Browsing by Author "Xie, L."

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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
Pmh1 - Healthcare Utilization and Costs of Serotonin Syndrome With Concomitant Use of Serotonergic Agents
(2015) Wang, Z.; Xie, L.; Nguyen, C; Alley, S.; Başer, Onur
OBJECTIVES: Serotonin syndrome (SS) is an adverse drug reaction that may occurin patients receiving monotherapy or combinations of serotonergic agents (SAs).This study examined healthcare utilization and costs of SS in two different populations. METHODS: Adult (age ?18 years) patients prescribed SAs were identifiedusing the Veterans Health Administration (VHA) dataset (01OCT2008-30SEPT2012) andthe IMS PharMetrics Plus dataset (01JAN2010-31DEC2013). Patients with continuoushealth plan enrollment 12 months pre-index date, defined as the first SA prescription claim date, were included and observed until death, disenrollment or the end ofthe study period. Patients were assigned to cohorts based on drug exposure: singlemonoamine oxidase inhibitor (MAOI) drug, MAOI drugs in combination with otherSAs, single non-MAOI SA, and multiple non-MAOI SAs (2, 3, 4, and ?5 SAs). Outcomesof interest were annual incidences of SS event (ICD-9-CM: 333.99) and associatedhealth care utilization and costs.
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.
Citation - WoS: 2
Pnd43 - Adherence and Persistence To Anti-Epileptic Drugs Among Us Veterans Diagnosed With Epilepsy
(2015) Velez, F. F.; Başer, Onur; Xie, L.
OBJECTIVES: To evaluate patient adherence and persistence to anti-epileptic drug(AED) monotherapy. METHODS: Adult patients (age>18 years) with ?2 epilepsydiagnosis claims (ICD-9-CM:345) or one epilepsy diagnosis claim and one claim forother convulsion (ICD-9-CM: 780.39) were selected from the U.S. Veterans HealthAdministration database (01OCT2008-30SEPT2013). Patients were required tohave ?1 AED prescription post-epilepsy diagnosis, and the first AED prescription claim date was designated as the index date. Continuous health plan enrollment12 months pre- and post-index date was required. Patients were assigned to fourmonotherapy AED cohorts based on drug class: sodium channel blockers (SCs),gamma-aminobutyric acid analogs (GABAs), synaptic vesicle protein 2A binding(SV2) and multiple mechanisms (MMs). Adherence was assessed using the proportion of days covered (PDC) and persistence was defined as days to discontinuation with an allowable treatment gap of 45 days without the index AED. Logisticand Cox proportional hazards models were used to compare the results amongthe cohorts. RESULTS: Patients in the SC cohort had significantly lower baselineCharlson Comorbidity Index scores (1.82), indicating that they were healthier thanthose in the GAMA (2.08, p<0.001) and SV2 (2.46, p<0.001) cohorts. Patients in the SCcohort were significantly less likely to have a baseline psychiatric disorder (37.6%)than those in the GABA (63.8%, p<0.001) and MM (52.1%, p<0.001) cohorts. Patientstreated with GABAs (OR=0.44, p<0.001) and MMs (OR=0.63, p<0.001) were significantly less likely to adhere to their medications (PDC <80%) than those treatedwith SC. Furthermore, patients treated with GABAs (hazard ratio [HR]=1.74; 95%confidence interval [CI]=1.59-1.90) and MMs (HR=1.18; 95% CI=1.07-1.29) were morelikely to discontinue treatment during the follow-up period compared to those in theSC cohort. CONCLUSIONS: Patients treated with Sodium channel blockers are morelikely adhere to treatment and have lower discontinuation of AED monotherapythan those treated with GABAs and MMs.
Prs23 - a Descriptive Analysis of Patient Characteristics and Health Care Burden Associated With Chronic Obstructive Pulmonary Disease in the Us Medicare Population
(2015) Xie, L.; Kariburyo, M. Furaha; Wang, Y; Başer, Onur
Objectives: To evaluate the patient characteristics and health care burden associated with chronic obstructive pulmonary disease (COPD) in the U.S. Medicarepopulation. Methods: COPD patients were identified (International Classificationof Disease, 9th Revision, Clinical Modification [ICD-9-CM] codes: 491.xx, 492.xx and496.xx) using U.S. national Medicare claims from 01JAN2007 to 31DEC2010. The firstdiagnosis date was designated as the index date. Patients were required to: a) be age?65 years on the index date; b) have continuous medical and pharmacy benefits for 12months pre-index date (baseline period); c) have continuous enrollment for 12 monthspost-index date (follow-up period), unless there was earlier evidence of death; and d)have no COPD diagnosis pre-index date. The outcomes of interest included medicationuse, including a long-acting beta agonist (LABA) or LABA/inhaled corticosteroid (ICS)combination, mortality and health care resource utilization and costs. Results: Atotal of 543,249 COPD patients were identified. Patients were, on average, age 78 years.Most patients were white (94%) and resided in the South U.S. region (41%). The averageCharlson Comorbidity Index score was 3.23, and hypertension (67%), diabetes (28%),congestive heart failure (21%) and chronic pulmonary disease (20%) were the mostfrequently diagnosed comorbidities. A 13.82% mortality rate was observed duringthe first year of the follow-up period. Post-index LABA medications, including arfomoterol (0.55%), formoterol (0.25%) and salmeterol (0.32%) were prescribed to 1.10%of the population. Identified LABA/ICS combinations included budesonide/formoterol(1.97%) and fluticasone/salmeterol (10.02%). High health care resource utilization wasencountered for Medicare carrier (99.40%), pharmacy (90.27%), outpatient (76.52%)and inpatient visits (48.83%). The main cost drivers were inpatient ($10,645), Medicarecarrier ($4,888), outpatient ($3,322) and skilled nursing facility ($2,695) costs, resultingin $25,397 in total health care costs. Conclusions: U.S. Medicare patients have ahigh COPD-related health care burden