WoS İndeksli Yayınlar Koleksiyonu / WoS Indexed Publications Collection

Permanent URI for this collectionhttps://hdl.handle.net/20.500.11779/256

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Citation - WoS: 1
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.
Citation - WoS: 7
Citation - Scopus: 8
Hematocrit Levels and Thrombotic Events in Patients With Polycythemia Vera: an Analysis of Veterans Health Administration Data
(Springer, 2019) Parasuraman, Shreekant; Robyn Scherber; Jingbo Yu; Li Wang; Dilan Paranagama; Sulena Shrestha; Başer, Onur
Patients with polycythemia vera (PV) have a high incidence of thrombotic events (TEs), contributing to a greater mortality risk than the general population. The relationship between hematocrit (HCT) levels and TE occurrence among patients with PV from the Veterans Health Administration (VHA) was evaluated to replicate findings of the CYTO-PV trial with a real-world patient population. This retrospective study used VHA medical record and claims data from the first claim with a PV diagnosis (index) until death, disenrollment, or end of study, collected between October 1, 2005, and September 30, 2012. Patients were aged ? 18 years at index, had ? 2 claims for PV (ICD-9-CM code, 238.4) ? 30 days apart during the identification period, continuous health plan enrollment from 12 months pre-index until end of study, and ? 3 HCT measurements per year during follow-up. This analysis focused on patients with no pre-index TE, and with all HCT values either < 45% or ? 45% during the follow-up period. The difference in TE risk between HCT groups was assessed using unadjusted Cox regression models based on time to first TE. Patients (N = 213) were mean (SD) age 68.9 (11.5) years, 98.6% male, and 61.5% white. TE rates for patients with HCT values < 45% versus ? 45% were 40.3% and 54.2%, respectively. Among patients with ? 1 HCT before TE, TE risk hazard ratio was 1.61 (95% CI, 1.03–2.51; P = 0.036). This analysis of the VHA population further supports effective monitoring and control of HCT levels < 45% to reduce TE risk in patients with PV.
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
Citation - WoS: 4
Citation - Scopus: 4
Effects of Vaccination and the Spatio-Temporal Diffusion of Covid-19 Incidence in Turkey
(John Wiley and Sons Inc, 2022) Bilgel, Fırat; Karahasan, Burhan Can
This study assesses the spatio-temporal impact of vaccination efforts on Covid-19 incidence growth in Turkey. Incorporating geographical features of SARS-CoV-2 transmission, we adopt a spatial Susceptible–Infected–Recovered (SIR) model that serves as a guide of our empirical specification. Using provincial weekly panel data, we estimate a dynamic spatial autoregressive (SAR) model to elucidate the short- and the long-run impact of vaccination on Covid-19 incidence growth after controlling for temporal and spatio-temporal diffusion, testing capacity, social distancing behavior and unobserved space-varying confounders. Results show that vaccination growth reduces Covid-19 incidence growth rate directly and indirectly by creating a positive externality over space. The significant association between vaccination and Covid-19 incidence is robust to a host of spatial weight matrix specifications. Conspicuous spatial and temporal diffusion effects of Covid-19 incidence growth were found across all specifications: the former being a severer threat to the containment of the pandemic than the latter.
Citation - WoS: 10
Citation - Scopus: 12
Elevated White Blood Cell Levels and Thrombotic Events in Patients With Polycythemia Vera: a Real-World Analysis of Veterans Health Administration Data
(Elsevier Inc., 2019) Wang, Li; Parasuraman, Shreekant V.; Sulena Shrestha; Paranagama, Dilan C.; Yu, Jingbo; Scherber, Robyn Marie; Başer, Onur
Background: Patients with polycythemia vera (PV) have a substantial risk of thrombotic events (TEs). The objective of the present analysis was to describe the association between white blood cell (WBC) levels and occurrence of TEs among patients with PV from a large real-world population. Patients and Methods: The present retrospective analysis using Veterans Health Administration claims data (October 1, 2005, to September 30, 2012) evaluated adult patients assigned to 4 WBC count categories (WBC count < 7.0, 7.0-8.4, 8.5 to < 11.0, and ≥ 11.0 × 109/L) to compare the risk of TEs (reference, WBC count, < 7.0 × 109/L group). Analysis was performed using a Cox proportional hazards model, considering WBC status as a time-dependent covariate. Results: Of the 1565 patients with PV included in the present analysis, the WBC count was < 7.0 × 109/L for 428 (27.3%), 7.0 to 8.4 × 109/L for 375 (24.0%), 8.5 to < 11.0 × 109/L for 284 (18.1%), and ≥ 11.0 × 109/L for 478 (30.5%). Of the 1565 patients, 390 (24.9%) had experienced a TE during the study period. The mean follow-up ranged from 3.6 to 4.5 years. Compared with the reference group (WBC count < 7.0 ×109/L), the hazard ratio for TEs was 1.10 (95% confidence interval [CI], 0.82-1.48; P = .5395), 1.47 (95% CI, 1.10-1.96; P = .0097), and 1.87 (95% CI, 1.44-2.43; P < .0001) for patients with a WBC count of 7.0 to 8.4, 8.5 to < 11.0, and ≥ 11.0 ×109/L, respectively. Conclusion: A positive, significant association between an increased WBC count of ≥ 8.5 ×109/L and the occurrence of TEs was observed in patients with PV. The potential thrombogenic role of WBCs in patients with PV supports the continued inclusion of WBC count control in disease management and evaluation of the response to therapy. © 2019 The AuthorsPatients with polycythemia vera (PV) have a substantial risk of thrombotic events (TEs). In the present retrospective analysis using Veterans Health Administration claims data, 25% of 1565 patients experienced a TE during follow-up. We observed a positive, significant association between white blood cell (WBC) counts ≥ 8.5 × 109/L and TE occurrence (reference, WBC count < 7.0 × 109/L), supporting continued inclusion of WBC count control in disease management. © 2019 The Authors
Citation - WoS: 3
Citation - Scopus: 3
Warfarin Discontinuation in Patientswith Unprovoked Venous Thromboembolism: a Large Us Insurance Database Analysis
(2016) Mardekian, Jack; Liu, Xianchen; Phatak, Hemant; Xie, Lin; Tan, Wilson; Başer, Onur; Ramacciotti, Eduardo
This study examined warfarin therapy discontinuation and its risk factors among patients with unprovoked venous thromboembolism (VTE) in the US clinical practice setting. Adult patients with unprovoked VTE were identified from the MarketScan claims database from January 1, 2006 to December 31, 2012. The index date was defined as the date of first VTE diagnosis. Patients were required to have no VTE diagnosis in the 6 months before index date and continuous health plan enrollment for 6 months before and 12 months after the index date. Warfarin discontinuation rates and adjusted hazard ratios (HRs) were reported. Of 21,163 eligible patients, 15,463 were diagnosed with deep vein thrombosis (DVT) only (73.1%), 5027 with pulmonary embolism (PE) only (23.7%), and 673 with DVT and PE (3.2%). The average duration of warfarin therapy was 5.2 months (SD = 3.0). During 1-year follow-up, 21.4% patients discontinued therapy within 3 months, 42.8% within 6 months, and 70.1% within 12 months. PE versus DVT [HR = 0.77, 95% confidence interval (CI) = 0.74-0.80], comorbid atrial fibrillation (HR = 0.73, 95% CI = 0.66-0.81), thrombophilia (HR = 0.62, 95% CI = 0.54-0.71), and age >40 years (41-65 years: HR = 0.86, 95% CI = 0.81-0.91; >65 years: HR = 0.82, 95% CI = 0.77-0.87) were significantly associated with reduced risk of warfarin discontinuation. Alcohol abuse/dependence (HR = 1.36, 95% CI = 1.20-1.55), cancer history (HR = 1.13, 95% CI = 1.07-1.19), bleeding (HR = 1.07, 95% CI = 1.01-1.15), and catheter ablation (HR = 1.10, 95% CI = 1.00-1.20) in the 6 months before index date were significantly associated with increased risk for warfarin discontinuation. In conclusion, nearly 1 of 4 patients with unprovoked VTE discontinued warfarin within 3 months. Three of 4 patients discontinued therapy within 1 year. Younger age and multiple clinical factors are associated with warfarin therapy discontinuation.
Citation - WoS: 3
Citation - Scopus: 4
State–business Relations, Financial Access and Firm Performance: a Causal Mediation Analysis
(Wiley, 2020) Karahasan, Burhan Can; Bilgel, Fırat
This study investigates the triangular relationship among state–business relations, financial access and economic performance in the Middle East and North Africa. We hypothesize that financial intermediation is a significant mediating factor in the relationship between state–business relations and firm performance. Employing a causal mediation analysis, results show that inefficient ties with the state are a cause of poor firm performance. Inefficient state–business relations reduce firm performance by 2.3 to 4.4 per cent through access to finance and by 12 to 40 per cent via its direct effect. About 3 to 16 per cent of the total effect is mediated through financial access, while the remaining is the direct effect.
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: 5
Citation - Scopus: 3
Exports, Real Exchange Rates and Dollarization: Empirical Evidence From Turkish Manufacturing Firms
(Springer, 2019) Karamollaoğlu, Nazlı; Yalçın, Cihan
We attempt to uncover the relationship between the real exchange rates and exports shares of manufacturing firms in Turkey by taking into account FX exposures and various firm characteristics. We use a large panel of manufacturing firms to carry out an empirical analysis for the period 2002–2010. Contrary to macro-evidence, firm-level empirical evidence suggests that a depreciation of the Turkish lira seems to favor the external competitiveness of firms in general. We document that a real depreciation of the Turkish lira has a positive impact on export shares and its impact is muted to some extent for firms operating in sectors that use imported inputs intensively. In addition, we estimate that export shares increase as a result of real depreciation for firms having low (naturally hedged) and moderate FX debt-to-export ratios. We do not confirm a strong balance sheet channel where a depreciation of the currency may harm firms’ export performance due to currency mismatch. On the contrary, FX borrowing is estimated to support export performance probably due to undermining finance constraints.
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 - Scopus: 1
Infant Mortality in Turkey: Causes and Effects in a Regional Context
(Wiley, 2020) Bilgel, Firat
This study attempts to identify the causal and/or direct effects of sociocultural determinants of infant mortality in Turkey within a regional context using causal graph analysis and global and local spatial models. The conceptual framework, combined with the data, shows that fertility and consanguinity have direct effects on infant mortality rates, and that female illiteracy, as a proxy for maternal education, is the main cause of rising infant mortality even in the presence of latent confounding. The surface of estimates further shows that the local effects of female illiteracy and consanguinity are non-stationary across space, calling for location-specific policies.
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.
Citation - WoS: 15
Citation - Scopus: 14
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)
Citation - WoS: 4
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.
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.
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.
Psy14 - Evaluating Trends in Chronic Pain Prevalence in the United States Veterans Health Administration Population
(2015) Li, L.; Shrestha, S.; Başer, Onur; Yuce, H; Wang, L
OBJECTIVES: The current study examined chronic pain prevalence in the U.S. Veterans Health Administration (VHA) population. METHODS: The study sample was based on the VHA Medical SAS Datasets from fiscal year 2008 through 2012. All patients diagnosed with chronic pain throughout the study period were identified using International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes 338.2 and 338.4. The variation in the prevalence of chronic pain was assessed and categorized according to the pain scale. Pain score was determined using a scale ranging from 0 to 10 as reported by patients using the following categories: 1 to 4: mild, 5 to 6: moderate and ?7: severe pain. To identify prior prevalence cases, we restricted continuous enrollment throughout that fiscal year and at least 2 years prior
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.
Understanding Covid-19 Mobility Through Human Capital: a Unified Causal Framework
(Springer, 2023) Bilgel, Fırat; Karahasan, Burhan Can
This paper seeks to identify the causal impact of educational human capital on social distancing behavior at workplace in Turkey using district-level data for the period of April 2020 - February 2021. We adopt a unified causal framework, predicated on domain knowledge, theory-justified constraints anda data-driven causal structure discovery using causal graphs. We answer our causal query by employing machine learning prediction algorithms; instrumental variables in the presence of latent confounding and Heckman's model in the presence of selection bias. Results show that educated regions are able to distance-work and educational human capital is a key factor in reducing workplace mobility, possibly through its impact on employment. This pattern leads to higher workplace mobility for less educated regions and translates into higher Covid-19 infection rates. The future of the pandemic lies in less educated segments of developing countries and calls for public health action to decrease its unequal and pervasive impact.
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.