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: 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: 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: 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.
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
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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.
Pcv50 - a Retrospective Analysis of Health Care Resource Utilization and the Economic Burden Among Us Long-Term Care Facility Patients Diagnosed With Stroke
(2015) Huang, A; Shrestha, S; Başer, Onur; Yuce, H; Wang, L
Objectives: To assess the economic burden and health care resource utilization among patients in long-term care facilities who were diagnosed withstroke. Methods: Patients diagnosed with stroke (International Classification ofDiseases, 9th Revision, Clinical Modification diagnosis codes 433, 434 and 436) wereidentified using the Long Term Care Minimum Data Set (MDS) linked to 5% Medicaredata from 01JAN2009 through 31DEC2010. The initial diagnosis date was designatedas the index date. Patients without a stroke diagnosis (control cohort) were matchedto stroke patients, and 1:1 propensity score matching (PSM) was used to control forage, region, gender and baseline Charlson Comorbidity Index score. The index datefor the control cohort was randomly chosen to reduce selection bias. Patients inboth cohorts were required to be age ?65 years, have at least two consecutive quarterly assessments documented in MDS data 6 months prior to the index date andhave continuous medical and pharmacy benefits 1 year before and after the indexdate. Results: Once PSM was applied, 1,014 patients were included in each cohort,and baseline characteristics were balanced. A higher percentage of stroke patientshad inpatient admissions (40.34% vs. 23.37%, p<0.0001), outpatient visits (92.31%vs. 89.45%, p=0.0253), skilled nursing facility (SNF; 37.67% vs. 28.21%, p<0.0001) anddurable medical equipment (DME) claims (30.47% vs. 22.09%, p<0.0001) than thosein the control cohort. Stroke patients also incurred considerably higher inpatient($7,068 vs. $3,418, p<0.0001), outpatient ($3,545 vs. $2,539, p<0.0001), SNF ($8,036 vs.$3,695, p<0.0001), DME ($394 vs. $235, p=0.0023) and carrier claim costs ($3,606 vs.$2,489, p<0.0001) than those without a stroke diagnosis. Conclusions: Patientsdiagnosed with stroke had considerably higher health care resource utilization andcosts than those in the control cohort.
Citation - WoS: 2
Pcv58 - Long-Term Economic Burden Associated With Cardiovascular Events Among High-Risk Patients With Hyperlipidemia
(2015) Fox, Kathleen M; Wang, Li; Gandra, S. R; Quek, R. G. W; Li, L; Başer, Onur
Objectives: This study evaluated the economic burden associated with new cardiovascular events (CVEs) for 3 years post-CVE among high-risk patients diagnosedwith hyperlipidemia. Methods: A retrospective cohort study was conductedamong high-risk hyperlipidemic patients with and without a new CVE, using IMSLifeLink PharMetrics Plus data 01/01/2006-06/30/2012. CVEs included primary inpatient claims for myocardial infarction, unstable angina, ischemic stroke, transientischemic attack, revascularization and heart failure. Patients were assigned torisk cohorts based on history of CVE and coronary heart disease risk equivalent(CHD RE) condition. Propensity score matching was applied to compare healthcarecosts among patients with and without new CVEs, ranging from 1 month (acutephase) to 3 years post-CVE date. Results: A total of 21,482 matched patientswere included in the history of CVE cohort and 181,228 in the CHD RE cohort.Hyperlipidemic patients with new CVEs were, on average, aged 65-72 years, bothcohorts had 65.2% male and 74.7-84.4% had hypertension (most common baselinecomorbidity). Total costs per patient per month (PPPM) were significantly higheramong patients with versus without new CVEs during the acute phase (history ofCVE: $27,247 vs. $1,586; CHD RE: $30,742 vs. $914; p<0.0001) and remained higherduring years 1, 2 and 3, respectively, post-CVE among patients in the history of CVEcohort ($2,603 vs. $1,252; $2,055 vs. $1,191; $2,061 vs. $1,166, p<0.0001) and CHD REcohort ($1,926 vs. $844; $1,535 vs. $850; $1,475 vs. $853, p<0.0001). Significant costdifferences were observed between patients with and without new CVEs in bothcohorts, including inpatient, outpatient, emergency room and pharmacy visit costsPPPM, during 1-3 years post-CVE. Conclusions: Healthcare costs for high-riskpatients with new CVEs remained significantly higher than for matched patients without CVEs for up to 3 years post-CVE, imposing a significant economic burdenon U.S. commercial payers.
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.
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.
Pmh1 - Healthcare Utilization and Costs of Serotonin Syndrome With Concomitant Use of Serotonergic Agents
(2015) Wang, Z.; Xie, L.; Nguyen, C; Alley, S.; Başer, Onur
OBJECTIVES: Serotonin syndrome (SS) is an adverse drug reaction that may occurin patients receiving monotherapy or combinations of serotonergic agents (SAs).This study examined healthcare utilization and costs of SS in two different populations. METHODS: Adult (age ?18 years) patients prescribed SAs were identifiedusing the Veterans Health Administration (VHA) dataset (01OCT2008-30SEPT2012) andthe IMS PharMetrics Plus dataset (01JAN2010-31DEC2013). Patients with continuoushealth plan enrollment 12 months pre-index date, defined as the first SA prescription claim date, were included and observed until death, disenrollment or the end ofthe study period. Patients were assigned to cohorts based on drug exposure: singlemonoamine oxidase inhibitor (MAOI) drug, MAOI drugs in combination with otherSAs, single non-MAOI SA, and multiple non-MAOI SAs (2, 3, 4, and ?5 SAs). Outcomesof interest were annual incidences of SS event (ICD-9-CM: 333.99) and associatedhealth care utilization and costs.
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.

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