Browsing by Author "Shrestha, S"

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Demographic Distribution and Health Care Burden of Patients Diagnosed With Ankylosing Spondylitis in the Us Medicare Population
(2015) Mao, X; Li, L; Shrestha, S; Başer, Onur; Yuce, H; Wang, L
OBJECTIVES: To investigate the demographic distribution and health care burdenof patients diagnosed with ankylosing spondylitis (AS) using Medicare fee-forservice (FFS) data. METHODS: A retrospective analysis was performed using the100% Medicare FFS Datasets from October 1, 2008 through December 31, 2012.Patients diagnosed with AS were identified using International Classification ofDiseases, 9th Revision, Clinical Modification diagnosis code 720.0, and the firstdiagnosis date was designated as the index date. All patients were required tohave continuous medical and pharmacy benefits 1-year pre- (baseline period)and post-index date (follow-up period). Health care resource utilization and costsduring the baseline and follow-up periods were calculated. RESULTS: A total of8,990 AS patients were included in the study. The average age at diagnosis was 75years. Nearly 88.7% of patients were white, 62.97% were women and many residedin the South U.S. region (40.33%). The most common baseline comorbidities werechronic obstructive pulmonary disease (33.20%), diabetes (30.50%), cerebrovasculardisease (22.65%) and congestive heart failure (18.85%). During the follow-up period,73.04% of patients had inpatient admissions, 52.31% had emergency room visits,91.43% had outpatient office visits, 91.43% had outpatient visits and 57.67% hadpharmacy visits, resulting in average costs of, $37,077, $298, $5,397, $5,695 and$6,668, respectively. The average total costs were $49,440 during the follow-upperiod. The four most frequently prescribed medications for AS were prednisonehydrocodone (3.59%), bit/acetaminophen (3.17%), methotrexate sodium (2.79%)and levothyroxine sodium (2.42%). CONCLUSIONS: AS patient demographic andclinical characteristics in the Medicare population were assessed. Study patientswere often diagnosed with comorbid conditions, and had high health care utilization and costs.
Pcv113 - Assessing the Health Care Resource Utilization and Economic Burden Among Us Cardiovascular Disease Patients in the Veterans Health Administration Population
(2015) Mao, X; Shrestha, S; Başer, Onur; Wang, L
Objectives: To assess health care resource utilization and costs among U.S.patients diagnosed with cardiovascular disease (CVD) using the Veterans HealthAdministration (VHA) dataset. Methods: Patients diagnosed with CVD or whounderwent CVD-related procedures were identified (International Classificationof Disease, 9th Revision, Clinical Modification [ICD-9-CM] diagnosis codes 410, 412,411.1, 411.81, 411.89, 434, 436, 437.0, 437.1, 438, 997.02, 435 and 428, ICD-9 procedurecodes 00.66, 36.09 and current procedural terminology [CPT]-4 codes 33503-33545)using the VHA dataset from 01OCT2008 through 30SEPT2012. The initial diagnosisdate was designated as the index date. Patients without a CVD diagnosis, who wereof the same age, race and gender as study CVD patients, were identified for comparison. An index date was selected at random to minimize bias. Patients in bothgroups were required to be age ?18 years with continuous medical and pharmacybenefits 1 year pre- and post-index date. One-to-one propensity score matching(PSM) was used to compare health care resource utilization and costs between theCVD and comparison groups during the follow-up period, adjusting for baselinedemographic and clinical characteristics. Results: After risk-adjusted analysisusing PSM, 536,125 patients in each group were matched. More CVD patients hadinpatient admissions (14.40% vs. 1.43%, p<0.0001) and emergency room (14.89%vs. 3.66%, p<0.0001), outpatient office (60.90% vs. 47.19%, p<0.0001), outpatient(61.35% vs. 47.99%, p<0.0001) and pharmacy visits (64.41% vs. 54.89%, p<0.0001)compared to those without CVD. CVD patients also incurred higher costs. Costswere significantly higher for CVD patients than for those without CVD ($8,248vs. $1,638, p<0.0001). Conclusions: CVD patients in the VHA population morefrequently utilized health care resources and incurred higher costs than thosewithout CVD.
Pcv50 - a Retrospective Analysis of Health Care Resource Utilization and the Economic Burden Among Us Long-Term Care Facility Patients Diagnosed With Stroke
(2015) Huang, A; Shrestha, S; Başer, Onur; Yuce, H; Wang, L
Objectives: To assess the economic burden and health care resource utilization among patients in long-term care facilities who were diagnosed withstroke. Methods: Patients diagnosed with stroke (International Classification ofDiseases, 9th Revision, Clinical Modification diagnosis codes 433, 434 and 436) wereidentified using the Long Term Care Minimum Data Set (MDS) linked to 5% Medicaredata from 01JAN2009 through 31DEC2010. The initial diagnosis date was designatedas the index date. Patients without a stroke diagnosis (control cohort) were matchedto stroke patients, and 1:1 propensity score matching (PSM) was used to control forage, region, gender and baseline Charlson Comorbidity Index score. The index datefor the control cohort was randomly chosen to reduce selection bias. Patients inboth cohorts were required to be age ?65 years, have at least two consecutive quarterly assessments documented in MDS data 6 months prior to the index date andhave continuous medical and pharmacy benefits 1 year before and after the indexdate. Results: Once PSM was applied, 1,014 patients were included in each cohort,and baseline characteristics were balanced. A higher percentage of stroke patientshad inpatient admissions (40.34% vs. 23.37%, p<0.0001), outpatient visits (92.31%vs. 89.45%, p=0.0253), skilled nursing facility (SNF; 37.67% vs. 28.21%, p<0.0001) anddurable medical equipment (DME) claims (30.47% vs. 22.09%, p<0.0001) than thosein the control cohort. Stroke patients also incurred considerably higher inpatient($7,068 vs. $3,418, p<0.0001), outpatient ($3,545 vs. $2,539, p<0.0001), SNF ($8,036 vs.$3,695, p<0.0001), DME ($394 vs. $235, p=0.0023) and carrier claim costs ($3,606 vs.$2,489, p<0.0001) than those without a stroke diagnosis. Conclusions: Patientsdiagnosed with stroke had considerably higher health care resource utilization andcosts than those in the control cohort.
Pdb44 - Health Care Resource Utilization and Costs Among Diabetes Patients Residing in Long-Term Care Facilities
(2015) Huang, A; Shrestha, S; Başer, Onur; Yuce, H; Wang, L
OBJECTIVES: To evaluate health care resource utilization and costs among diabetespatients residing in long-term care facilities. METHODS: Patients diagnosed withdiabetes (International Classification of Diseases, 9th Revision, Clinical Modificationdiagnosis codes 250.x0, 250.x2) were identified using the Long-Term Care MinimumData Set (MDS) linked to 5% Medicare data from 01JAN2009 through 31DEC2010. Theinitial diagnosis date was designated as the index date. A comparison cohort wascreated for patients without diabetes, using 1:1 propensity score matching (PSM)to control for age, region, gender and baseline Charlson Comorbidity Index score.The index date for the comparison cohort was randomly chosen to reduce selection bias. Patients in both cohorts were required to be age ?65 years, have at leasttwo consecutive quarterly assessments documented in MDS data 6 months priorto the index date and have continuous medical and pharmacy benefits for 1-yearpre- and post-index date. Health care resource utilization and costs were comparedbetween the diabetes and comparison cohorts. RESULTS: After applying PSM, 783patients were included in each cohort, and baseline characteristics were balanced.Diabetes patients had a higher percentage of inpatient (31.29% vs. 22.73%, p=0.0001),skilled nursing facility (SNF, 31.55% vs. 22.73%, p<0.001), durable medical equipment (27.46% vs. 16.48%, p<0.0001) and pharmacy visit claims (93.10% vs. 88.76%,p=0.0028) compared to those without diabetes. Patients in the diabetes cohort alsoincurred significantly higher inpatient ($5,801 vs. $3,071, p<0.0001), SNF ($5,532 vs.$3,244, p<0.0001), carrier claim ($3,118 vs. $2,437, p=0.0002) and pharmacy visit costs($5,040 vs. $4,275, p=0.0005) than those in the comparison cohort. CONCLUSIONS:Patients diagnosed with diabetes had significantly higher health care resource utilization and costs than those without diabetes.
Pms37 - Health Care Cost Burden and Demographic Distribution of Patients Diagnosed With Psoriatic Arthritis in the Us Medicare Population
(2015) Li, L; Mao, X; Shrestha, S; Başer, Onur; Yuce H.; Li Wang
OBJECTIVES: To investigate the health care cost burden and demographic distributionof patients diagnosed with psoriatic arthritis (PSA) in the Medicare fee-for-service(FFS) Dataset. METHODS: A retrospective database analysis was performed usingthe 100% Medicare FFS Datasets from October 1, 2008 through December 31, 2012.Patients diagnosed with PSA were identified using International Classification ofDiseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis code 696.0, andthe index date was the date of the initial diagnosis. All patients were required to havecontinuous medical and pharmacy benefits 1-year pre- and post-index date. Healthcare costs and utilization during the baseline (1 year before the diagnosis date) andfollow-up (1 year after the diagnosis date) periods were calculated. RESULTS: Usingthe aforementioned criteria, 11,324 PSA patients were identified. The average ageat diagnosis was 74 years, 66.10% of patients were women and almost 92.36% werewhite. The majority of patients resided in the South U.S. region (39.01%). Diabetes(33.84%), chronic obstructive pulmonary disease (29.04%) and cerebrovascular disease(17.36%) were the main comorbidities observed during the baseline period. Duringthe follow-up period, 62.96% of patients had inpatient admissions, 47.29% had emergency room visits, 91.67% had outpatient office visits, 91.67% had outpatient visitsand 58.03% had pharmacy visits, costing, on average, $23,960, $237, $5,015, $5,252and $7,335, respectively. The average total cost of PSA patients was $36,548. The fivemost commonly prescribed medications for PSA were methotrexate sodium (4.54%),prednisone (3.37%), levothyroxine sodium (2.59%), hydrocodone bit/acetaminophen(2.43%) and simvastatin (2.11%). CONCLUSIONS: PSA patient demographic and healthcare cost information was obtained and the most commonly prescribed PSA medications were identified.
Pms38 - Demographic Distribution and Economic Burden of Patients Diagnosed With Rheumatoid Arthritis in the Us Medicare Population
(2015) Li, L; Mao, X; Shrestha, S; Başer, Onur; Yuce H.; Wang, Li
OBJECTIVES: To determine the demographic distribution and health care burden ofpatients diagnosed with rheumatoid arthritis (RA) using Medicare fee-for-service(FFS) data. METHODS: A retrospective analysis was performed using the 100%Medicare FFS datasets from October 1, 2008 through December 31, 2012. Patientsdiagnosed with RA were identified using International Classification of Diseases,9th Revision, Clinical Modification diagnosis code 714, and the first diagnosis datewas designated as the index date. All patients were required to have continuousmedical and pharmacy benefits 1 year pre- (baseline period) and post-index date(follow-up period). Health care resource utilization and costs during the baseline andfollow-up periods were calculated. RESULTS: Using Medicare FFS data, 112,550 RApatients were identified. The average age at diagnosis was 76 years, and 72.54% ofpatients were women and 83.94% were white. The most common baseline comorbidities were diabetes (35.48%), followed by chronic obstructive pulmonary disease(30.83%) and cerebrovascular disease (21.50%). During the follow-up period, 66.35%of patients had inpatient admissions, 49.01% had emergency room visits, 87.93%had outpatient office visits, 87.93% had outpatient visits and 61.67% had pharmacyvisits and costs were, on average, $26,510, $256, $4,204, $4,460 and $6,249, respectively. The average total costs incurred by RA patients were $37,219. The five mostcommonly-prescribed medications prescribed to treat RA were prednisone (3.40%),levothyroxine sodium (2.63%), hydrocodone bit/acetaminophen (2.39%), furosemide(2.13%) and omeprazole (2.13%). CONCLUSIONS: RA patient demographic distributions and RA-related health care cost information was obtained and the mostcommonly prescribed medications to treat RA were identified.
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Pnd29 - a Retrospective Analysis of the Economic Burden Among Patients Diagnosed With Chronic Migraine Using the Veterans Health Administration Medical Data
(2015) Mao, X; Shrestha, S; Başer, Onur; Wang, L
OBJECTIVES: To evaluate the health care resource utilization and costsamong patients diagnosed with chronic migraine (CM) in the Veterans HealthAdministration (VHA) medical dataset. METHODS: Patients diagnosed with CMwere identified (International Classification of Diseases, 9th Revision, ClinicalModification diagnosis code 346.XX) using the VHA dataset from October 1, 2008through September 30, 2010. The initial diagnosis date was designated as the indexdate. Patients without CM with the same age, gender and region (comparison cohort)were matched using a randomly chosen index date to minimize selection bias.Patients in both cohorts were at least age 18 years and had continuous medicaland pharmacy benefits for 1 year before and after the index date. One-to-one propensity score matching (PSM) was used to compare health care costs and utilizations between the CM and the comparison cohorts, and was adjusted for baselinedemographic and clinical characteristics. Pain scores were also included to investigate wellness after CM diagnosis. RESULTS: After risk-adjustment by PSM, 123,241patients in each cohort were matched. Significantly more CM patients had inpatientadmissions (6.44% vs. 1.75%, p<0.0001) and emergency room (ER; 14.42% vs. 5.50%,p<0.0001), outpatient office (68.80% vs. 42.15%, p<0.0001), outpatient (69.30% vs.42.91%, p<0.0001) and pharmacy visits (70.84% vs. 41.43%, p<0.0001) compared tothose without CM. Accordingly, CM patients also incurred higher costs for inpatient admissions and ER, office, outpatient and pharmacy visits compared to thosewithout CM. Total costs incurred by CM patients were $4,776, almost triple that of patients without CM ($1,756). There were more CM patients with accompanying painat all levels (mild: 19.53% vs. 0.16%; moderate: 13.10% vs. 0.10%; severe: 16.20% vs.0.12%; all p<0.0001). CONCLUSIONS: CM patients in the VHA population had substantial health care resource utilization, incurred higher costs and suffered worsepain compared to those without the disease.
Pnd30 - Health Care Resource Utilizations and Costs Among Migraine Patients in the Us Medicaid Population
(2015) Huang, A; Shrestha, S; Başer, Onur; Yuce H.; Wang, Li
OBJECTIVES: To examine the health care resource utilizations and costs amongmigraine patients in the U.S. Medicaid population. METHODS: Migraine patientswere identified (International Classification of Disease, 9th Revision, ClinicalModification [ICD-9-CM] diagnosis code 346) using Medicaid data from January 01,2009 through December 31, 2009. The first diagnosis date was designated as theindex date, and patients were required to have at least a 1-year baseline (pre-indexdate) and 1-year follow-up (post-index date) period. A comparison cohort was created for patients without a migraine diagnosis during the study period, using 1:1propensity score matching to control for age, region, gender and baseline CharlsonComorbidity Index score. The comparison cohort’s index date was chosen at random to minimize selection bias. Patients in both cohorts were required to be age?18 years and have continuous medical and pharmacy benefits 1-year pre- andpost-index date. Study outcomes (health care resource utilizations and costs) werecompared between the migraine and comparison cohorts. RESULTS: After applyingPSM, 380,751 patients were assigned to each cohort, and baseline characteristicswere well-balanced. A higher percentage of patients with migraines had inpatientstays (21.53% vs. 11.00%, p<0.0001), other therapy (99.88% vs. 65.78%, p<0.001) andpharmacy visit claims (90.52% vs. 48.35%, p<0.0001), compared to those without amigraine diagnosis. The patients in the migraine cohort also incurred significantlyhigher other therapy ($4,111 vs. $2,312, p<0.0001) and pharmacy visit costs ($1,074vs. $512, p<0.0001) than those in the comparison cohort. CONCLUSIONS: Migrainepatients incurred significantly higher costs and had higher health care resourceutilizations than those without migraines