to NSM and PVP, respectively. Sensitivity analysis showed that the cost-effectiveness of BKP vs. NSM was robust when mortality and HRQoL benefits with BKP were varied. The cost-effectiveness of BKP compared to PVP was particularly sensitive to changes in the mortality benefit. Conclusion: BKP may be a cost-effective strategy for the treatment of patients hospitalised with acute OVCF in the UK compared to NSM and PVP. Additional RCT data on the benefits of BKP and PVP compared to simulated sham surgery and further data on the mortality benefits with BKP compared to NSM and PVP would reduce uncertainty. © 2012 International Osteoporosis Foundation and National Osteoporosis Foundation.

Objective: The objective of this study was to analyze the comparative gastrointestinal tolerability of proprietary versus generic alendronate in patients treated for primary osteoporosis. Methods: The study was based on all patients starting therapy with alendronate in Sweden between 2005 and 2009. The primary outcome measure was the start of treatment with a gastroprotective agent and the secondary outcome was hospitalization for gastrointestinal adverse event (GIAE). The incidence of both outcomes was measured within the first six months after the initiation of the alendronate treatment. Results: The crude incidence of gastroprotective treatment during the first six months following the start of the alendronate therapy was 5.45% (bootstrapped CI95 4.09%-7.19%) and 5.04% (bootstrapped CI95 4.74%-5.38%) for patients prescribed proprietary and generic alendronate, respectively. The crude six-month incidence of hospitalization for GIAE was 0.43% (bootstrapped CI95 0.14%-1.29%) and 0.71% (bootstrapped CI95 0.55%-0.91%) for proprietary and generic alendronate, respectively. Controlling for age, sex, and other available covariates, there was no significant difference in the risk of GIAEs between proprietary and generic alendronate. Conclusions: No significant difference in the incidence of GIAEs was identified between patients prescribed proprietary and generic alendronate between 2005 and 2009 in Sweden. More research is needed to provide conclusive evidence of the gastrointestinal tolerability profiles of proprietary and generic alendronate. © 2012 Elsevier Inc.

Strom O.,Karolinska Institutet | Landfeldt E.,OptumInsight
Osteoporosis International | Year: 2012

Summary Automatic generic substitution of alendronate products, used to reduce drug costs, and medication persistence was studied retrospectively between 2006 and 2009. During this period the number of, and the rate of substitution between, alendronate products increased while persistence decreased. Patient preferences should be considered when designing and evaluating generic policies. Introduction Automatic generic substitution (AGS) was implemented in Sweden in 2002. The objective of this study was to investigate the association between AGS and persistence with alendronate treatment of primary osteoporosis in Sweden. Methods An open historical cohort of women and men (n= 36,433) was identified in the Swedish Prescribed Drug Register through filled prescriptions for alendronate or risedronate between 2005 and 2009. Co-morbidity data was extracted from the National Patient Register. The association between AGS and medication persistence was investigated using non-parametric and parametric survival analysis. Results Between 2006 and 2009, the number of alendronate products increased from 15 to 25, the proportion of prescriptions constituting a substitution increased from 10.8% to 45.2%, and the proportion of patients persisting with alendronate treatment for 12 months fell from 66.9% to 51.7%. Patients starting alendronate treatment in 2006 had lower risk of stopping treatment compared with those starting in 2007 (HR 1.34, 95% CI 1.29-1.39), 2008 (HR 1.49, 95% CI 1.43-1.55), and 2009 (HR 1.50, 95% CI 1.40-1.60). No difference was observed in persistence with proprietary risedronate during the same period. Individuals who had their alendronate product substituted at the first prescription refill had significantly higher probability of discontinuation (HR 1.25, 95% CI 1.20-1.30). Conclusion AGS causes increased product substitution which appears to be associated with reduced treatment persistence. Poor health outcomes and associated costs due to forgone drug exposure should be taken into account in the design and evaluation of policies implemented to encourage utilisation of generic medicines. © International Osteoporosis Foundation and National Osteoporosis Foundation 2011.

Henk H.,Health Economics and Outcomes Research | Teitelbaum A.,OptumInsight | Kaura S.,Novartis
Current Medical Research and Opinion | Year: 2012

Background: Skeletal complications of malignant bone disease are common among patients with both solid tumors and multiple myeloma (MM). Zoledronic acid (ZOL; Zometa*) is an intravenous bisphosphonate with proven efficacy in reducing the incidence of skeletal complications and delaying the time to a first skeletal complication. This study was designed to assess the continued benefit of ZOL treatment over a prolonged period. Methods: This was a retrospective claims analysis study using information gathered from two national US managed-care plan databases. Patients ≥18 years of age with a single type of solid tumor or MM who were diagnosed with bone lesions and experienced at least one skeletal complication (before or after receiving ZOL) were included. Results: Of the 28,385 patients, those with lung and breast cancer composed the largest group. Greater percentages of MM and breast cancer patients were treated with ZOL. On average, those with renal cell carcinoma and lung cancer had a longer time between bone metastasis diagnosis and start of therapy with ZOL. Compared with an untreated cohort, patients treated with ZOL had a 24 reduction in incidence of fracture, a 45 reduction in incidence of spinal cord compression, and a 56 reduction in risk of mortality. Patients with persistence with ZOL over 180 days had a reduced incidence of fracture before controlling for other factors. Conclusions: Patients treated with ZOL had reduced risks of fracture, spinal cord compression, and mortality compared with patients in the no-treatment cohort. Longer persistence with ZOL was associated with better outcomes. Greatest benefits were observed for patients treated on a regular basis with ZOL for a period beyond 18 months. © 2012 Informa UK Ltd.

Teitelbaum A.,OptumInsight | Ba-Mancini A.,Millennium Pharmaceuticals Inc. | Huang H.,Millennium Pharmaceuticals Inc. | Henk H.J.,OptumInsight
Oncologist | Year: 2013

Background. Treatment of multiple myeloma has dramatically improved with the introduction of bortezomib (BOR), thalidomide (THAL), and lenalidomide (LEN). Studies assessing health care costs, particularly economic burden on patients, are limited. We conducted a claims-based, retrospective analysis of total health care costs as well as patient burden (patient out-of-pocket costs and number of ambulatory/ hospital visits) associated with BOR/THAL/LEN treatment versus other therapies (OTHER). Methods. Treatment episodes starting between January 1, 2005 and September 30, 2010 were identified from the claims database of a large U.S. health plan. Health care costs and utilization were measured during 1 year after initiation and analyzed per treatment episode. Multivariate analyses were used to adjust for patient characteristics, comorbidities, and line of treatment. Results. A total of 4,836 treatment episodes were identified. Mean adjusted total costs were similar between BOR ($112,889) and OTHER ($111,820), but higher with THAL ($129,412) and LEN ($158,428). Mean adjusted patient outof- pocket costs were also similar for BOR ($3,846) and OTHER ($3,900) but remained higher with THAL ($4,666) and LEN ($4,483). Mean adjusted rates of ambulatory visits were similar across therapies (BOR: 69.67; THAL: 66.31; LEN: 65.60; OTHER: 69.42). Conclusions. Adjusted analyses of real-world claims data show that total health care costs, as well as patient out-of-pocket costs, are higher with THAL/LEN treatment episodes than with BOR/OTHER therapies. Additionally, similar rates of ambulatory visits suggest that any perceived advantage in patient convenience of the orally administered drugs THAL/LEN is not supported by these data. © AlphaMed Press.

Svedbom A.,OptumInsight
Archives of osteoporosis | Year: 2014

This report describes the epidemiology, economic burden and treatment of osteoporosis in Switzerland. Osteoporosis is characterized by reduced bone mass and disruption of bone architecture, resulting in increased risks of fragility fractures which represent the main clinical consequence of the disease. Fragility fractures are associated with substantial pain and suffering, disability and even death for the affected patients and substantial costs to society. The aim of this report is to describe the epidemiology and economic burden of fragility fractures as a consequence of osteoporosis in Switzerland, as a detailed addition to the report for the European Union (EU27): "Osteoporosis in the European Union: Medical Management, Epidemiology and Economic Burden". The literature on fracture incidence and costs of fractures in Switzerland was reviewed and incorporated into a model estimating the clinical and economic burden of osteoporotic fractures in 2010. Furthermore, data on sales of osteoporosis treatments and the population at high risk of fracture were used to estimate treatment uptake and treatment gap. It was estimated that approximately 74,000 new fragility fractures were sustained in Switzerland in 2010, comprising 14,000 hip fractures, 11,000 vertebral fractures, 13,000 forearm fractures and 36,000 other fractures (i.e. fractures of the pelvis, rib, humerus, tibia, fibula, clavicle, scapula, sternum and other femoral fractures). The economic burden of incident and previous fragility fractures was estimated at CHF 2,050 million for the same year. Incident fractures represented 76 % of this cost, long-term fracture care 21 % and pharmacological prevention 3 %. Previous and incident fractures also accounted for 24,000 quality-adjusted life years (QALYs) lost during 2010. When accounting for the demographic projections for 2025, the number of incident fractures was estimated at 98,786 in 2025, representing an increase of 25,000 fractures. Hip, clinical vertebral (spine), forearm and other fractures were estimated to increase by 4,900, 3,200, 3,500 and 13,000, respectively. The burden of fractures in terms of costs (excluding value of QALYs lost) in Switzerland in 2025 was estimated to increase by 29 % to CHF 2,642 million. Though the uptake of osteoporosis treatments increased from 2001, the proportion of patients aged 50 or above who received treatment remained at low levels in the past few years. The majority of women at high fracture risk do not receive active treatment. In spite of the high cost of osteoporosis, a substantial treatment gap and projected increase of the economic burden driven by an aging population, the use of pharmacological prevention of osteoporosis is significantly less than optimal, suggesting that a change in health care policy concerning the disease is warranted.

Panjabi S.,Daiichi Sankyo | Lacey M.,OptumInsight | Bancroft T.,OptumInsight | Cao F.,OptumInsight
Journal of the American Society of Hypertension | Year: 2013

Poor antihypertensive treatment adherence adversely affects blood pressure control. We analyzed US health plan data to assess the impact of fixed- versus loose-dose triple-combination therapy on adherence, clinical, and economic outcomes. Patients initiating triple therapy with an angiotensin receptor blocker, angiotensin-converting enzyme inhibitor, or beta blocker plus amlodipine and hydrochlorothiazide comprised three cohorts. Within-cohort comparisons were made between fixed-dose combinations of two antihypertensives plus a second pill (two pills) or three separate pills. Outcomes included adherence, cardiovascular events, health care resource use, and costs for patients with ≥12 months follow-up. A total of 16,290 patients were matched. Patients receiving two pills were more likely to be adherent (P <.001) and less likely to discontinue treatment (P <.001) across all cohorts. Therapy with two versus three pills resulted in significantly lower adjusted risk of cardiovascular events (hazard ratio = 0.76, P =.005) in the beta blocker cohort only. Total adjusted health care costs were significantly lower for two- versus three-pill therapy in the beta blocker cohort only (cost ratio = 0.74 overall, P <.01; 0.71 hypertension-attributable, P <.01). In patients with hypertension requiring triple therapy, fixed-dose combinations that lower pill burden may improve adherence (seen across all cohorts) and clinical outcomes (seen in the beta blocker cohort) without increasing health care costs. © 2013 American Society of Hypertension. All rights reserved.

Karampampa K.,OptumInsight
Multiple sclerosis (Houndmills, Basingstoke, England) | Year: 2012

Multiple sclerosis (MS) is a common cause of neurological disability in young adults. The TRIBUNE study provides a detailed exploration of costs in relation to relapses and disease severity, and assesses the quality of life impact on MS patients in terms of utilities, fatigue and activities of daily living (ADL). Patients in five European countries (France, Germany, Italy, Spain and the United Kingdom) completed a self-administered web-based questionnaire capturing information on demographics, disease characteristics and severity (EDSS), co-morbidities, relapses, resource consumption, utilities, fatigue, and activities of daily living. In total, 1261 MS patients completed the questionnaire. More than half of the patients (68%) had the relapsing-remitting form of the disease; 87% of the sample reported receiving MS treatments. Costs were higher with advancing disease severity; for mild patients (EDSS score ≤ 3) the costs ranged between €13,534 and €22,461 across countries; for moderate (EDSS score 4 - 6.5) between €28,524 and €43,948; for severe (EDSS ≥ 7) between €39,592 and €65,395. Relapses were also associated with increasing costs; the difference in the cost per patient per year for relapsing-remitting patients with EDSS score ≤ 5 that did experience at least one relapse during the past 12 months and those who did not ranged between €3321 and €9430. The quality of life of patients decreased with disease progression and existence of relapses. The TRIBUNE study provides an important update on the economic burden of MS in an era of more widespread use of disease-modifying therapies. It explores the cost of MS linked to relapses and disease severity, and examines the impact of MS on additional health outcomes beyond utilities such as ADL and fatigue.

Ettinger A.B.,Neurological Surgery | Good M.B.,OptumInsight | Manjunath R.,Glaxosmithkline | Edward Faught R.,Emory University | Bancroft T.,OptumInsight
Epilepsy and Behavior | Year: 2014

We sought to examine the impact of depression upon antiepileptic drug (AED) adherence in patients with epilepsy. We administered the Center for Epidemiologic Studies Depression Scale (CES-D), Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), Seizure Severity Questionnaire (SSQ), and Quality of Life in Epilepsy-10 (QOLIE-10) and measured AED adherence by utilizing the medication possession ratio (MPR) in adult patients with epilepsy identified through a pharmacy claims database. From a sampling frame of over 10,000 patients identified in claims, 2750 were randomly selected and contacted directly by mail to participate in the cross-sectional survey. A total of 465 eligible patients completed a survey. Survey data were combined with administrative claims data for analysis. We conducted a path analysis to assess the relationships between depression, adherence, seizure severity, and quality of life (QOL). Patients with depression scored significantly worse on measures of seizure severity (p = .003), QOL (p < .001), and adherence (p = .001). On path analysis, depression and QOL and seizure severity and QOL were related, but only the NDDI-E scores had a significant relationship with medication adherence (p = .001). Depression as measured by the NDDI-E was correlated with an increased risk of AED nonadherence. Depression or seizure severity adversely impacted QOL. These results demonstrate yet another important reason to screen for depression in epilepsy. © 2014 .

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