Ekonomi Bölümü Koleksiyonu

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A Comparative Analysis of the Health Care Utilization and Costs of Patients Diagnosed With and Without Liver Cancer in the Us Medicare Population
(2017) Ogbomo, A.; Lin, Y.; Keshishian, A; Xie, L; Yuce, H; Başer, Onur
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Citation - WoS: 5
Citation - Scopus: 7
Arbitrageur Behavior in Sentiment-Driven Asset-Pricing
(World Scientific Publishing, 2021) Kılıç, Erdem; Oğuzhan, Göksel
This study aims to model arbitrageur behavior in a sentiment-driven capital asset-pricing model under the premise of reflecting a more detailed decomposition of investor types in the equity markets. We explore the behavior and the impact of arbitrageur behavior, particularly, on pricing and on key financial ratios. We observe that the prevalence of the arbitrageur counteracts the effects of unsophisticated investors, resulting in a lower volatility of the price–dividend ratio, lower predictive power of changes in consumption for future price changes and lower equity premium. Thus, the results of our research allow us to conjecture that the extrapolation bias in the prices is lowered.
Citation - WoS: 17
Citation - Scopus: 23
Benefit of Early Discharge Among Patients With Low-Risk Pulmonary Embolism
(2017) Wang, Li; Wells, Phil; Fermann, Gregory J; Peacock, W. Frank; Schein, Jeff; Coleman, Craig I; Crivera, Concetta; Başer, Onur
Clinical guidelines recommend early discharge of patients with low-risk pulmonary embolism (LRPE). This study measured the overall impact of early discharge of LRPE patients on clinical outcomes and costs in the Veterans Health Administration population. Adult patients with >= 1 inpatient diagnosis for pulmonary embolism (PE) (index date) between 10/2011-06/2015, continuous enrollment for >= 12 months pre-and 3 months post-index date were included. PE risk stratification was performed using the simplified Pulmonary Embolism Stratification Index. Propensity score matching (PSM) was used to compare 90-day adverse PE events (APEs) [recurrent venous thromboembolism, major bleed and death], hospital-acquired complications (HACs), healthcare utilization, and costs among short (<= 2 days) versus long length of stay (LOS). Net clinical benefit was defined as 1 minus the combined rate of APE and HAC. Among 6,746 PE patients, 95.4% were men, 22.0% were African American, and 1,918 had LRPE. Among LRPE patients, only 688 had a short LOS. After 1:1 PSM, there were no differences in APE, but short LOS had fewer HAC (1.5% vs 13.3%, 95% CI: 3.77-19.94) and bacterial pneumonias (5.9% vs 11.7%, 95% CI: 1.24-3.23), resulting in better net clinical benefit (86.9% vs 78.3%, 95% CI: 0.84-0.96). Among long LOS patients, HACs (52) exceeded APEs (14 recurrent DVT, 5 bleeds). Short LOS incurred lower inpatient ($2,164 vs $5,100, 95% CI: $646.8-$5225.0) and total costs ($9,056 vs $12,544, 95% CI: $636.6-$6337.7). LRPE patients with short LOS had better net clinical outcomes at lower costs than matched LRPE patients with long LOS.
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: 9
Citation - Scopus: 10
Contagion Effects of U.s. Dollar and Chinese Yuan in Forward and Spot Foreign Exchange Markets
(Elsevier, 2017) Kılıç, Erdem
Financial contagion in forex markets is modeled by the application of a bivariate Hawkes stochastic jumpprocess. The self-exciting and mutually exciting properties of the jump-clustering model allow for illustratinginternal and cross-sectional transmission processes. The results obtained suggest stronger effects from US tomutual markets than in the reverse case. Cross-sectional excitation dynamics in the spot markets are larger thanin the forward markets. As a central result, we can observe that the results for the Hawkes-model parameters aremore significant in the forward markets. Transmission dynamics beyond volatility determine the likelihood ofcontagion occurrence. The significance of the decay parameters towards the long term jump intensities supportsthe importance of abrupt fluctuations in the contagion discourse.
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.
Citation - WoS: 4
Citation - Scopus: 6
Does the Unification of Health Financing Affect the Distribution Pattern of Out-Of Health Expenses in Turkey?
(Wiley, 2019) Çınaroğlu, Songül; Başer, Onur
Turkey has implemented health reforms for over a decade and has taken significant steps toward unifying health financing. This study investigated the financial burden associated with out-of-pocket (OOP) expenditures under universal health coverage, using national 2003–2015 household budget data from the Turkish Statistical Institute. Progress was evaluated using Kakwani–Suits indices and Lorenz concentration curves. The results indicate that overall, more than a decade after its unification, redistribution of wealth in the Turkish health financing system has benefitted the wealthy but not the poor. Both curve and index approaches (Kakwani index 2003 = -0.50; 2015 = -0.44) reveal an increasingly regressive pattern of OOP health expenditures. The effective use of fiscal space and good political leadership are essential for the successful continuation of reforms to combat poverty in Turkey.
Citation - WoS: 4
Citation - Scopus: 4
Economic Geography and Human Capital Accumulation in Turkey: Evidence From Micro-Data
(Routledge, 2021) Karahasan, Burhan Can; Bilgel, Fırat
This study examines the impact of market access on human capital accumulation in Turkey. Using individual-level data, the analysis explores the background of human capital accumulation, combining market accessibility, wages and human capital development. Upon the treatment of wages as an endogenous covariate of interest and overtime work as an exogenous source of variation, we find evidence that the impact of market access on human capital development vanishes in ways not predicted by the augmented New Economic Geography set-up for human capital accumulation. Findings confirm that economic policies may be effective in reducing regional variation in human capital endowments.
Citation - WoS: 13
Citation - Scopus: 14
Economic Outcomes in Patients With Chemotherapy-Naive Metastatic Castration-Resistant Prostate Cancer Treated With Enzalutamide or Abiraterone Acetate Plus Prednisone
(Springer, 2020) Lechpammer, Stanislav; Ramaswamy, Krishnan; Wang, Li; Mardekian, Jack; George, Daniel J.; Sandin, Rickard; Schultz, Neil M.; Başer, Onur; Huang, Ahong
Introduction: Prostate cancer (PC) is the second leading cause of cancer death among US men and accounts for considerable healthcare expenditures. We evaluated economic outcomes in men with chemotherapy-naı¨ve metastatic castration-resistant PC (mCRPC) treated with enzalutamide or abiraterone acetate plus prednisone (abiraterone). Methods: We performed a retrospective analysis on 3174 men (18 years or older) utilizing the Veterans Health Administration (VHA) database from 1 April 2014 to 31 March 2018. Men with mCRPC were included if they had at least one pharmacy claim for enzalutamide or abiraterone (ﬁrst claim date = index date) following surgical or medical castration, had no chemotherapy treatment within 12 months prior to the index date, and had continuous VHA enrollment for at least 12 months pre- and post-index date. Men were followed until death, disenrollment, or end of study and were 1:1 propensity score matched (PSM). All-cause and PC-related resource use and costs per patient per month (PPPM) in the 12 months post index were compared between matched cohorts. Results: We identiﬁed 1229 men with mCRPC prescribed enzalutamide and 1945 prescribed abiraterone with mean ages of 74 and 73 years, respectively. After PSM, each cohort had 1160 patients. The enzalutamide cohort had fewer all-cause (2.51 vs 2.86; p\0.0001) and PC-related outpatient visits (0.86 vs 1.03; p\0.0001), with corresponding lower all-cause ($2588 vs $3115; p\0.0001) and PC-related ($1356 vs $1775; p\0.0001) PPPM outpatient costs compared with the abiraterone cohort. Allcause total costs (medical and pharmacy) PPPM ($8085 vs $9092; p = 0.0002) and PC-related total costs PPPM ($6321 vs $7280; p\0.0001) were signiﬁcantly lower in the enzalutamide cohort compared with the abiraterone cohort. Conclusions: Enzalutamide-treated men with chemotherapy-naı ¨ve mCRPC had signiﬁcantly lower resource utilization and healthcare costs compared with abiraterone-treated men. Plain Language Summary: Plain language summary available for this article.
Citation - WoS: 3
Citation - Scopus: 3
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.
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
Examining Health Care Utilization and Costs Among Atherosclerosis Patients in the Us Veteran Health Administration Population
(2017) Zhang, Q.; Kariburyo, M. T.; Xu, J.; Başer, Onur
...
Citation - WoS: 17
Citation - Scopus: 17
Guns and Homicides: a Multiscale Geographically Weighted Instrumental Variables Approach
(Wiley, 2019) Bilgel, Fırat
This article assesses the locally varying effects of gun ownership levels on total and gun homicide rates in the contiguous United States using cross-sectional county data for the period 2009–2015. Employing a multiscale geographically weighted instrumental variables regression that takes into account spatial nonstationarity in the processes and the endogenous nature of gun ownership levels, estimates show that gun ownership exerts spatially monotonically negative effects on total and gun homicide rates, indicating that there are no counties supporting the “more guns, more crime” hypothesis for these two highly important crime categories. The number of counties in the contiguous United States where the “more guns, less crime” hypothesis is confirmed is limited to at least 1258 counties (44.8% of the sample) with the strongest total homicide-decreasing effects concentrated in southeastern Texas and the deep south. On the other hand, stricter state gun control laws exert spatially monotonically negative effects on gun homicide rates with the strongest effects concentrated in the southern tip of Texas extending toward the deep south.
Citation - WoS: 5
Citation - Scopus: 5
Health Outcomes Among Patients Diagnosed With Schizophrenia in the Us Veterans Health Administration Population Who Transitioned From Once-Monthly To Once-Every Paliperidone Palmitate: an Observational Retrospective Analysis
(Springer, 2019) Khouyr, Antoine El; Wang, Li; Joshi, Kruti; Patel, Charmi; Başer, Onur; Huang, Ahong
There is limited literature on treatment patterns, healthcare resource utilization (HRU), and costs among patients who transition from once-monthly paliperidone palmitate (PP1M) to once-every-3-month paliperidone palmitate (PP3M) in a real-world setting. Hence, this study compared treatment patterns, HRU, and costs 12-month pre- and post-PP3M transition among Veteran’s Health Administration (VHA) patients with schizophrenia.
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)
Pcn62 - Assessing the Economic Burden and Health Care Resource Utilizations of Us Medica Re Patients With Myeloproliferative Neoplasms
(2015) Keshishian, A; Du, J; Xie, L; Başer, Onur
OBJECTIVES: To examine the economic burden and health care resource utilization of myeloproliferative neoplasms (MPNs) in the U.S. Medicare population. METHODS: A retrospective data analysis was performed using the U.S.national Medicare claims from January 2008 through December 2012. MPN patientswere identified using International Classification of Disease 9th Revision ClinicalModification (ICD-9-CM) diagnosis codes 238.4, 238.71, 238.76 and 289.83. The diagnosis date was designated as the index date. A comparison cohort without a MPNdiagnosis was created for patients of the same age, region, gender, index year andbaseline Charlson Comorbidity Index score. A random index date was chosen forthe comparison cohort to reduce selection bias. Patients were required to havecontinuous medical and pharmacy benefits 1 year pre- and post-index date. Oneto-one propensity score matching (PSM) was performed to compare follow-uphealth care costs and utilizations between the cohorts, adjusting for demographicand clinical characteristics. RESULTS: Eligible patients (N=17,950) were identifiedfor the MPN and comparison cohorts. After 1:1 PSM, a total of 5,546 patients werematched from each cohort and baseline characteristics were well-balanced. MPNpatients had a higher percentage of health care resource utilizations, includingMedicare carrier (98.6% vs. 65.9%), Durable Medical Equipment (DME; 29.5% vs.14.4%), Home Health Agency (HHA; 12.4% vs. 5.0%), outpatient visits (76.6% vs.37.4%), inpatient hospitalizations (27.2% vs. 6.8%) and Skilled Nursing Facility (SNF;7.5% vs. 2.0%) visits than non-MPN patients. Patients diagnosed with MPNs alsoincurred significantly higher costs, including Medicare carrier ($3,872 vs. $1,283),DME ($266 vs. $91), HHA ($639 vs. $250), outpatient ($10,061 vs. $3,204), inpatient($5,449 vs. $1,054), pharmacy ($1,069 vs. $713) and total health care costs ($23,060vs. $7,076; p<0.0001). CONCLUSIONS: MPN patients had a higher burden of illnesscompared to non-MPN patients.
Pcn62 - Assessing the Economic Burden of Us Medicare Patients Diagnosed With Non-hodgkin's Lymphoma
(2015) Xie, L; Keshishian, A; Du, J; Başer, Onur
OBJECTIVES: To evaluate the health care resource utilization and economic burdenof non-Hodgkin’s lymphoma (NHL) in the U.S. Medicare population. METHODS:NHL patients were identified (International Classification of Diseases, 9th Revision,Clinical Modification [ICD-9-CM] diagnosis codes 200.xx and 202.xx) using nationalU.S. Medicare claims from January 1, 2009 through December 31, 2011. The first diagnosis date was designated as the index date for the NHL cohort. Control patients of thesame age, region, gender and index year were identified and matched to case patientsbased on baseline Charlson Comorbidity Index (CCI) scores, and were assigned a randomly chosen index date to minimize selection bias. Patients were required to havecontinuous medical and pharmacy benefits 1 year pre- and post-index date. Studyoutcomes, including health care costs and utilizations, were compared between thedisease and comparison cohorts using 1:1 propensity score matching (PSM). RESULTS:A total of 20,254 patients were included in the NHL and comparison cohorts. After1:1 PSM, 4,705 patients were matched from each cohort and baseline characteristicswere balanced. Patients diagnosed with NHL were more likely to utilize health careresources including Medicare carrier (99.0% vs. 70.5%), Durable Medical Equipment(DME, 28.1% vs. 17.7%), Home Health Agency (HHA, 11.4% vs. 4.8%), outpatient visits(80.2% vs. 41.0%), inpatient stays (25.7% vs. 7.4%) and Skilled Nursing Facility (SNF,4.8% vs. 1.7%) and hospice admissions (0.9% vs. 0.3%). Patients diagnosed with NHLalso incurred higher Medicare carrier ($10,603 vs. $1,522), DME ($264 vs. $120), HHA($531 vs. $270), outpatient ($30,013 vs. $4,268), inpatient ($5,762 vs. $1,167), SNF ($875vs. $307), hospice ($197 vs. $67), pharmacy ($1,050 vs. $785) and total costs ($49,296vs. $8,507; p<0.005). CONCLUSIONS: The economic burden and health care resourceutilizations were significantly higher for patients diagnosed with NHL compared topatients without NHL.
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.
Pcv3 - a Descriptive Analysis of Patient Characteristics, Bleeding and Recurrence Risk Among U.s Veteran Patients Diagnosed With Venous Thromboembolism
(2015) Xie, L; Du, J; Kariburyo, M. Furaha; Başer, Onur
Objectives: Patient characteristics and bleeding and recurrence risk of venousthromboembolism (VTE) were assessed among patients in the Veterans HealthAdministration (VHA) population. Methods: Adult patients (?18 years) with VTE(International Classification of Diseases, 9th Revision, Clinical Modification codes:451-453, 671.3, 671.4 and 671.9 deep vein thrombosis [DVT]; 415.1, 673.2, 673.8 pulmonary embolism [PE]) were identified from the VHA Medical SAS datasets. Theindex date was defined as the first VTE diagnosis date between 01APR2006 and30SEP2012. Patients were required to have ?2 outpatient VTE diagnosis claimswithin 3 weeks and one inpatient stay with a VTE diagnosis, continuous healthplan enrollment for 6 months pre-index date and no VTE diagnosis (V12.51, V12.52)in the baseline period. Patient data were assessed until the earlier of death or endof the study period. Outcomes of interest included VTE recurrence, major bleedingand clinically-relevant non-major bleeding (CRNM). The incidence rate (per 100person-year) was calculated for VTE recurrence and bleeding outcomes. Results:Total 88,280 VTE patients were identified, of which 67.6% had DVT and 24.9% had PE.VTE patients were mean age 66 years, 95.9% were male and more often resided inthe Southern U.S. region (37%). The baseline Charlson comorbidity index score was3.3 and common comorbid conditions included hypertension (56.00%), respiratorydisease (34.3%) and heart disease (34.3%). Non-steroidal anti-inflammatory drugs(60.10%), antidepressants (33.00%) and anticoagulants (36.8%) were also frequentlyprescribed in the baseline period. During the follow-up period, 37.5% of VTE casesoccurred in outpatient settings and 62.50% occurred in inpatient settings. The incidence rate for VTE recurrence (20.7%) was 10.5 per 100 person-years, major bleeding (21.9%) was 10.9 per 100 person-years and CRNM (23.00%) was 12.1 per 100person-years. Conclusions: U.S. veteran patients diagnosed with VTE had frequent comorbid conditions and were at high-risk for bleeding and VTE recurrence.
Citation - WoS: 1
Pcv5 - Clinical Outcomes and Treatment Patterns of Venous Thromboembolism Among Cancer Patients in a Large Commercial Database
(2015) Masseria, C; Kariburyo, M. Furaha; Mardekian, J; Başer, Onur
OBJECTIVES: Describe venous thromboembolism (VTE) treatment patterns and clinical outcomes among cancer patients. METHODS: Adult patients (age >18 years)with ?2 VTE diagnosis claims (ICD-9-CM codes) in an outpatient setting or oneVTE diagnosis in an inpatient setting were selected from the Humedica database(01JAN2008-31MAR2014). Continuous health plan enrollment 6 months pre-indexdate (VTE diagnosis) was required. Cancer patients (ICD-9 codes for cancer diagnosis, medication use, radiation therapy, or surgery) were differentiated from activecancer patients (ICD-9 codes for cancer diagnosis and treatment) based on diagnosiscodes during baseline period. VTE treatment patterns with low molecular weightheparin (LMWH), unfractionated heparin (UFH), fondaparinux and oral anticoagulants (OACs) were evaluated. Incidence rate (in person-years) was calculated forclinical outcomes: VTE recurrence, bleeding, major bleeding and clinically relevantnon-major bleeding. RESULTS: Patients with active cancer were on average sicker(Charlson Comorbidity Index score: 6.7 vs. 2.9) and had higher proportions of numerous comorbid conditions, including respiratory disease (52.7% vs. 40.4%), hepaticdisease (14.9% vs. 6.1%) and baseline bleeding (30.4% vs. 17.8%) compared to allcancer patients. More than 70% of cancer patients were prescribed anticoagulants,and the majority received a combination of parenteral andoral anticoagulant treatment. A higher proportion of active cancer patients received only parenteral anticoagulant compared to all cancer patients (26.1% vs. 16.2%), and LMWH was themost commonly prescribed parenteral anticoagulant. The incidence rate of VTErecurrence (24.7 vs. 14.3 per 100 person-years) and major bleeding events (31.2 vs.15.9 per 100 person-years) was higher among active cancer patients than all VTEcancer patients. CONCLUSIONS: Approximately 30% of VTE cancer patients didnot receive any anticoagulation, with difference in treatment patterns betweenVTE cancer and active cancer patients. Active cancer patients had higher incidencerates of VTE recurrence and bleeding events compared to all VTE cancer patients.

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