Ekonomi Bölümü Koleksiyonu

Permanent URI for this collectionhttps://hdl.handle.net/20.500.11779/1936

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Citation - WoS: 5
Fuzzy Optimization for Portfolio Selection Based on Embedding Theorem in Fuzzy Normed Linear Spaces
(De Gruyter, 2014) Solatikia, Farnaz; Kılıç, Erdem; Weber, Gerhard-Wilhelm
In this paper, we propose a novel approach Embedding Theoremabout Menger probabilistic normed Spaces. The main idea behind ourapproach consists of taking advantage of interplays between Mengerprobabilistic normed spaces and normed spaces in a way to get anequivalent stochastic program. This helps avoiding pitfalls due to severe over simplification of the reality. The embedding theorem showsthat the set of all fuzzy numbers can be embedded into a Mengerprobabilistic Banach space. Inspired by this embedding theorem, wepropose a solution concept of fuzzy optimization problem which isobtained by applying the embedding function to the original fuzzyoptimization problem.
Citation - WoS: 3
Citation - Scopus: 3
Cancer Chemotherapy Treatment Patterns and Febrile Neutropenia in the Us Veterans Health Administration
(2014) Wang, Li; Dale, David C; Barron, Richard; Langeberg, Wendy J; Başer, Onur
Background: The Veterans Health Administration (VHA) is the largest integrated health care system in the United States and a major cancer care provider. Objective: To use VHA database to conduct a population-based study of patterns of myelosuppressive chemotherapy use and to assess the incidence and management of febrile neutropenia (FN) among VHA patients with lung, colorectal, or prostate cancer or non-Hodgkin lymphoma (NHL). Methods: Data were extracted for the initial myelosuppressive chemotherapy course for 27,899 patients who began treatment in the period 2006 to 2011. FN-related costs were defined as claims containing FN diagnosis. Results: Most patients were men (98.0%); most were 65 years or older (55.8%). Patients received a mean 3.4 to 3.9 chemotherapy cycles/course (median cycle duration 34-43 days). The incidence of FN among patients with lung, colorectal, or prostate cancer or NHL was 10.2%, 4.6%, 5.4%, and 17.3%, respectively. Primary or secondary prophylactic antibiotics/colony-stimulating factors were received by 21% and 12% of patients, respectively. Antibiotics were more commonly given as primary or secondary prophylaxis for patients with lung, colorectal, and prostate cancer; colony-stimulating factors were more common for patients with NHL. Among patients with FN, those with lung cancer had the highest inpatient mortality (10%); patients with NHL had the highest costs ($24,571) and the longest hospital length of stay (15.4 days). Conclusions: VHA cancer care was generally consistent with National Comprehensive Cancer Network recommendations; however, compared with the general population, chemotherapy cycles were longer, combination chemotherapy was used less, and treatment to prevent FN was used less, differences that may be attributed to the unique VHA patient population. The impact of these practices warrants further investigation.
Citation - WoS: 8
Citation - Scopus: 9
A Value-Adding Approach To Reliability Under Preventive Maintenance Costs and Its Applications
(2014) Dubey, Rameshwar; Kılıç, Erdem; Ali, Sadia Samar; Weber, Gerhard Wilhelm
No equipment (system) can be perfectly reliable in spite of the utmost care and best efforts on the part of the designer, decision-maker and manufacturer. The two sides of maintenance are corrective and preventive maintenance. It is generally assumed that a preventive maintenance action is less costly than a repair maintenance action. We examine this proposition in detail on the basis of a failure-time model that relates conformance quality to reliability. Illustratively, we present reliability in the context of contracts with asymmetric information. The model shows how to overcome information rents through price distortions and quantity rationing. The paper ends with a conclusion and an outlook to future studies.
Citation - WoS: 14
Citation - Scopus: 13
Hepatic Decompensation in Patients With Hiv/Hepatitis B Virus (hbv)/Hepatitis C Virus (hcv) Triple Infection Versus Hiv/Hcv Coinfection and the Effect of Anti-Hbv Nucleos(t)ide Therapy
(2014) Wang, Li; Devine, Scott; Lo Re, Vincent, III; Olufade, Temitope; Başer, Onur
The incidence rate of hepatic decompensation was higher in patients with human immunodeficiency virus (HIV)/hepatitis B virus (HBV)/hepatitis C virus (HCV) triple infection than in those with HIV/HCV coinfection (24.1 vs 10.8 events per 1000 person-years; hazard ratio [HR], 1.89; 95% confidence interval [CI], 1.12–3.18). Compared with HIV/HCVinfected patients, the rate of decompensation was increased among HIV/HBV/HCV-infected patients receiving no anti-HBV therapy (HR, 2.48; 95% CI, 1.37–4.49) but not among those who did receive such therapy (HR, 1.09; 95% CI, .40–2.97)
Ekonomik Öncü Göstergelerinin Bes Katılımcı Sayısı Üzerindeki Etkisi
(Maliye Finans Yazıları Dergisi, 2014) Kılıç, Erdem
Ekonomik öncü göstergelerinin Bireysel Emeklilik Sistemi (BES) katılımcı sayısı üzerindeki etkisi sayıma dayalı olan yöntemler ile araştırılmıştır. Geçinme endeksinde bulunan tüm değişkenler ile katılımcı sayısı arasında pozitif bir ilişki bulunmuştur. Harcamalar, BES katılımcı sayısı üzerinde pozitif bir etkiye sahipken, katılımcı sayısı tasarruflar ele alındığında düşmektedir. Dayanıksız mallar ve hizmetler için yapılan harcamalar katılımcı sayısı üzerinde büyük bir etkiye sahiptirler. Enflasyon ve BES katılımcı sayısı arasında anlamlı bir ilişki bulunmaktadır. BES katılımı ile ilgili ileriye yönelik projeksiyonlarda, devlet katkı payının ve toplumdaki BES’e ilişkin bilinçlenmenin etkileri analize dahil edilmelidir.
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.
...
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
Evaluation of the Burden of Parkinson’s Disease in Medicare and Linked Long Term Care Populations
(2015) Xie, L; Tan, H; Ogbomo, A; Wang, Y; Başer, Onur; Yuce H.
Objectives: To examine the economic burden and health care utilization forpatients diagnosed with Parkinson’s disease using linked data from Medicare andthe Long Term Care (LTC) Minimum Data Set (MDS). Methods: Patients wereincluded in the study if they had at least one diagnosis claim for Parkinson’s disease(International Classification of Diseases, 9thRevision, Clinical Modification code 332.xx) during the identification period (01JUL2008-31DEC2010). The first Parkinson’s disease diagnosis claim date was designated as the index date. Patients were requiredto be age ?65 and have continuous health plan enrollment with medical benefitsfor 6 months pre- and post-index date. Residents in a LTC facility were defined asstudy patients using two quarterly assessments recorded in the MDS during the6-month baseline period. Demographic and clinical characteristics and follow-uphealth care costs and utilizations were described. Results: After 1:1 matching,1,620 patients were included in each group (disease and control patients), and thebaseline characteristics were well-balanced. Patients with Parkinson’s diseasewere more likely to have inpatient stays (14.26% vs. 9.51%, p<0.0001), outpatientvisits (47.72% vs. 41.11%, p=0.0002), skilled nursing facility (SNF) visits (20.37% vs.4.51%, p<0.0001), hospice visits (8.64% vs. 1.36%, p<0.0001), and part D pharmacyvisit (62.65% vs. 53.33%, p<0.0001). Compared to control patients, higher all-causehealth care costs were also observed for Parkinson’s disease patients, includinginpatient costs ($2,451 vs. $1,301, p<0.0001), SNF costs ($2,503 vs. $778, p<0.0001),hospice costs ($1,164 vs. $245, p<0.0001), total outpatient costs ($4,477 vs. $1,304,p<0.0001), pharmacy costs ($695 vs. $1,399, p<0.0001) and total costs ($9,775 vs.$5,314, p<0.0001). Conclusions: During a period of 12 months, patients diagnosed with Parkinson’s disease had higher health care utilization and costs thanmatched control patients.
Fayda, Sosyal Seçim ve Mutluluk. Makale
(2015) Gökgemir, Özge; Öztürk, Murat
...
Venous Thromboembolism Recurrence and Bleeding Risk Among Cancer Patients Using a Large Commercial Database
(2015) Masseria, C; Kariburyo, M. Furaha; Mardekian, J; Lee, C; Ravee, Y; Phatak, H; Başer, Onur; Hamilton, M; Xie, L
...
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.
Citation - WoS: 25
Citation - Scopus: 25
Impact of Switching From an Initial Tumor Necrosis Factor Inhibitor on Health Care Resource Utilization and Costs Among Patients With Rheumatoid Arthritis
(2015) Roy, Sanjoy; Ganguli, Arijit; Xie, Lin; Başer, Onur; Cifaldi, Mary
Purpose: Despite improved clinical outcomes for the majority of patients, nearly 30% of patients with rheumatoid arthritis (RA) who initiate tumor necrosis factor antagonist (anti-TNF) biologic agents fail to respond to their first-line anti-TNF and switch to another anti-TNF or a non-TNF biologic. How this change affects health care costs and resource utilization is unknown. We therefore compared RA patients taking first-line anti-TNFs who switched to a second anti-TNF versus those patients who switched to an alternate biologic. Methods: Health care claims data were obtained from a large US database for eligible adults with confirmed RA diagnoses who initiated anti-TNF treatment and switched to another biologic. Health care costs and utilization during the first 12 months' postswitch were compared. Generalized linear models were used to adjust for differences in demographic and clinical characteristics before switching. Findings: Patients who switched to a second anti-TNF rather than a non-TNF biologic were generally younger (53.0 vs. 55.3 years; P < 0.0001) and less likely to be female (79.7% vs. 82.7%; P = 0.0490). Of the 3497 eligible patients who switched from first-line anti-TNFs, 2563 (73.3%) switched to another anti-TNF and 934 (26.7%) switched to a non-TNF. Adalimumab was the most frequently prescribed (43.4%) second-line anti-TNF, and abatacept was the most common non anti-TNF (71.4%). Patients who switched to a second anti-TNF remained on their first medication for a significantly shorter period (342.5 vs 420.6 days; P < 0.0001) and had lower comorbidity indices and higher disease severity at baseline than those who switched to a non anti-TNF. After adjusting for baseline differences, patients who switched to second anti-TNFs versus a non-TNF incurred lower RA-related costs ($20,938.9 vs $22,645.2; P = 0.0010) and total health care costs ($34,894.6 vs $38,437.2; P = 0.0010) 1 year postswitch. These differences were driven by increased physician office visit costs among the non-TNF group. Implications: Among the anti-TNF initiators who switched therapy, more patients switched to a second anti-TNF than to a non-TNF. Switching to a second anti-TNF treatment was associated with lower all-cause and RA-related health care costs and resource utilization than switching to a non-TNF. Because switching therapy may be unavoidable, finding a treatment algorithm mitigating this increase to any extent should be considered. These data are limited by their retrospective design. Additional confounding variables that could not be controlled for may affect results. (C) 2015 The Authors. Published by Elsevier HS journals, Inc.
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.
Citation - WoS: 30
Citation - Scopus: 29
Out-Of Inr Values and Outcomes Among New Warfarin Patients With Non-Valvular Atrial Fibrillation
(2015) Schein, Jeffrey R; Wang, Li; Damaraju, Chandrasekharrao, V; Nelson, Winnie W; Başer, Onur
Background Although efficacious in stroke prevention in non-valvular atrial fibrillation, many warfarin patients are sub-optimally managed. Objective To evaluate the association of international normalized ratio control and clinical outcomes among new warfarin patients with non-valvular atrial fibrillation. Setting Adult non-valvular atrial fibrillation patients (a parts per thousand yen18 years) initiating warfarin treatment were selected from the US Veterans Health Administration dataset between 10/2007 and 9/2012. Method Valid international normalized ratio values were examined from the warfarin initiation date through the earlier of the first clinical outcome, end of warfarin exposure or death. Each patient contributed multiple in-range and out-of-range time periods. Main outcome measure The relative risk ratios of clinical outcomes associated with international normalized ratio control were estimated. Results 34,346 patients were included for analysis. During the warfarin exposure period, the incidence of events per 100 person-years was highest when patients had international normalized ratio < 2:13.66 for acute coronary syndrome; 10.30 for ischemic stroke; 2.93 for transient ischemic attack; 1.81 for systemic embolism; and 4.55 for major bleeding. Poisson regression confirmed that during periods with international normalized ratio < 2, patients were at increased risk of developing acute coronary syndrome (relative risk ratio: 7.9; 95 % confidence interval 6.9-9.1), ischemic stroke (relative risk ratio: 7.6; 95 % confidence interval 6.5-8.9), transient ischemic attack (relative risk ratio: 8.2; 95 % confidence interval 6.1-11.2), systemic embolism (relative risk ratio: 6.3; 95 % confidence interval 4.4-8.9) and major bleeding (relative risk ratio: 2.6; 95 % confidence interval 2.2-3.0). During time periods with international normalized ratio > 3, patients had significantly increased risk of major bleeding (relative risk ratio: 1.5; 95 % confidence interval 1.2-2.0). Conclusion In a Veterans Health Administration non-valvular atrial fibrillation population, exposure to out-of-range international normalized ratio values was associated with significantly increased risk of adverse clinical outcomes.
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.
Pmh15 - Prevalence and Incidence Rates Among Alcohol-Dependent Patients in the Us Medicare Population
(2015) Li, L,; Shrestha, S.; Başer, Onur; Yuce H.; Li Wang
OBJECTIVES: To examine incidence and prevalence rates among alcohol-dependentpatients in the U.S. Medicare population. METHODS: A prospective study was performed from 01JAN2008 through 31DEC2012 to determine the prevalence and incidence of patients diagnosed with alcohol dependence (International Classificationof Diseases, 9th Revision, Clinical Modification diagnosis code 303) in the U.S.Medicare population. Patients were required to have continuous enrollment in afee-for-service Medicare health plan during the calendar year and at least 2 yearsprior. The age- and gender-adjusted prevalence and incidence (overall and ageand gender-specific) rates of alcohol-dependent patients were calculated by directstandardization to the U.S. population age ?65 years in 2010. RESULTS: The annualadjusted overall prevalence rate increased from 0.30% in 2008 to 1.05% in 2012,whereas the annual overall incidence rate decreased from 0.30% in 2008 to 0.20%in 2012. Alcohol dependence prevalence and incidence rates were higher amongmen than women every year. Patients age 65-69 years had the highest prevalencerates during 2008 (0.43%) and 2009 (0.63%), whereas in 2010 (0.82%), 2011 (1.14%) and2012 (1.43%), patients age 70-74 years had the highest prevalence rates. Prevalencerates grew steadily among all age groups from 2008 to 2012. The highest alcoholdependence incidence rate was observed in the Virgin Islands (917.6 per 100,000person-years) in 2008, whereas in 2012, Wyoming (409.3 per 100,000 person-years)had the highest incidence rate. CONCLUSIONS: Increasing prevalence and decreas ing incidence of alcohol dependence was observed from 2008 to 2012. In addition,men were more likely to have alcohol dependence than women.
Citation - WoS: 8
Citation - Scopus: 8
Out-Of International Normalized Ratio Values and Healthcare Cost Among New Warfarin Patients With Non-Valvular Atrial Fibrillation
(2015) Wang, Li; Nelson, Winnie W.; Schein, Jeffrey R.; Damaraju, Chandrasekharrao, V; Başer, Onur
Patients with out-of-range international normalized ratio (INR) values <2.0 and >3.0 have been associated with increased risk of thromboembolic and bleeding events. INR monitoring is costly, because of associated physician and nurse time, laboratory resource use, and dose adjustments.
Pmh13 - Examining Prevalence, Incidence and Mortality Rates Among Opioid-Dependent Patients in the U.s. Medicare Population
(2015) Li, L.; Shrestha, S.; Başer, Onur; Yuce H.; Li Wang
OBJECTIVES: To examine incidence, prevalence and mortality rates among opioiddependent patients in the U.S. Medicare population. METHODS: A study was performed for the period from January 1, 2008 through December 31, 2012 to determinethe prevalence, incidence and mortality rates among opioid-dependent patients(International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes 304.0x and 304.7x) in the U.S. Medicare population. Patients who hadcontinuous fee-for-service Medicare health plan enrollment for the calendar yearand at least 2 years prior were selected for the study. Age- and gender-adjustedopioid dependence prevalence and incidence rates were calculated via direct standardization to the U.S. population age ?65 years in 2010 using gender-specific agegroups. RESULTS: The annual adjusted prevalence of opioid-dependent patientsincreased from 0.06% in 2008 to 0.35% in 2012. Incidence rates increased from 0.06%in 2008 to 0.10% in 2012. Prevalence rates were higher among women than men everyyear during the study period. Patients age 65-69 years had the highest prevalencerates during 2008 (0.09%), 2009 (0.16%), 2010 (0.22%) and 2011 (0.32%). However, in2012, patients who were age 70-74 years had the highest prevalence rates (0.43%).North American Natives had the highest prevalence of opioid dependence comparedto all other races. The highest incidence of opioid dependence was observed inNevada in 2008 (221.9 per 100,000 person-years) and 2012 (222.1 per 100,000 personyears). The 30-day and 1-year mortality rates decreased by 10.5% (3.8 to 3.4 per 1,000person-years) and 25.4% (17.3 to 12.9 per 1,000 person-years), respectively, from 2008to 2012. CONCLUSIONS: Opioid dependence incidence and prevalence decreasedfrom 2008 to 2012; however, opioid dependence-related mortality rates increased.
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
Pmh26 - Comparing Healthcare Resource Utilization and Costs Among Schizophrenic Patients Who Initiated Typical Vs. Atypical Long-Acting Injectables in the Us Veteran Population
(2015) Başer, Onur; Kariburyo, M. Furaha; Du, J; Xie, L
OBJECTIVES: To evaluate healthcare resource utilization and costs among schizophrenic patients who initiated typical and atypical long-acting injectables (LAIs) inthe U.S. veteran population. METHODS: Using the Veterans Health Administration(VHA) Medical SAS datasets, patients with ?1 pharmacy claim for LAIs were identified from 01OCT2005 through 30SEPT2012. The first LAI date was designated asthe index date. Patients were required to be age ?18 years, have continuous healthplan enrollment for 12 months pre-index date and a schizophrenia diagnosis(International Classification of Diseases, 9th Revision, Clinical Modification [ICD9-CM] code 295.xx) during the study period. Patient data was observed until theearlier date of death or the end of the study period, and patients were assigned totypical LAI (fluphenazine, haloperidol, perphenazine) or atypical LAI (aripiprazole,olanzapine, paliperidone, risperidone) antipsychotic cohorts. All-cause (follow-up)and psychiatric disorder-related healthcare resource utilization and costs wereassessed. Follow-up health care costs were adjusted to per-patient-per-month.The generalized linear model (GLM) was used to assess cost and utilization differences among the cohorts. RESULTS: A total of 4,796 patients were identified(Typical LAI cohort: N=1,941; Atypical LAI cohort: N=2,855). Typical LAI patientswere older (age 53.81 vs. 50.94 years, p<0.0001) and more likely to be black (34.47%vs. 28.27%, p<0.0001) than atypical LAI patients. After adjusting for baseline differences using GLM, more patients prescribed typical LAIs had all-cause emergencyroom [ER] visits (61.66% vs. 58.11%, p=0.024) and inpatient stays (63.11% vs. 59.00%, p=0.008) and psychiatric disorder-related ER visits (33.83% vs. 30.05%, p=0.011)than those prescribed atypical LAIs. However, typical LAI patients incurred lowerall-cause pharmacy ($197 vs. $433, p<0.001), total ($2,850 vs. $3,073, p=0.048) andpsychiatric disorder-related total costs ($1,615 vs. $1,624, p=0.908) than atypical LAIpatients. CONCLUSIONS: Although patients who initiated typical LAIs had highhealthcare resource utilization, their economic burden was lower compared to thosewho initiated atypical LAIs.

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