Browsing by Author "Keshishian, A"

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A Comparative Analysis of the Health Care Utilization and Costs of Patients Diagnosed With and Without Liver Cancer in the Us Medicare Population
(2017) Ogbomo, A.; Lin, Y.; Keshishian, A; Xie, L; Yuce, H; Başer, Onur
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Assessing the Economic Burden and Health Care Utilization of Attention Deficit/Hyperactivity Disorder Among Us Medicaid Patients
(2016) Zhang Q; Zhao, Y; Keshishian, A; Xie, L; Yuce, H; Başer, Onur
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Comparing Health Care Resource Utilization and Costs Among Obese Patients in the Us Medicaid Population
(2016) Zhang, Q; Zhao, Y; Keshishian, A; Xie, L; Yuce H.; Başer, Onur
Objectives : To evaluate health care resource utilization and costs among obese patients in the U.S. Medicaid population.
Comparison of Major-Bleeding Risk and Health Care Costs Among Treatment-Naïve Non-Valvular Atrial Fibrillation Patients Initiating Apixaban, Dabigatran, Rivaroxaban, or Warfarin
(2015) Amin, Alpesh; Keshishian, A; Xie, L; Başer, Onur; Price, K; Vo, L; Singh, P; Bruno, A; Mardekian, J; Tan, W; Singhal, S; Patel, C; Odell, K; Trocio J.
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Comparison of Short Term Bleeding-Related Health Care Utilization and Costs Among Treatment-Naïve Non-Valvular Atrial Fibrillation Patients Initiating Apixaban, Dabigatran, Rivoxaban or Warfarin
(2015) Keshishian, A; Xie, L; Başer, Onur; Price, K; Vo, L; Singh, P; Bruno, A; Mardekian, J; Tan, W; Singha, S; Patel C; Odell, K; Trocio J.
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Demographic and Socioeconomic Characteristics That Impact Selection of Oral Anticoagulants Among Non-Valvular Atrial Fibrillation Patients
(2016) Keshishian, A; Du, J; Xie, L; Yuce H.; Başer, Onur
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Early Comparison of Major Bleeding, Stroke and Associated Medical Costs Among Treatment-Naive Non-Valvular Atrial Fibrillation Patients Initiating Apixaban, Dabigatran, Rivaroxaban or Warfarin
(2015) Alpesh, A; Keshishian, A; Xie, L; Başer, Onur; Price, K; Vo, L; Singh, P; Bruno, A; Mardekian, J; Tan, W; Singhal, S; Patel, C; Odell, K; Trocio J.
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Evaluating Asthma-Related Expenses and Health Care Resource Utilization Among Children in the Us Medicaid Population
(2016) Zhang, Q; Zhao, Y; Keshishian, A; Xie L; Yuce H.; Başer, Onur
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Evaluating Fracture-Related Expenses and Health Care Resource Utilization Among Post-Menopausal Women in the Us Medicaid Population
(2015) Xie, L.; Keshishian, A; Wang, Y.; Başer, Onur
Objectives: Use of potentially inappropriate medications (PIMs) among the elderlyis a serious public health problem because it is intrinsically linked to increasedmorbidity and mortality, causing the high costs to public health systems. Objectivesof this study were to determine the prevalence and predictors of PIM prescribingin elderly inpatients using STOP and START criteria Methods: The prospectiveobservational study was carried at a private tertiary care hospital. Prescriptionsof elderly inpatients aged 60 years and above were collected and analyzed. PIMswere identified with the help of STOP and START criteria. Predictors associatedwith use of PIMs were identified by bivariate and multivariate logistic regressionanalysis. Results: The results were based on data of 60 patients. More than half(56%) were males and 50% were aged between 60–69 years with a mean averageage of 69 years. Mean number of diagnoses and medications were two and nine,respectively. A total of 18 (30%) patients were prescribed with at least 1 PIM accordingSTOP Criteria. Most commonly prescribed PIMs were systemic corticosteroids (29%)followed by theophyline (18%) and betablockers (10%). On multivariate regression,important predictors for PIM prescribing were found to polypharmacy, number ofdiagnoses. Co nclusions: The results show that PIMs prescribing is high in Indianelderly inpatients STOP and START criteria, it is more effective in identifying thePIMs. This study is ongoing and we will present the data upto 250 patents beforethe presentation
Evaluating the Economic Burden and Health Care Utilization of Coronary Artery Disease in the Us Medi-Cal Population
(2016) Zhang, Q; Zhao, Y; Keshishian, A; Xie, L; Yuce, H; Başer, Onur
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Examination of the Economic Burden of Dyslipidemia in the Veterans Health Administration Population
(2016) Keshishian, A; Tan, H; Xie, L; Başer, Onur
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Examining the Economic Burden and Health Care Utilization of Menopausal Women in the U.s. Medicaid Population
(2015) Keshishian, A; Wang, Y; Xie, L; Başer, Onur; Yuce H.
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Pcn62 - Assessing the Economic Burden and Health Care Resource Utilizations of Us Medica Re Patients With Myeloproliferative Neoplasms
(2015) Keshishian, A; Du, J; Xie, L; Başer, Onur
OBJECTIVES: To examine the economic burden and health care resource utilization of myeloproliferative neoplasms (MPNs) in the U.S. Medicare population. METHODS: A retrospective data analysis was performed using the U.S.national Medicare claims from January 2008 through December 2012. MPN patientswere identified using International Classification of Disease 9th Revision ClinicalModification (ICD-9-CM) diagnosis codes 238.4, 238.71, 238.76 and 289.83. The diagnosis date was designated as the index date. A comparison cohort without a MPNdiagnosis was created for patients of the same age, region, gender, index year andbaseline Charlson Comorbidity Index score. A random index date was chosen forthe comparison cohort to reduce selection bias. Patients were required to havecontinuous medical and pharmacy benefits 1 year pre- and post-index date. Oneto-one propensity score matching (PSM) was performed to compare follow-uphealth care costs and utilizations between the cohorts, adjusting for demographicand clinical characteristics. RESULTS: Eligible patients (N=17,950) were identifiedfor the MPN and comparison cohorts. After 1:1 PSM, a total of 5,546 patients werematched from each cohort and baseline characteristics were well-balanced. MPNpatients had a higher percentage of health care resource utilizations, includingMedicare carrier (98.6% vs. 65.9%), Durable Medical Equipment (DME; 29.5% vs.14.4%), Home Health Agency (HHA; 12.4% vs. 5.0%), outpatient visits (76.6% vs.37.4%), inpatient hospitalizations (27.2% vs. 6.8%) and Skilled Nursing Facility (SNF;7.5% vs. 2.0%) visits than non-MPN patients. Patients diagnosed with MPNs alsoincurred significantly higher costs, including Medicare carrier ($3,872 vs. $1,283),DME ($266 vs. $91), HHA ($639 vs. $250), outpatient ($10,061 vs. $3,204), inpatient($5,449 vs. $1,054), pharmacy ($1,069 vs. $713) and total health care costs ($23,060vs. $7,076; p<0.0001). CONCLUSIONS: MPN patients had a higher burden of illnesscompared to non-MPN patients.
Pcn62 - Assessing the Economic Burden of Us Medicare Patients Diagnosed With Non-hodgkin's Lymphoma
(2015) Xie, L; Keshishian, A; Du, J; Başer, Onur
OBJECTIVES: To evaluate the health care resource utilization and economic burdenof non-Hodgkin’s lymphoma (NHL) in the U.S. Medicare population. METHODS:NHL patients were identified (International Classification of Diseases, 9th Revision,Clinical Modification [ICD-9-CM] diagnosis codes 200.xx and 202.xx) using nationalU.S. Medicare claims from January 1, 2009 through December 31, 2011. The first diagnosis date was designated as the index date for the NHL cohort. Control patients of thesame age, region, gender and index year were identified and matched to case patientsbased on baseline Charlson Comorbidity Index (CCI) scores, and were assigned a randomly chosen index date to minimize selection bias. Patients were required to havecontinuous medical and pharmacy benefits 1 year pre- and post-index date. Studyoutcomes, including health care costs and utilizations, were compared between thedisease and comparison cohorts using 1:1 propensity score matching (PSM). RESULTS:A total of 20,254 patients were included in the NHL and comparison cohorts. After1:1 PSM, 4,705 patients were matched from each cohort and baseline characteristicswere balanced. Patients diagnosed with NHL were more likely to utilize health careresources including Medicare carrier (99.0% vs. 70.5%), Durable Medical Equipment(DME, 28.1% vs. 17.7%), Home Health Agency (HHA, 11.4% vs. 4.8%), outpatient visits(80.2% vs. 41.0%), inpatient stays (25.7% vs. 7.4%) and Skilled Nursing Facility (SNF,4.8% vs. 1.7%) and hospice admissions (0.9% vs. 0.3%). Patients diagnosed with NHLalso incurred higher Medicare carrier ($10,603 vs. $1,522), DME ($264 vs. $120), HHA($531 vs. $270), outpatient ($30,013 vs. $4,268), inpatient ($5,762 vs. $1,167), SNF ($875vs. $307), hospice ($197 vs. $67), pharmacy ($1,050 vs. $785) and total costs ($49,296vs. $8,507; p<0.005). CONCLUSIONS: The economic burden and health care resourceutilizations were significantly higher for patients diagnosed with NHL compared topatients without NHL.
Pih13 - Examining the Fracture-Related Cost Burden and Health Care Resource Utilization Post-Menopause in the Us Medicare Population
(2015) Xie, L; Keshishian, A; Du, J; Başer, Onur
Objectives: To examine the fracture-related cost burden and healthcareresource utilization among post-menopausal women in the U.S. Medicare population. Methods: Post-menopausal women were identified using InternationalClassification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosiscodes from the U.S. Medicare claims dataset from 01JAN2008 through 31DEC2012.The first fracture diagnosis date was designated as the index date. One year ofcontinuous health plan enrollment was required for all patients pre- and postindex date. A comparison group was created, identifying patients without fracturesof the same age, region, gender and index year and were matched to case patientsbased on baseline Charlson Comorbidity Index scores. A randomly chosen indexdate for the comparison group reduced selection bias. Healthcare costs and utilizations were compared using 1:1 propensity score matching (PSM). Results: Beforematching (n=182,124), patients with fractures were more likely to be white (92.6%vs. 85.8%), reside in the Northeast U.S. region (19.4% vs. 16.4%), and have diagnosis of depression (18.0% vs. 13.0%) and chronic obstructive pulmonary disease(26.3% vs. 23.3%). After 1:1 PSM, 65,549 patients were included in each cohort andbaseline characteristics were well-balanced. Significantly more post-menopausalwomen with fractures had inpatient admission (42.3% vs. 8.6%, p<0.0001), outpatient (80.3% vs. 48.7%, p<0.0001), home health agency (31.2% vs. 6.9%, p<0.0001)skilled nursing facility (SNF) (25.7% vs. 2.72%, p<0.0001) and hospice admission(1.4% vs. 1.0%, p<0.0001) claims. Higher healthcare resource utilization translated to higher costs for post-menopausal fracture patients, including inpatient($7,869 vs. $1,203, p<0.0001), outpatient ($1,928 vs. $622, p<0.0001), SNF ($5,980vs. $437, p<0.0001), hospice ($338 vs. $244, p<0.0001), pharmacy ($1,052 vs. $829,p<0.0001) and total costs ($23,097 vs. $5,247, p<0.0001), than for those in the comparison cohort. Conclusions: Post-menopausal women with fractures in theU.S. Medicare population had higher healthcare resource utilization and expenditures than those without fractures.
Pmh21 - Comparing the Healthcare Utilization and Costs of Early- and Late-Stage Alzheimer's Disease Patients Residing in Long-Term Care Facilities
(2015) Xie, L.; Keshishian, A; Wang, Y.; Başer, Onur
OBJECTIVES: To compare healthcare utilization and costs between early- andlate-stage Alzheimer’s disease (AD) patients residing in long-term care (LTC)facilities. METHODS: Patients diagnosed with AD (International Classification ofDiseases, 9th Revision, Clinical Modification [ICD-9-CM] code 331.0) were identifiedusing U.S. Medicare claims linked with the Long-Term Care Minimum Data Set (MDS)from 01JULY2008 through 31DEC2010. The first diagnosis date was designated asthe index date. Patients were required to be age ?65 years, with continuous medicaland pharmacy benefits for 6 months pre- and post-index date, and reside in an LTCfacility. Patients were categorized as early- or late-stage. Late-stage AD was definedby a cognitive performance scale score ?5 (range 0-6) and Activities of Daily Livingshort-form activities score ?10 points. Patients with and without AD were matchedbased on demographic and clinical characteristics, and 1:1 propensity score matching was used to compare follow-up all-cause and AD-related healthcare costs andutilizations. RESULTS: Before matching, late-stage AD patients (n=5,323) were lesslikely to be white (83.0% vs. 86.4%), male (16.4% vs. 21.7%) and have comorbid conditions measured by the Charlson Comorbidity Index score (3.55 vs. 4.83, p<0.001) thanearly-stage AD patients (n=20,023). After 1:1 matching, 3,804 patients were matchedfrom each cohort and baseline characteristics were balanced. Fewer late-stage ADpatients had skilled nursing facility admissions (25.3% vs. 29.8%, p<0.0001), but morehad hospice admissions (17.8% vs. 7.3%, p<0.0001) and pharmacy visits (85.8% vs.81.9%, p<0.0001) than early-stage AD patients. There were no significant differencesin total all-cause healthcare costs; however, late-stage AD patients incurred significantly higher disease-related total ($14,739 vs. $13,673, p=0.0242) and hospice costs($4,157 vs. $1,553, p<0.0001) compared to early-stage AD patients. CONCLUSIONS:Patients with late-stage AD incurred higher disease-related costs than those withearly-stage AD; however, there were no significant differences in total all-causehealthcare costs.
Real-World Comparison of Major Bleeding and Associated Costs Among Treatment-Naïve Nonvalvular Atrial Fibrillation Patients Initiating Apixaban or Warfarin
(2016) Amin, Alpesh; Keshishian, A; Xie L; Başer, Onur; Price, K; Vo, L; Mardekian, J; Mendoza, M; Singhal, S; Patel, C; Odell, K; Trocio, J
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Real-World Comparison of Major Bleeding Risk Among Untreated Non-Valvular Atrial Fibrillation Patients and Those Initiating Apixaban, Dabigatran, Rivaroxaban, or Warfarin
(2016) Amin, Alpesh; Keshishian, A; Xie, L; Başer, Onur; Price, K; Lien Vo; Mardekian, J; Mendoza, M; Singhal, S; Patel, C; Odell, K; Trocio J.
Background: Recent large randomized controlled trials have shown that novel oral anticoagulants (NOACs) are at least as effective as warfarin for risk reduction of stroke in patients with non-valvular atrial fibrillation (NVAF) and are associated with similar or lower rates of bleeding. The study aim was to compare major bleeding risk among untreated NVAF patients to those initiating apixaban, dabigatran, rivaroxaban or warfarin
Citation - WoS: 59
Citation - Scopus: 60
Risk of Stroke/Systemic Embolism, Major Bleeding and Associated Costs in Non-Valvular Atrial Fibrillation Patients Who Initiated Apixaban, Dabigatran or Rivaroxaban Compared With Warfarin in the United States Medicare Population
(2017) Amin, Alpesh; Lien Vo; Trocio, Jeffrey; Keshishian, A; Liu, Xianchen; Mardekian, Jack; Zhang, Qisu; Rosenblatt, Lisa; Dina, Oluwaseyi; Başer, Onur; Le, Hannah
Objective: To compare the risk and cost of stroke/systemic embolism (SE) and major bleeding between each direct oral anticoagulant (DOAC) and warfarin among non-valvular atrial fibrillation (NVAF) patients. Methods: Patients (65 years) initiating warfarin or DOACs (apixaban, rivaroxaban, and dabigatran) were selected from the Medicare database from 1 January 2013 to 31 December 2014. Patients initiating each DOAC were matched 1:1 to warfarin patients using propensity score matching to balance demographics and clinical characteristics. Cox proportional hazards models were used to estimate the risks of stroke/SE and major bleeding of each DOAC vs. warfarin. Two-part models were used to compare the stroke/SE- and major-bleeding-related medical costs between matched cohorts. Results: Of the 186,132 eligible patients, 20,803 apixaban-warfarin pairs, 52,476 rivaroxaban-warfarin pairs, and 16,731 dabigatran-warfarin pairs were matched. Apixaban (hazard ratio [HR]=0.40; 95% confidence interval [CI] 0.31, 0.53) and rivaroxaban (HR=0.72; 95% CI 0.63, 0.83) were significantly associated with lower risk of stroke/SE compared to warfarin. Apixaban (HR=0.51; 95% CI 0.44, 0.58) and dabigatran (HR=0.79; 95% CI 0.69, 0.91) were significantly associated with lower risk of major bleeding; rivaroxaban (HR=1.17; 95% CI 1.10, 1.26) was significantly associated with higher risk of major bleeding compared to warfarin. Compared to warfarin, apixaban ($63 vs. $131) and rivaroxaban ($93 vs. $139) had significantly lower stroke/SE-related medical costs; apixaban ($292 vs. $529) and dabigatran ($369 vs. $450) had significantly lower major bleeding-related medical costs. Conclusions: Among the DOACs in the study, only apixaban is associated with a significantly lower risk of stroke/SE and major bleeding and lower related medical costs compared to warfarin.
Citation - WoS: 3
Citation - Scopus: 2
The Economic Impact of Symptomatic Menopause Among Low-Socioeconomic Women in the United States
(2016) Başer, Onur; Keshishian, A; Xie, Lin; Wang, Yuexi
Background: Menopausal symptoms have a significant negative impact on patient's quality of life and increase healthcare costs among women. Methods: This retrospective analysis used data from a U.S. national database (01 January 2008-31 December 2010). Patients with a diagnosis of menopause symptoms or a prescription claim for hormone therapy were matched to control patients. Healthcare resource utilization and costs during the 6-month follow-up period were compared. Generalized linear models were used to adjust for differences in baseline and demographic characteristics between the cohorts. Results: A total of 71,076 patients were included in each cohort. Patients with menopausal symptoms were more likely to have depression and anxiety and incurred significantly higher follow-up healthcare costs ($7237 vs $6739, p < 0.001) and healthcare utilization during the 6-month follow-up period. Conclusion: Patients diagnosed with menopausal symptoms or treated with hormone therapy incurred significantly higher healthcare costs than those without menopausal symptoms or treatment.