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Lee D.W.,General Electric | Rawson J.V.,Georgia Regents University | Wade S.W.,Wade Outcomes Research and Consulting
Journal of the American College of Radiology | Year: 2011

Purpose Radiology benefit managers (RBMs) are widely used by private payers to manage the utilization of imaging services through prior authorization, and they have been proposed for use in the Medicare program. The authors created a framework for evaluating the impact of key parameters on the ability of RBMs to lower costs and used decision-analytic modeling to simulate the net impact of RBMs on health care costs under uncertainty from a societal perspective. Methods The authors' model of a "typical" RBM's prior authorization process used base-case values for each parameter (utilization rate and costs for MR, CT, and PET imaging; physician and staff time spent in complying with RBM requirements; approval and denial rates; and RBM fees to insurers) drawn from published data and the experience of a large, academic institution. Different values were tested in the sensitivity analysis to account for uncertainty in the parameter estimates. A hypothetical 100,000-member private health plan with an imaging utilization rate of 135 per 1,000 members per year was assumed. Results Under the authors' base-case scenario, in which RBMs have no net impact on costs, they estimated that 28% ($182,066/$640,263) of the projected RBM-related savings are shifted to providers. RBMs were cost saving in 45% of simulations, and 95% of simulations fell between a cost decrease of $397,880 and a cost increase of $341,991. The probability of an initial approval by the RBM, the RBM's fee, and the imaging utilization rate and associated charges had the largest influence on the results. Conclusions The authors' models shows that RBMs shift significant costs to physicians and that their net impact on societal costs depends on parameters for which supporting data are incomplete. © 2011 American College of Radiology.

Curtis J.R.,University of Alabama at Birmingham | Cai Q.,HealthCore Inc. | Wade S.W.,Wade Outcomes Research and Consulting | Stolshek B.S.,Amgen Inc. | And 4 more authors.
Bone | Year: 2013

Few data are available on physician perceptions of osteoporosis medication adherence. This study compared physician-estimated medication adherence with adherence calculated from their patients' pharmacy claims. Women aged ≥ 45 years, with an osteoporosis-related pharmacy claim between January 1, 2005 and August 31, 2008, and continuous coverage for ≥ 12 months before and after first (index) claim, were identified from a commercial health plan population. Prescribing physicians treating ≥ 5 of these patients were invited to complete a survey on their perception of medication adherence and factors affecting adherence in their patients. Pharmacy claims-based medication possession ratio (MPR) was calculated for the 12-month post-index period for each patient. Physicians who overestimated the percentage of adherent (MPR ≥0.8) patients by ≥ 10 points were considered "optimistic". Logistic regression assessed physician characteristics associated with optimistic perception of adherence. A total of 376 (17.2%) physicians responded to the survey; 62.0% were male, 58.2% were aged 45 to 60. years, 55.3% had ≥ 20 years of practice, and 35.4% practiced in an academic setting. Participating physicians prescribed osteoporosis medications for 2748 patients with claims data (mean [SD] age of 62.0 [10.6] years). On average, physicians estimated 67.2% of their patients to be adherent; however, only 40% of patients were actually adherent based on pharmacy data. Optimistic physicians (73.4%) estimated 71.9% of patients to be adherent while only 32.2% of their patients were adherent based on claims data. Physicians in academic settings were more likely to be optimistic than community-based physicians (odds ratio 1.69, 95% CI: 1.01, 2.85). Overestimation of medication adherence may impede physicians' ability to provide high quality care for their osteoporosis patients. © 2013 Elsevier Inc.

Ahnen D.J.,University of Colorado at Denver | Wade S.W.,Wade Outcomes Research and Consulting | Jones W.F.,University of Louisville | Sifri R.,Thomas Jefferson University | And 6 more authors.
Mayo Clinic Proceedings | Year: 2014

In the United States, colorectal cancer (CRC) is the third most common and second most lethal cancer. More than one-tenth of CRC cases (11% of colon cancers and 18% of rectal cancers) have a young onset (ie, occurring in individuals younger than 50 years). The CRC incidence and mortality rates are decreasing among all age groups older than 50 years, yet increasing in younger individuals for whom screening use is limited and key symptoms may go unrecognized. Familial syndromes account for approximately 20% of young-onset CRCs, and the remainder are typically microsatellite stable cancers, which are more commonly diploid than similar tumors in older individuals. Young-onset CRCs are more likely to occur in the distal colon or rectum, be poorly differentiated, have mucinous and signet ring features, and present at advanced stages. Yet, stage-specific survival in patients with young-onset CRC is comparable to that of patients with later-onset cancer. Primary care physicians have an important opportunity to identify high-risk young individuals for screening and to promptly evaluate CRC symptoms. Risk modification, targeted screening, and prophylactic surgery may benefit individuals with a predisposing hereditary syndrome or condition (eg, inflammatory bowel disease) or a family history of CRC or advanced adenomatous polyps. When apparently average-risk young adults present with CRC-like symptoms (eg, unexplained persistent rectal bleeding, anemia, and abdominal pain), endoscopic work-ups can expedite diagnosis. Early screening in high-risk individuals and thorough diagnostic work-ups in symptomatic young adults may improve young-onset CRC trends. © 2014 Mayo Foundation for Medical Education and Research.

Woo C.,Amgen Inc. | Gao G.,Amgen Inc. | Wade S.,Wade Outcomes Research and Consulting | Hochberg M.C.,University of Maryland, Baltimore
Current Medical Research and Opinion | Year: 2010

Objective: To characterize gastrointestinal side effects (GI SEs) and its associations with medication discontinuation, health-related quality of life (HRQoL), and treatment) satisfaction in postmenopausal women prescribed osteoporosis (OP) therapies. Methods: Prospective Observational Scientific Study Investigating Bone Loss Experience (POSSIBLE US* *POSSIBLE US is a trade mark of Amgen Inc., Thousand Oaks, CA, USA.) participants enrolled October 27, 2004 January 25, 2007 and complete questionnaires for up to 3 years. GI SEs for women new to or stable on therapy at entry were characterized at 6 and 12 months. Adjusted odds of experiencing GI SEs; mean HRQoL and treatment satisfaction scores; and risk of discontinuing therapy for bisphosphonate (BP) versus non-BP users were compared with logistic and generalized linear models. Results: About 20 of women reported 1 GI SE at entry. GI SEs at month 6 were more common in BP than non-BP users (new: OR1.5, 95 CI: 1.22.0; stable: OR1.7, 95 CI: 1.32.1). Women new to OP therapy with GI SEs at month 6 had lower LS Mean HRQoL (OPAQ-SV Emotional Status: 72.3 vs. 78.2, p0.005) and treatment satisfaction scores (SEs: 71.4 vs. 82.9; Efficacy: 58.6 vs. 65.6; Global: 55.0 vs. 64.4; all p≤0.02) than those without GI SEs. Women reporting any GI SE had higher therapy discontinuation than those without GI SEs (6-month OR1.39, 95 CI: 1.051.84; 12-month OR1.30, 95 CI: 1.031.63; both p≤0.03). Conclusion: GI SEs were common among women on OP therapy, were more common in BP than non-BP users, and were associated with increased therapy discontinuation. Lower HRQoL and treatment satisfaction associated with GI SEs may influence medication discontinuation. © 2010 Informa UK Ltd All rights reserved.

Latini D.M.,Baylor College of Medicine | Latini D.M.,Houston Center for Quality of Care | Lerner S.P.,Baylor College of Medicine | Wade S.W.,Wade Outcomes Research and Consulting | And 2 more authors.
Urology | Year: 2010

Bladder cancer (BlCa) is the fifth most common cancer in the United States and one of the ten deadliest. It ranks fifth among all cancers in total costs, consuming almost $3 billion annually, and has an extensive effect on quality of life for survivors and their families. Despite this human and economic toll, BlCa ranks comparatively low on the national agenda. Our understanding of this disease has grown exponentially over the last decade, paving the way for better prevention, detection, treatment, monitoring, and quality of life. Increasing national attention to BlCa is likely to improve disease burden and patient quality of life.

Wade S.W.,Wade Outcomes Research and Consulting | Strader C.,Kantar Health | Fitzpatrick L.A.,Glaxosmithkline | Anthony M.S.,Amgen Inc.
Archives of Osteoporosis | Year: 2012

Various methodological approaches have estimated the incidence of osteoporosis-related fractures, making comparisons difficult. This study estimated the incidence rates of non-traumatic fractures in 12 countries using standard definitions. Applying these rates to the 2010 population figures of these countries, a total of 5.2 million non-traumatic fractures were estimated, mostly in women. Purpose: The purpose of this study was to estimate annual country-, sex-, and age-specific incidence of non-traumatic hip, vertebral, and other fractures for women aged ≥50 and men ≥60 years and the number of fractures expected in 12 countries based on these incidence rates. Methods: Electronically indexed medical literature and relevant web sites were reviewed to identify studies reporting age- and sex-specific fracture incidence rates to obtain estimates of the proportion of fractures considered to be non-traumatic and to gather relevant census data. From these data, we extrapolated to estimate the number of fractures in 12 countries in North America, Europe, Japan, and Australia. Results: Annual non-traumatic hip fracture incidence rates were highest for women in Sweden, Denmark, and Finland. In women, vertebral fractures were more common than hip fractures. The incidence of vertebral fractures was highest among Scandinavian and Canadian women. In men, Scandinavians had the highest incidence of hip fractures, while Australian men had the highest incidence of vertebral fractures. Hip and vertebral fracture incidence increased steeply with age for both women and men. Age appears to exert less influence on the incidence of fractures at sites other than hip and vertebrae. In 2010, 5.2 million non-traumatic fractures were expected in the 12 countries studied, of which 2.8 million were at the hip or spine. Women accounted for most of the total non-traumatic fracture burden (77 %). Conclusions: Non-traumatic fractures pose a significant burden, affecting millions of women and men in countries around the world each year. © 2012 International Osteoporosis Foundation and National Osteoporosis Foundation.

Wade S.W.,Wade Outcomes Research and Consulting | Satram-Hoang S.,Q. D. Research Inc. | Stolshek B.S.,Amgen Inc.
Osteoporosis International | Year: 2014

Summary: Persistence with postmenopausal osteoporosis (PMO) medications is not well characterized beyond 12 months. Of 3,011 postmenopausal women treated in primary care, 36.8 % continued baseline PMO medication during 36 months of follow-up. Many factors were associated with nonpersistence, including newly initiating or switching therapy, and reporting moderate to severe side effects. Introduction: Persistence with postmenopausal osteoporosis (PMO) medications is not well characterized beyond 12 months. We describe 24- and 36-month persistence using patient-reported data from women with different PMO treatment histories in the US primary care setting. Methods: Data from 3,011 participants of the Prospective Observational Scientific Study Investigating Bone Loss Experience (POSSIBLE US™, 10/2005-12/2008) and Kaplan-Meier methods were used to estimate the probability of persisting (i.e., not discontinuing or switching PMO agents) with baseline PMO medication and hazard ratios for predictors of nonpersistence 24 and 36 months after study entry. Results: The probability of persisting with the baseline medication was 46.2 % (95 % confidence interval [CI] 44.2-48.1 %) during 24 months of follow-up and 36.8 % (95 % CI 34.7-38.9 %) during 36 months of follow-up. In adjusted analyses, newly initiating therapy or switching to a new agent, reporting moderate to severe side effects, having lower disease-specific quality of life scores, smoking, and residing in the South or West USA (all measured at study entry) were independent predictors of nonpersistence in both time periods. The majority of participants who discontinued therapy and had the opportunity to reinitiate (i.e., discontinued ≥4 months before the end of follow-up) restarted therapy (24 months 69 %; 36 months 75 %). Conclusions: In this primary care cohort, a minority of women continued their baseline PMO therapy during a 24- to 36-month follow-up. Supporting patients during the initiation of a new therapy or if side effects occur may improve persistence and increase the therapeutic benefit of PMO medications. © 2014 International Osteoporosis Foundation and National Osteoporosis Foundation.

Barrett-Connor E.,University of California at San Diego | Wade S.W.,Wade Outcomes Research and Consulting | Do T.P.,Amgen Inc. | Satram-Hoang S.,Amgen Inc. | And 3 more authors.
Osteoporosis International | Year: 2012

Summary: Women in POSSIBLE US™ who expressed greater treatment satisfaction at study entry were more likely to persist with osteoporosis therapy over a 1-year period. Lower satisfaction among women with moderate/severe side effects increased the risk of discontinuation/switching by 67%. Treatment satisfaction and side effect experience influence osteoporosis medication adherence. Introduction: Non-adherence is common among women using postmenopausal osteoporosis (PMO) medications. We describe the association between treatment satisfaction, measured with the Treatment Satisfaction Questionnaire for Medication (TSQM), and the risk of discontinuation/switching PMO medications using patient-reported data from a large, longitudinal cohort study. Methods: Data from 2,405 participants in the Prospective Observational Scientific Study Investigating Bone Loss Experience (POSSIBLE US™) Study were evaluated. Cox proportional hazards regression was used to estimate hazard ratios (HR) for the association between treatment satisfaction at study entry and self-reported discontinuation/switching of pharmacologic PMO medications over a 1-year follow-up period. Logistic regression was used to evaluate relationships between treatment satisfaction, lifestyle behaviors, and compliance with bisphosphonate dosing instructions. Results: Median TSQM scores were highest (indicating greatest satisfaction) for the side effects domain [n = 1,182; median = 87.5 (Q1 = 75.0, Q3 = 100.0)] and lowest for global satisfaction [n = 2,340; median = 64.0 (Q1 = 55.7, Q3 = 77.7)]. Median scores decreased for the side effects and global satisfaction domains as patient-reported side effect severity increased. Women with higher satisfaction were less likely to discontinue/switch medications than women with lower scores (adjusted HRs for convenience 0.73, 95% CI = 0.63-0.85; effectiveness 0.82, 95% CI = 0.70-0.97; and global satisfaction 0.73, 95% CI = 0.63-0.85). Lower treatment satisfaction was particularly influential among women who reported moderate/severe side effects (HR = 0.60, 95% CI = 0.37-0.97). Conclusions: Lower treatment satisfaction was associated with a 22% (1/0.82) to 67% (1/0.60) increased risk of discontinuation/switching osteoporosis medication during 1 year of follow-up. © 2011 International Osteoporosis Foundation and National Osteoporosis Foundation.

Wade S.W.,Wade Outcomes Research and Consulting
Archives of osteoporosis | Year: 2014

In nine industrialized countries in North America, Europe, Japan, and Australia, country-specific osteoporosis prevalence (estimated from published data) at the total hip or hip/spine ranged from 9 to 38 % for women and 1 to 8 % for men. In these countries, osteoporosis affects up to 49 million individuals. Standardized country-specific prevalence estimates are scarce, limiting our ability to anticipate the potential global impact of osteoporosis. This study estimated the prevalence of osteoporosis in several industrialized countries (USA, Canada, five European countries, Australia, and Japan) using the World Health Organization (WHO) bone mineral density (BMD)-based definition of osteoporosis: BMD T-score assessed by dual-energy x-ray absorptiometry ≤-2.5. Osteoporosis prevalence was estimated for males and females aged 50 years and above using total hip BMD and then either total hip or spine BMD. We compiled published location-specific data, using the National Health and Nutrition Examination Survey (NHANES) III age and BMD reference groups, and adjusted for differences in disease definitions across sources. Relevant NHANES III ratios (e.g., male to female osteoporosis at the total hip) were applied where data were missing for countries outside the USA. Data were extrapolated from geographically similar countries as needed. Population counts for 2010 were used to estimate the number of individuals with osteoporosis in each country. For females, osteoporosis prevalence ranged from 9 % (UK) to 15 % (France and Germany) based on total hip BMD and from 16 % (USA) to 38 % (Japan) when spine BMD data were included. For males, prevalence ranged from 1 % (UK) to 4 % (Japan) based on total hip BMD and from 3 % (Canada) to 8 % (France, Germany, Italy, and Spain) when spine BMD data were included. Up to 49 million individuals met the WHO osteoporosis criteria in a number of industrialized countries in North America, Europe, Japan, and Australia.

Tosteson A.N.A.,Dartmouth Institute for Health Policy and Clinical Practice | Do T.P.,Amgen Inc. | Wade S.W.,Wade Outcomes Research and Consulting | Anthony M.S.,Amgen Inc. | Downs R.W.,Virginia Commonwealth University
Osteoporosis International | Year: 2010

During the first year of Prospective Observational Scientific Study Investigating Bone Loss Experience (POSSIBE US™), many women transitioned (i.e., discontinued or switched) from their baseline osteoporosis medication. Participants not on stable therapy at entry, with side effects, and with poor physical status were at higher risk of transitioning. Understanding factors associated with persistence may lead to improved outcomes. Introduction: Postmenopausal osteoporosis (PMO) medication use patterns may differ by treatment history and drug class. We describe these patterns among patients in primary care settings using patient-reported data. Methods: Data from 3,006 participants of the POSSIBLE US™ were used to estimate the probability of a baseline PMO medication transition (i.e., discontinuation or switch) and hazard ratios (HRs) for predictors of these transitions. Results: One year after study entry, the probability of persisting with a baseline medication was 66% (95% CI: 64-68%). After adjusting for age and osteoporosis diagnosis, factors at entry independently associated with a higher risk of baseline medication transition were treatment status cohort, side effect severity, and OPAQ-SV physical function score. Compared to participants stable on therapy at entry, others had a higher risk, ranging from HR = 1.59 (95% CI: 1.36-1.85) for those new to therapy to HR = 2.00 (95% CI: 1.27-3.15) for those who recently augmented therapy at entry. Participants reporting moderate (HR = 1.31, 95% CI: 1.09-1.57) or severe (HR = 1.88, 95% CI: 1.49-2.39) side effects had a higher risk than those not reporting side effects. Participants reporting Osteoporosis Assessment Questionnaire-Short Version physical function scores in the lowest tertile had a higher risk (HR = 1.27, 95% CI: 1.07-1.52) than those reporting scores in the highest tertile. Conclusion: Baseline osteoporosis medication transitions were common in the first year of POSSIBLE US™. Participants not on stable therapy at entry, or who reported severe side effects, or had poor physical health status were at higher risk for these transitions. © 2010 International Osteoporosis Foundation and National Osteoporosis Foundation.

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