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Landsman-Blumberg P.B.,Xcenda | Wei W.,Sanofi S.A. | Douglas D.,Sloan Kettering Cancer Center | Smith D.M.,Xcenda | And 2 more authors.
Journal of Allergy and Clinical Immunology: In Practice | Year: 2013

Background: Food-induced anaphylaxis is a potentially life-threatening condition that frequently results in emergency department (ED) visits and/or hospitalization. Little information is available on patient compliance with recommended postdischarge anaphylaxis care. Objective: To describe patient characteristics, concordance with recommended postdischarge care, and risk of repeated events among adults with an initial ED visit and/or hospitalization for food-induced anaphylaxis. Methods: In this retrospective study of health care claims, adults with an ED visit and/or hospitalization for food-induced anaphylaxis were identified from the 2002-2008 Truven Health MarketScan Databases by using an expanded International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code algorithm. The first identified ED visit and/or hospitalization was the index event. Data from patients with continuous medical and prescription coverage for ≥1 year before and after the index event were retained for analysis. Analyses included baseline demographic and clinical characteristics, postdischarge epinephrine autoinjector (EAI) prescription fills and allergist/immunologist visits, and repeated events in the 1-year postindex period. Results: Patients (n= 1370) had a mean (SD) age of 44 ± 15 years, 58% were women. Most (86%) were seen in the ED and/ discharged from the ED. Within 1 year after discharge, 54% of adults had filled ≥1 EAI prescription (71% within 1 week) and 22% had ≥1 allergist/immunologist visit (53% within 4 weeks). Overall, 73 patients (5%) had evidence of a subsequent anaphylaxis-related ED visit and/or hospitalization 1 year after discharge. Conclusion: Concordance with recommended postdischarge anaphylaxis care was low among adults with food-induced anaphylaxis. Within 1 year after discharge, 54% of patients filled an EAI prescription and 22% consulted an allergist/immunologist. © 2013 American Academy of Allergy, Asthma & Immunology.


Min J.K.,Cornell University | Gilmore A.,Xcenda | Budoff M.J.,University of California at Los Angeles | Berman D.S.,Cedars Sinai Medical Center | O'Day K.,Xcenda
Radiology | Year: 2010

Purpose: To evaluate the cost-effectiveness of diagnostic strategies for individuals with chest pain without known coronary artery disease (CAD) in the Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography-eligible population. Materials and Methods: A decision analysis was performed in which the following were compared: coronary computed tomographic (CT) angiography followed by invasive coronary angiography for positive or equivocal findings (coronary CT angiography only), coronary CT angiography followed by invasive coronary angiography for positive findings and myocardial perfusion single photon emission computed tomography (SPECT) for equivocal findings (coronary CT angiography first), myocardial perfusion SPECT followed by invasive coronary angiography for positive/equivocal findings (myocardial perfusion SPECT only), myocardial perfusion SPECT followed by invasive coronary angiography for positive findings and coronary CT angiography for equivocal findings (myocardial perfusion SPECT first), and invasive coronary angiography. Analyses were conducted from the payer perspective for a nearterm diagnostic period and a long-term lifetime period. The base case was a 55-year-old man with 30% risk of obstructive CAD. Results: By using the base case for near-term cost per correct diagnosis, a coronary CT angiography-first strategy was the least expensive, followed by coronary CT angiography only (incremental cost-effectiveness ratio [ICER] = $17 516). For long-term cost-effectiveness, a coronary CT angiography-only strategy demonstrated a favorable ICER of $20 429 per quality-adjusted life-year (QALY) relative to the least expensive coronary CT angiography-first strategy. Both myocardial perfusion SPECT-only and myocardial perfusion SPECT-first strategies were more costly and less effective than either coronary CT angiographic strategy. Long-term results were sensitive to coronary CT angiographic sensitivity, myocardial perfusion SPECT sensitivity, and CAD prevalence. Coronary CT angiography-first and coronary CT angiography-only strategies remained dominant up to a baseline coronary CT angiography test cost of $1100 and 80% CAD prevalence. Conclusion: With a $20 000 threshold level for cost per correct diagnosis and $50 000 per QALY, a coronary CT angiography-only approach is the most cost-effective diagnostic strategy for evaluation of patients who have stable chest pain without known CAD with intermediate CAD prevalence. © RSNA, 2010.


Velligan D.I.,University of Texas Health Science Center at San Antonio | Carroll C.,Xcenda | Lage M.J.,HealthMetrics Outcomes Research | Fairman K.,Kathleen Fairman Ltd.
Psychiatric Services | Year: 2015

Objective: Patients with treatment-resistant schizophrenia commonly receive nonrecommended drug regimens, including antipsychotic polypharmacy, sometimes in lieu of clozapine. This analysis compared utilization and cost outcomes for cohorts of Medicaid beneficiaries treated with clozapine monotherapy and with antipsychotic polypharmacy. Methods: Data were from the Medicaid MarketScan database. Patients (age 18-64) initiated second-generation antipsychotic polypharmacy or clozapine monotherapy between July 2006 and January 2009, had continuous Medicaid coverage from six months before (preperiod) through 12 months after (postperiod) treatment initiation, and had a diagnosis of schizophrenic disorder (ICD-9-CM code 295.XX). Study outcomes included disease-specific and all-cause hospitalization, emergency department use, and Medicaid payments. Logistic regression analyses and generalized linear models controlled for demographic factors, preperiod utilization, and comorbidities. Results: Characteristics associated with use of clozapine monotherapy (N=479) instead of antipsychotic polypharmacy (N=2,440) included younger age, fewer comorbidities, lower preperiod utilization rates, nonwhite race, and male sex. When the analysis controlled for baseline differences, clozapine monotherapy was associated with lower odds of mental disorder-related (odds ratio [OR]=.75, 95% confidence interval [CI]=.60-.95) or schizophrenia-related (OR=.70, CI=.54-.90) emergency department use but not with hospitalization or all-cause emergency department use. Total Medicaid payments were significantly lower for the clozapine group than for the polypharmacy group: reductions of $21,315 for all-cause, $17,457 for mental disorder-related, and $10,582 for schizophrenia-related payments. Conclusions: Among nonelderly adult Medicaid beneficiaries with schizophrenia, treatment with clozapine instead of antipsychotic polypharmacy was associated with reduced disease-specific emergency department use and with reduced disease-specific and all-cause health care costs. © 2015, American Psychiatric Association. All rights reserved.


Miller R.M.,Cerner LifeSciences | Happe L.E.,Presbyterian College | Meyer K.L.,Global Outcomes Solutions | Spear R.J.,Xcenda
Journal of Managed Care Pharmacy | Year: 2012

Background: Multiple sclerosis (MS) is a chronic, disabling, and costly disease with several treatment options available; however, there is variability in evidence-based clinical guidelines. Therefore, payers are at a disadvantage when making management decisions without the benefit of definitive guidance from treatment guidelines. Objective: To outline approaches for the management of agents used to treat MS, as determined from a group of U.S. managed care pharmacists and physicians. Methods: A modified Delphi process was used to develop consensus statements regarding MS management approaches. The panel was composed of experts in managed care and included 8 pharmacy directors and 6 medical directors presently or previously involved in formulary decision making from 12 health plans, 1 specialty pharmacy, and 1 consulting company. These decision makers, who have experience designing health care benefits that include MS treatments, provided anonymous feedback through 2 rounds of web-based surveys and participated in 1 live panel meeting held in December 2010. Consensus was defined as a mean response of at least 3.3 or 100% of responses either "agree" or "strongly agree" (i.e., no panelist answered "disagree" or "strongly disagree") on a 4-item Likert scale (1 = strongly disagree, 2 = disagree, 3 = agree, 4 = strongly agree). Results: After 3 phases, these managed care representatives reached consensus on 25 statements for management of patients with MS. Consistent with managed care principles, this group of managed care experts found that health plans should consider efficacy, effectiveness, and safety, as well as patient preference, when evaluating MS therapies for formulary placement. Cost and contracting should be considered if efficacy and safety are judged to be comparable between agents. Conclusion: The consensus statements developed by a panel of managed care representatives provide some insight into decision making in formulary and utilization management of MS therapies. © 2012, Academy of Managed Care Pharmacy.


Diette G.B.,Johns Hopkins University | Dalal A.A.,Glaxosmithkline | D'souza A.O.,Xcenda | Lunacsek O.E.,Xcenda | Nagar S.P.,Glaxosmithkline
International Journal of COPD | Year: 2015

Background: This study evaluated patterns of pharmacotherapy in chronic obstructive pulmonary disease (COPD) as they relate to recommended guidelines in a prevalent COPD patient population with employer-sponsored health insurance in the US. Methods: Health care claims data from 2007 and 2008 were retrospectively analyzed for the study population defined as patients aged 40 years and older, continuously enrolled during the study period, and having at least one inpatient or one emergency department (ED) visit, or at least two outpatient claims coded with COPD (International Classification of Diseases, 9th Revision, Clinical Modification code 491.xx, 492.xx, 496.xx). Rates of any pharmacotherapy (both maintenance and reliever), long-acting maintenance pharmacotherapy in patients with an exacerbation history, and short-term treatment of acute exacerbations of COPD were evaluated in the overall population, newly diagnosed, and previously diagnosed patients (including maintenance-naïve and maintenance-experienced). Stratified analyses were also conducted by age group (40–64 years, ≤65 years) and physician specialty. Results: A total of 55,361 patients met study criteria of whom 39% were newly diagnosed. The mean age was 66 years, and 46% were male. Three-fourths (74%) of all COPD patients had some pharmacotherapy (maintenance or reliever) with less than half (45%) being treated with maintenance medications. The combination of an inhaled corticosteroid and a long-acting beta-agonist was the most prevalent drug class for maintenance treatment followed by tiotropium. Only 64% of patients with an exacerbation history had a prescription for a long-acting maintenance medication, and short-term treatment with oral corticosteroids or antibiotics was higher for hospitalization exacerbations compared to ED visit exacerbations (68% vs 44%). In general, the rates of pharmacotherapy were highest in patients who were maintenance-experienced followed by newly diagnosed and maintenance-naïve. Conclusion: The majority of COPD patients received maintenance or reliever COPD medications, but less than half received guideline-recommended care, especially those with an exacerbation history or receiving short-term treatment for acute exacerbations. © 2015 Weinreich et al.


D'souza A.O.,Xcenda | Shah M.,Xcenda | Dhamane A.D.,Xcenda | Dalal A.A.,Glaxosmithkline
COPD: Journal of Chronic Obstructive Pulmonary Disease | Year: 2014

Objective: To evaluate the clinical and economic burden of COPD patients to Medicaid. Study Design: Retrospective, observational matched cohort design. Methods: We calculated the incremental costs incurred and medical resources used by COPD patients relative to those without COPD. Data were obtained from 8 Medicaid states during 2003-2007. COPD patients were defined as Medicaid beneficiaries ≥40 years with a COPD diagnosis (ICD-9 CM: 491.xx, 492.xx, 496.xx) and treated with maintenance drugs for COPD. Patients were matched (1:3) to Medicaid beneficiaries without a COPD diagnosis on age, gender, race, index year, Medicare/Medicaid dual eligibility, and use of long-term care. Results were stratified by Medicare/Medicaid dual eligibility status and race. Results: A total of 10,221 COPD and 30,663 non-COPD patients were included. Cohorts were on average 65 years of age, 80% White, and 64.8% having Medicare/Medicaid dual eligibility. Inpatient hospitalizations and home healthcare visits/durable medical equipment were primary drivers of incremental medical costs. COPD patients were more than twice as likely to have a hospitalization (odds ratio [95% confidence interval] = 2.32 [2.19, 2.45]) or home healthcare visit/durable medical equipment (2.95 [2.82, 3.08]) compared to non-COPD patients. Medicaid incurred $2118/year in incremental costs due to COPD. On average, incremental costs were 7 times greater for non-dual-eligible patients ($4917) compared to dual-eligible patients ($667), and were more than double for Blacks compared to Whites ($4141 vs $1593). Conclusion: COPD imposes a substantial economic and clinical burden on the Medicaid program; this burden differs by dual eligibility status and race. © 2013 Informa Healthcare USA, Inc.


Boswell K.,Xcenda | Kwong W.J.,Johnson and Johnson Pharmaceutical Services LLC | Kavanagh S.,Worldwide Health Economics and Pricing
Journal of Opioid Management | Year: 2010

Opioid analgesia is the mainstay of treatment for moderate to severe acute and chronic pain and is highly effective in relieving pain but can be limited by side effects, the most common of which affect the gastrointestinal (GI) and central nervous systems. A growing body of evidence demonstrates that opioid-associated GI side effects constitute an important health problem with significant humanistic and economic consequences that warrant consideration by healthcare professionals and administrators in optimizing patients' pain management. This article documents the frequency of opioid-associated GI side effects and describes its clinical and economic burdens based on a systematic review of the medical literature between 1966 and 2008. © 2010 Journal of Opioid Management, All Rights Reserved.


Eaddy M.T.,Xcenda | Cook C.L.,Glaxosmithkline | O'Day K.,Xcenda | Burch S.P.,Glaxosmithkline | Cantrell C.R.,Glaxosmithkline
P and T | Year: 2012

Objective: We sought to assess the relationship between patient cost sharing; medication adherence; and clinical, utilization, and economic outcomes. Methodology:We conducted a literature review of articles and abstracts published from January 1974 to May 2008. Articles were identified using PubMed, Ovid, MEDLINE, Web of Science, and Google Scholar databases. The following terms were used in the search: adherence, compliance, copay, cost sharing, costs, noncompliance, outcomes, hospitalization, utilization, economics, income, and persistence. Results: We identified and included 160 articles in the review. Although the types of interventions, measures, and populations studied varied widely, we were able to identify relatively clear relationships between cost sharing, adherence, and outcomes. Of the articles that evaluated the relationship between changes in cost sharing and adherence, 85% showed that an increasing patient share of medication costs was significantly associated with a decrease in adherence. For articles that investigated the relationship between adherence and outcomes, the majority noted that increased adherence was associated with a statistically significant improvement in outcomes. Conclusion: Increasing patient cost sharing was associated with declines in medication adherence, which in turn was associated with poorer health outcomes.


Dalal A.A.,Glaxosmithkline | Shah M.,Xcenda | Lunacsek O.,Xcenda | Hanania N.A.,Baylor College of Medicine
COPD: Journal of Chronic Obstructive Pulmonary Disease | Year: 2011

Background: Anxiety and depression are common co-morbidities that can complicate the course of chronic obstructive pulmonary disease (COPD). The purpose of this study was to evaluate their impact on healthcare utilization and costs in a managed care COPD population. Methods: Administrative claims data were used to conduct a retrospective cohort study of COPD patients ≥40 years of age, including those with co-morbid COPD-Depression (including anxiety). COPD-Depression patients were matched to COPD patients without depression (COPD-Only cohort) using propensity scores. Conditional logistic regression models assessed the 1-year risk of COPD exacerbations (i.e., emergency room [ER] visit/inpatient hospitalization) between cohorts. Differences in annual all-cause and COPD-related utilization/costs, along with 2-year costs, were also compared between the cohorts. Results: There were 3,761 patients per cohort. Patients in the COPD-Depression cohort were 77% more likely to have a COPD-related hospitalization (odds ratio [OR] = 1.77, P < 0.001), 48% more likely to have an ER visit (OR = 1.48, P < 0.001), and 60% more likely to have hospitalization/ER visit (OR = 1.60, P < 0.001) compared to the COPD-Only cohort. Average annual all-cause medical cost per patient was $$23,759 for COPD-Depression vs $$17,765 for COPD-Only (P < 0.001) and total (medical plus pharmacy) cost was $$28,961 vs $$22,512 (P < 0.001), respectively; corresponding average annual COPD-related medical cost was $$2,040 vs $$1,392 (P < 0.001) and total cost was $$3, 185 vs $$2,680 (P < 0.001). Similar trends were observed over the 2-year period. Conclusions: In the COPD population, patients with depression/anxiety have significantly higher risk of COPD exacerbations and annual all-cause and COPD-related costs than patients without these co-morbidities. These findings may have therapeutic implications and seem worthy of further exploration. © 2011 Informa Healthcare USA, Inc.


Dalal A.A.,Moore Research | Shah M.,Xcenda | Lunacsek O.,Xcenda | Hanania N.A.,Baylor College of Medicine
Respiratory Medicine | Year: 2011

Background: Cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) commonly coexist, increasing the risk of hospitalization and mortality compared to either condition alone. The purpose of this study was to evaluate the impact of comorbid CVD on healthcare utilization and costs in a COPD population. Methods: A retrospective cohort study of COPD patients CVD ± ≥40 years of age using administrative claims data was conducted. COPD-CVD patients were matched to COPD patients without CVD (COPD-Only cohort) using propensity scores. Multivariate analyses were conducted to assess the 1-year risk of COPD exacerbations (hospitalization and/or emergency room [ER] visits), along with differences in 1-year and 2-year all-cause and COPD-related utilization and costs (2008 USD) among COPD-CVD and COPD-Only cohorts. Results: Each cohort included 4594 patients. Compared to COPD-Only cohort, the COPD-CVD cohort was almost 2 times more likely to require COPD-related hospitalization (odds ratio [OR], 1.95; p < 0.001), 47% more likely to have an ER visit (OR, 1.47; p < 0.001) and 62% more likely to require hospitalization and/or ER visit (OR, 1.62; p < 0.001). Average annual all-cause medical costs per patient were $22,755 for COPD-CVD vs $8036 for COPD-Only (p < 0.001), and total costs were $27,032 vs $11,506 (p < 0.001), respectively; corresponding average COPD-related annual medical costs were $1891 vs $1060 (p < 0.001) and total costs were $3295 vs $2379 (p < 0.001). Conclusions: COPD patients with CVD have significantly higher risk of COPD exacerbations and increased costs than COPD patients without CVD. This suggests a close association between COPD and CVD that warrants further exploration. © 2011 Elsevier Ltd. All rights reserved.

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