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.
  • Article
    Citation - WoS: 7
    Citation - Scopus: 8
    The Use of Decomposition Methods in Real-World Treatment Benefits Evaluation for Patients With Type 2 Diabetes Initiating Different Injectable Therapies: Findings From the Initiator Study
    (Elsevier Science Inc, 2017-12-01) Ke, Xuehua; Buysman, Erin; Wei, Wenhui; Xie, Lin; Grabner, Michael; Brekke, Lee; Başer, Onur
    Background: Determining characteristics of patients likely to benefit from a particular treatment could help physicians set personalized targets. OBJECTIVES: To use decomposition methodology on real-world data to identify the relative contributions of treatment effects and patients' baseline characteristics. METHODS: Decomposition analyses were performed on data from the Initiation of New Injectable Treatment Introduced after Antidiabetic Therapy with Oral-only Regimens (INITIATOR) study, a real-world study of patients with type 2 diabetes started on insulin glargine (GLA) or liraglutide (LIRA). These analyses investigated relative contributions of differences in baseline characteristics and treatment effects to observed differences in 1-year outcomes for reduction in glycated hemoglobin A1c (HbA1c) and treatment persistence. RESULTS: The greater HbA1c reduction seen with GLA compared with LIRA (-1.39% vs. -0.74%) was primarily due to differences in baseline characteristics (HbA1c and endocrinologist as prescribing physician; P < 0.050). Patients with baseline HbA1c of 9.0% or more or evidence of diagnosis codes related to mental illness achieved greater HbA1c reductions with GLA, whereas patients with baseline polypharmacy (6-10 classes) or hypogylcemia achieved greater reductions with LIRA. Decomposition analyses also showed that the higher persistence seen with GLA (65% vs. 49%) was mainly caused by differences in treatment effects (P < 0.001). Patients 65 years and older, those with HbA1c of 9.0% or more, those taking three oral antidiabetes drugs, and those with polypharmacy of more than 10 classes had higher persistence with GLA; patients 18 to 39 years and those with HbA1c of 7.0% to less than 8.0% had higher persistence with LIRA. CONCLUSIONS: Although decomposition does not demonstrate causal relationships, this method could be useful for examining the source of differences in outcomes between treatments in a real-world setting and could help physicians identify patients likely to respond to a particular treatment. Copyright (C) 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
  • 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
    The Relationship Between Medical Innovation and Health Expenditures
    (Elsevier Science Inc, 2016-11-01) Çınaroğlu, Songül; Guzel, E; Başer, Onur
    Objectives: It is widely accepted that medical innovation includes many costly activities, and that it is a key driver of rising health care expenditures. Understanding the relationship between medical innovation and health care expenditures is critical for health policy makers to effectively make resource allocation decisions. This study seeks to investigate the relationship between medical innovation and health care expenditures. Methods: We assessed data from the World Intellectual Property Organization and World Bank statistics for the year 2014, which included data from 72 countries. The number of patent publications in the categories of medical technology, biotechnology, and pharmaceuticals were included as medical innovation indicators; public heath, health care costs per capita, and total health care costs (percentage of gross domestic product [GDP]) were included as indicators of health care-related expenditures. A canonic correlation analysis (CCA) was performed to examine the degree of association between the sets of medical innovation and health care expenditure variables. Results: Study results indicate that there is a strong positive correlation between medical innovation and health care expenditure variables (rc= 0.68, p<0.001). Conclusions: In light of this study, health policy makers should manage the relationship between medical innovation and health care expenditures with a focus on accessibility. Improved communication channels in the social system, increased international cooperation, and the determination of a proper balance between the benefits and costs of innovation may help to continue improving medical innovation and enhance health care accessibility. We hope that the study results offer an increased awareness of the relationship and balance between innovation and expenditure, and will help to create an improved health system.
  • 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.