PubMed İndeksli Yayınlar Koleksiyonu / PubMed Indexed Publications Collection
Permanent URI for this collectionhttps://hdl.handle.net/20.500.11779/1928
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Article Citation - WoS: 6Citation - Scopus: 5The Economic Impact of Symptomatic Menopause Among Low-Socioeconomic Women in the United States(Taylor & Francis Ltd, 2015-08-02) Başer, Onur; Keshishian, A; Xie, Lin; Wang, YuexiBackground: 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.Article Citation - WoS: 3Citation - Scopus: 3Warfarin Discontinuation in Patientswith Unprovoked Venous Thromboembolism: a Large Us Insurance Database Analysis(Lippincott Williams & Wilkins, 2016-11-01) Mardekian, Jack; Liu, Xianchen; Phatak, Hemant; Xie, Lin; Tan, Wilson; Başer, Onur; Ramacciotti, EduardoThis 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.Article Citation - WoS: 25Citation - Scopus: 25Impact of Switching From an Initial Tumor Necrosis Factor Inhibitor on Health Care Resource Utilization and Costs Among Patients With Rheumatoid Arthritis(Elsevier, 2015-07-01) Roy, Sanjoy; Ganguli, Arijit; Xie, Lin; Başer, Onur; Cifaldi, MaryPurpose: 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.Article Citation - WoS: 18Citation - Scopus: 18Adding Rapid-Acting Insulin or Glp-1 Receptor Agonist To Basal Insulin: Outcomes in a Community Setting(Amer Assoc Clinical Endocrinologists, 2015) Dalal, Mehul R; DiGenio, Andres; Xie, Lin; Başer, OnurTo evaluate real-world outcomes in patients with type 2 diabetes mellitus (T2DM)receiving basal insulin, who initiate add-on therapy with a rapid-acting insulin (RAI) or aglucagon-like peptide 1 (GLP-1) receptor agonist.Data were extracted retrospectively from a U.S. health claims database. Adults withT2DM on basal insulin who added an RAI (basal+RAI) or GLP-1 receptor agonist (basal+GLP-1) were included. Propensity score matching (1 up to 3 ratio) was used to control for differencesin baseline demographics, clinical characteristics, and health resource utilization. Endpointsincluded prevalence of hypoglycemia, pancreatic events, all-cause and diabetes-relatedresource utilization, and costs at 1 year follow-up. Overall, 6,718 matched patients were included: 5,013 basal+RAI and 1,705basal+GLP1. Patients in both groups experienced a similar proportion of any hypoglycemicevent (P = .4079). Hypoglycemic events leading to hospitalization were higher in the basal+RAIcohort (2.7% vs. 1.8%; P = .0444). The basal+GLP-1 cohort experienced fewer all-cause(13.55% vs. 18.61%; P<.0001) and diabetes-related hospitalizations (11.79% vs. 15.68%;P<.0001). The basal+GLP-1 cohort had lower total all-cause health care costs ($18,413 vs.$20,821; P = .0002), but similar diabetes-related costs ($9,134 vs. $8,985; P<.0001) comparedwith the basal+RAI cohort. Add-on therapy with a GLP-1 receptor agonist in T2DM patients receiving basalinsulin was associated with fewer hospitalizations and lower total all-cause costs compared withadd-on therapy using a RAI, and could be considered an alternative to a RAI in certain patientswith T2DM, who do not achieve effective glycemic control with basal insulin.