Ekonomi Bölümü Koleksiyonu

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  • Conference Object
    Spatial Distribution of the Total Number of Medical Devices in Turkey: a Classification Analysis
    (Elsevier Science Inc, 2016-11-01) Cinaroğlu, S.; Başer, Onur
    Objectives: The unbalanced distribution of medical technologies and devices between rural and urban areas is a major problem for developing countries including Turkey. After the establishment of Public Hospital Unions (PHUs) in Turkey, legislative changes were made to improve the autonomy of public hospitals. This study utilizes spatial analysis to assess the distribution of medical device use in Turkey using PHUs as a decision making unit. Methods: Data from the PHUs’ statistics year book for the year 2014 was assessed. The total number of PHUs is 89. A Hierarchical cluster analysis was performed to classify PHUs according to the total number of medical devices. The Euclidean distance measure and Wards methods were used in the analysis for classification. Results: Study results show that, in Turkey, PHUs were categorized into two clusters based on the total number of medical devices available. Regarding the spatial distribution of the clusters, the first cluster represents PHUs in rural areas, and the second represents PHUs located in urban areas of Turkey. PHUs representing large cities with high population density were included in one cluster, and all other PHUs were included in the second. Statistical test results indicated that the two clusters differ according to the total number of magnetic resonance imaging (MRI: t= -14.10, p< 0.01), computed tomography (CT) scan (t= -15.75, p< 0.01), mammography (t= -11.40, p< 0.01), ultrasonography (t= -14.62, p< 0.01), and electrocardiography (EKG; t= -12.29, p< 0.01) equipment available. Conclusions: It is advisable for health policy makers and health technology assessment authorities in Turkey to focus on the differences between rural and urban areas of the country when determining the need for medical devices.
  • Conference Object
    Socio-Economic Status and Self-Rated Health: Are They Good Predictors of Income? an Analysis of Survey Panel Data From Turkey
    (Elsevier Science Inc, 2016) Çınaroğlu, Songül; Başer, Onur
    ...
  • Conference Object
    Pmh1 - Healthcare Utilization and Costs of Serotonin Syndrome With Concomitant Use of Serotonergic Agents
    (Elsevier Science Inc, 2015-05-01) 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.
  • Conference Object
    Prs12 - Mortality and Rehospitalization Rates Among Hospitalized Pneumonia Patients in the Us Medicare Population
    (Elsevier Science Inc, 2015-05-01) Li, L.; Shrestha, S.; Başer, Onur; Yuce, H; Wang, L
    Objectives: To examine the mortality and rehospitalization rates among hospitalized U.S. Medicare patients diagnosed with pneumonia. Methods: Using U.S.Medicare data, 30-day and 1-year mortality rates as well as rehospitalization rateswere calculated for patients with a primary diagnosis of pneumonia (InternationalClassification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] codes480.0-483.99 or 485-487) or a secondary discharge diagnosis of pneumonia witha primary diagnosis of respiratory failure (ICD-9-CM code 518.81) or sepsis (038.xx). Patients with continuous enrollment in a fee-for-service Medicare healthplan throughout the calendar year, and at least 2 years prior, were included inthe study. Age- and gender-adjusted readmission rates were calculated by directstandardization of the U.S. population age ?65 years in 2010 using gender-specificage groups. Results: The 30-day and 1-year mortality rates increased by 5.9% (17 to18 per 1,000 person-years) and 13.2% (38 to 43 per 1,000 person-years), respectively,from 2008 to 2012. The overall adjusted readmission rates were 3.82% in 2008, 3.93%in 2009, 3.98% in 2010 and 2011, and 3.17% in 2012. Men had higher readmission ratesthan women for all study years except 2011. Patients age 65-69 years had the highestreadmission rates in 2008 (4.47%), 2009 (4.59%) and 2011 (4.77%). In 2010, patients age70-74 years (4.41%), and in 2012, patients who were age 75-79 years (3.73%) had thehighest readmission rates. Black patients had the highest readmission rates in 2008(5.08%), North American Natives in 2009 (4.86%), other race in 2010 (5.87%), Hispanicsin 2011 (5.70%) and North American Natives in 2012 (7.11%). Conclusions: AmongU.S. Medicare beneficiaries diagnosed with pneumonia, mortality rates were higherfrom 2009 to 2012 than in 2008. Overall, hospital readmission rates were lower in2012 than 2008, after adjusting for age and gender. Readmission rates varied acrossrace and age groups.
  • Conference Object
    Citation - WoS: 1
    Pcv5 - Clinical Outcomes and Treatment Patterns of Venous Thromboembolism Among Cancer Patients in a Large Commercial Database
    (Elsevier Science Inc, 2015-05-01) Masseria, C; Kariburyo, M. Furaha; Mardekian, J; Başer, Onur; Lee, T.; Phatak, H.; Xie, L.
    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.
  • Conference Object
    Citation - WoS: 2
    Pnd43 - Adherence and Persistence To Anti-Epileptic Drugs Among Us Veterans Diagnosed With Epilepsy
    (Elsevier Science Inc, 2015-05-01) Velez, F. F.; Başer, Onur; Xie, L.
    OBJECTIVES: To evaluate patient adherence and persistence to anti-epileptic drug(AED) monotherapy. METHODS: Adult patients (age>18 years) with ?2 epilepsydiagnosis claims (ICD-9-CM:345) or one epilepsy diagnosis claim and one claim forother convulsion (ICD-9-CM: 780.39) were selected from the U.S. Veterans HealthAdministration database (01OCT2008-30SEPT2013). Patients were required tohave ?1 AED prescription post-epilepsy diagnosis, and the first AED prescription claim date was designated as the index date. Continuous health plan enrollment12 months pre- and post-index date was required. Patients were assigned to fourmonotherapy AED cohorts based on drug class: sodium channel blockers (SCs),gamma-aminobutyric acid analogs (GABAs), synaptic vesicle protein 2A binding(SV2) and multiple mechanisms (MMs). Adherence was assessed using the proportion of days covered (PDC) and persistence was defined as days to discontinuation with an allowable treatment gap of 45 days without the index AED. Logisticand Cox proportional hazards models were used to compare the results amongthe cohorts. RESULTS: Patients in the SC cohort had significantly lower baselineCharlson Comorbidity Index scores (1.82), indicating that they were healthier thanthose in the GAMA (2.08, p<0.001) and SV2 (2.46, p<0.001) cohorts. Patients in the SCcohort were significantly less likely to have a baseline psychiatric disorder (37.6%)than those in the GABA (63.8%, p<0.001) and MM (52.1%, p<0.001) cohorts. Patientstreated with GABAs (OR=0.44, p<0.001) and MMs (OR=0.63, p<0.001) were significantly less likely to adhere to their medications (PDC <80%) than those treatedwith SC. Furthermore, patients treated with GABAs (hazard ratio [HR]=1.74; 95%confidence interval [CI]=1.59-1.90) and MMs (HR=1.18; 95% CI=1.07-1.29) were morelikely to discontinue treatment during the follow-up period compared to those in theSC cohort. CONCLUSIONS: Patients treated with Sodium channel blockers are morelikely adhere to treatment and have lower discontinuation of AED monotherapythan those treated with GABAs and MMs.
  • Conference Object
    Pcv50 - a Retrospective Analysis of Health Care Resource Utilization and the Economic Burden Among Us Long-Term Care Facility Patients Diagnosed With Stroke
    (Elsevier Science Inc, 2015-05-01) 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.
  • Conference Object
    Pms38 - Demographic Distribution and Economic Burden of Patients Diagnosed With Rheumatoid Arthritis in the Us Medicare Population
    (Elsevier Science Inc, 2015) Li, L; Mao, X; Shrestha, S; Başer, Onur; Yuce H.; Wang, Li; Yuce, H.
    OBJECTIVES: To determine the demographic distribution and health care burden ofpatients diagnosed with rheumatoid arthritis (RA) using Medicare fee-for-service(FFS) data. METHODS: A retrospective analysis was performed using the 100%Medicare FFS datasets from October 1, 2008 through December 31, 2012. Patientsdiagnosed with RA were identified using International Classification of Diseases,9th Revision, Clinical Modification diagnosis code 714, and the first diagnosis datewas designated as the index date. All patients were required to have continuousmedical and pharmacy benefits 1 year pre- (baseline period) and post-index date(follow-up period). Health care resource utilization and costs during the baseline andfollow-up periods were calculated. RESULTS: Using Medicare FFS data, 112,550 RApatients were identified. The average age at diagnosis was 76 years, and 72.54% ofpatients were women and 83.94% were white. The most common baseline comorbidities were diabetes (35.48%), followed by chronic obstructive pulmonary disease(30.83%) and cerebrovascular disease (21.50%). During the follow-up period, 66.35%of patients had inpatient admissions, 49.01% had emergency room visits, 87.93%had outpatient office visits, 87.93% had outpatient visits and 61.67% had pharmacyvisits and costs were, on average, $26,510, $256, $4,204, $4,460 and $6,249, respectively. The average total costs incurred by RA patients were $37,219. The five mostcommonly-prescribed medications prescribed to treat RA were prednisone (3.40%),levothyroxine sodium (2.63%), hydrocodone bit/acetaminophen (2.39%), furosemide(2.13%) and omeprazole (2.13%). CONCLUSIONS: RA patient demographic distributions and RA-related health care cost information was obtained and the mostcommonly prescribed medications to treat RA were identified.
  • Conference Object
    Pcn62 - Assessing the Economic Burden of Us Medicare Patients Diagnosed With Non-hodgkin's Lymphoma
    (Elsevier Science Inc, 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.
  • Conference Object
    Pcv113 - Assessing the Health Care Resource Utilization and Economic Burden Among Us Cardiovascular Disease Patients in the Veterans Health Administration Population
    (Elsevier Science Inc, 2015-05-01) 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.