Ekonomi Bölümü Koleksiyonu

Permanent URI for this collectionhttps://hdl.handle.net/20.500.11779/1936

Browse

Filters

2014 - 201729

Settings

Publisher: search.filters.publisher.Elsevier Science Inc

Search Results

Now showing 1 - 10 of 29
  • Conference Object
    Pmh21 - Comparing the Healthcare Utilization and Costs of Early- and Late-Stage Alzheimer's Disease Patients Residing in Long-Term Care Facilities
    (Elsevier Science Inc, 2015-05-01) Xie, L.; Keshishian, A; Wang, Y.; Başer, Onur
    OBJECTIVES: To compare healthcare utilization and costs between early- andlate-stage Alzheimer’s disease (AD) patients residing in long-term care (LTC)facilities. METHODS: Patients diagnosed with AD (International Classification ofDiseases, 9th Revision, Clinical Modification [ICD-9-CM] code 331.0) were identifiedusing U.S. Medicare claims linked with the Long-Term Care Minimum Data Set (MDS)from 01JULY2008 through 31DEC2010. The first diagnosis date was designated asthe index date. Patients were required to be age ?65 years, with continuous medicaland pharmacy benefits for 6 months pre- and post-index date, and reside in an LTCfacility. Patients were categorized as early- or late-stage. Late-stage AD was definedby a cognitive performance scale score ?5 (range 0-6) and Activities of Daily Livingshort-form activities score ?10 points. Patients with and without AD were matchedbased on demographic and clinical characteristics, and 1:1 propensity score matching was used to compare follow-up all-cause and AD-related healthcare costs andutilizations. RESULTS: Before matching, late-stage AD patients (n=5,323) were lesslikely to be white (83.0% vs. 86.4%), male (16.4% vs. 21.7%) and have comorbid conditions measured by the Charlson Comorbidity Index score (3.55 vs. 4.83, p<0.001) thanearly-stage AD patients (n=20,023). After 1:1 matching, 3,804 patients were matchedfrom each cohort and baseline characteristics were balanced. Fewer late-stage ADpatients had skilled nursing facility admissions (25.3% vs. 29.8%, p<0.0001), but morehad hospice admissions (17.8% vs. 7.3%, p<0.0001) and pharmacy visits (85.8% vs.81.9%, p<0.0001) than early-stage AD patients. There were no significant differencesin total all-cause healthcare costs; however, late-stage AD patients incurred significantly higher disease-related total ($14,739 vs. $13,673, p=0.0242) and hospice costs($4,157 vs. $1,553, p<0.0001) compared to early-stage AD patients. CONCLUSIONS:Patients with late-stage AD incurred higher disease-related costs than those withearly-stage AD; however, there were no significant differences in total all-causehealthcare costs.
  • Conference Object
    Pmh15 - Prevalence and Incidence Rates Among Alcohol-Dependent Patients in the Us Medicare Population
    (Elsevier Science Inc, 2015-05-01) Li, L,; Shrestha, S.; Başer, Onur; Yuce H.; Li Wang; Yuce, H.; Wang, L.
    OBJECTIVES: To examine incidence and prevalence rates among alcohol-dependentpatients in the U.S. Medicare population. METHODS: A prospective study was performed from 01JAN2008 through 31DEC2012 to determine the prevalence and incidence of patients diagnosed with alcohol dependence (International Classificationof Diseases, 9th Revision, Clinical Modification diagnosis code 303) in the U.S.Medicare population. Patients were required to have continuous enrollment in afee-for-service Medicare health plan during the calendar year and at least 2 yearsprior. The age- and gender-adjusted prevalence and incidence (overall and ageand gender-specific) rates of alcohol-dependent patients were calculated by directstandardization to the U.S. population age ?65 years in 2010. RESULTS: The annualadjusted overall prevalence rate increased from 0.30% in 2008 to 1.05% in 2012,whereas the annual overall incidence rate decreased from 0.30% in 2008 to 0.20%in 2012. Alcohol dependence prevalence and incidence rates were higher amongmen than women every year. Patients age 65-69 years had the highest prevalencerates during 2008 (0.43%) and 2009 (0.63%), whereas in 2010 (0.82%), 2011 (1.14%) and2012 (1.43%), patients age 70-74 years had the highest prevalence rates. Prevalencerates grew steadily among all age groups from 2008 to 2012. The highest alcoholdependence incidence rate was observed in the Virgin Islands (917.6 per 100,000person-years) in 2008, whereas in 2012, Wyoming (409.3 per 100,000 person-years)had the highest incidence rate. CONCLUSIONS: Increasing prevalence and decreas ing incidence of alcohol dependence was observed from 2008 to 2012. In addition,men were more likely to have alcohol dependence than women.
  • Conference Object
    Citation - WoS: 1
    Pnd29 - a Retrospective Analysis of the Economic Burden Among Patients Diagnosed With Chronic Migraine Using the Veterans Health Administration Medical Data
    (Elsevier Science Inc, 2015-05-01) Mao, X; Shrestha, S; Başer, Onur; Wang, L
    OBJECTIVES: To evaluate the health care resource utilization and costsamong patients diagnosed with chronic migraine (CM) in the Veterans HealthAdministration (VHA) medical dataset. METHODS: Patients diagnosed with CMwere identified (International Classification of Diseases, 9th Revision, ClinicalModification diagnosis code 346.XX) using the VHA dataset from October 1, 2008through September 30, 2010. The initial diagnosis date was designated as the indexdate. Patients without CM with the same age, gender and region (comparison cohort)were matched using a randomly chosen index date to minimize selection bias.Patients in both cohorts were at least age 18 years and had continuous medicaland pharmacy benefits for 1 year before and after the index date. One-to-one propensity score matching (PSM) was used to compare health care costs and utilizations between the CM and the comparison cohorts, and was adjusted for baselinedemographic and clinical characteristics. Pain scores were also included to investigate wellness after CM diagnosis. RESULTS: After risk-adjustment by PSM, 123,241patients in each cohort were matched. Significantly more CM patients had inpatientadmissions (6.44% vs. 1.75%, p<0.0001) and emergency room (ER; 14.42% vs. 5.50%,p<0.0001), outpatient office (68.80% vs. 42.15%, p<0.0001), outpatient (69.30% vs.42.91%, p<0.0001) and pharmacy visits (70.84% vs. 41.43%, p<0.0001) compared tothose without CM. Accordingly, CM patients also incurred higher costs for inpatient admissions and ER, office, outpatient and pharmacy visits compared to thosewithout CM. Total costs incurred by CM patients were $4,776, almost triple that of patients without CM ($1,756). There were more CM patients with accompanying painat all levels (mild: 19.53% vs. 0.16%; moderate: 13.10% vs. 0.10%; severe: 16.20% vs.0.12%; all p<0.0001). CONCLUSIONS: CM patients in the VHA population had substantial health care resource utilization, incurred higher costs and suffered worsepain compared to those without the disease.
  • Conference Object
    Prs23 - a Descriptive Analysis of Patient Characteristics and Health Care Burden Associated With Chronic Obstructive Pulmonary Disease in the Us Medicare Population
    (Elsevier Science Inc, 2015-05-01) Xie, L.; Kariburyo, M. Furaha; Wang, Y; Başer, Onur
    Objectives: To evaluate the patient characteristics and health care burden associated with chronic obstructive pulmonary disease (COPD) in the U.S. Medicarepopulation. Methods: COPD patients were identified (International Classificationof Disease, 9th Revision, Clinical Modification [ICD-9-CM] codes: 491.xx, 492.xx and496.xx) using U.S. national Medicare claims from 01JAN2007 to 31DEC2010. The firstdiagnosis date was designated as the index date. Patients were required to: a) be age?65 years on the index date; b) have continuous medical and pharmacy benefits for 12months pre-index date (baseline period); c) have continuous enrollment for 12 monthspost-index date (follow-up period), unless there was earlier evidence of death; and d)have no COPD diagnosis pre-index date. The outcomes of interest included medicationuse, including a long-acting beta agonist (LABA) or LABA/inhaled corticosteroid (ICS)combination, mortality and health care resource utilization and costs. Results: Atotal of 543,249 COPD patients were identified. Patients were, on average, age 78 years.Most patients were white (94%) and resided in the South U.S. region (41%). The averageCharlson Comorbidity Index score was 3.23, and hypertension (67%), diabetes (28%),congestive heart failure (21%) and chronic pulmonary disease (20%) were the mostfrequently diagnosed comorbidities. A 13.82% mortality rate was observed duringthe first year of the follow-up period. Post-index LABA medications, including arfomoterol (0.55%), formoterol (0.25%) and salmeterol (0.32%) were prescribed to 1.10%of the population. Identified LABA/ICS combinations included budesonide/formoterol(1.97%) and fluticasone/salmeterol (10.02%). High health care resource utilization wasencountered for Medicare carrier (99.40%), pharmacy (90.27%), outpatient (76.52%)and inpatient visits (48.83%). The main cost drivers were inpatient ($10,645), Medicarecarrier ($4,888), outpatient ($3,322) and skilled nursing facility ($2,695) costs, resultingin $25,397 in total health care costs. Conclusions: U.S. Medicare patients have ahigh COPD-related health care burden
  • Conference Object
    Pdb44 - Health Care Resource Utilization and Costs Among Diabetes Patients Residing in Long-Term Care Facilities
    (Elsevier Science Inc, 2015-05-01) 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.
  • Conference Object
    Pmh13 - Examining Prevalence, Incidence and Mortality Rates Among Opioid-Dependent Patients in the U.s. Medicare Population
    (Elsevier Science Inc, 2015-05-01) Li, L.; Shrestha, S.; Başer, Onur; Yuce H.; Li Wang; Yuce, H.; Wang, L.
    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.
  • Conference Object
    Evaluating Fracture-Related Expenses and Health Care Resource Utilization Among Post-Menopausal Women in the Us Medicaid Population
    (Elsevier Science Inc, 2015-05-01) 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
  • Conference Object
    Pmh26 - Comparing Healthcare Resource Utilization and Costs Among Schizophrenic Patients Who Initiated Typical Vs. Atypical Long-Acting Injectables in the Us Veteran Population
    (Elsevier Science Inc, 2015-05-01) Başer, Onur; Kariburyo, M. Furaha; Du, J; Xie, L
    OBJECTIVES: To evaluate healthcare resource utilization and costs among schizophrenic patients who initiated typical and atypical long-acting injectables (LAIs) inthe U.S. veteran population. METHODS: Using the Veterans Health Administration(VHA) Medical SAS datasets, patients with ?1 pharmacy claim for LAIs were identified from 01OCT2005 through 30SEPT2012. The first LAI date was designated asthe index date. Patients were required to be age ?18 years, have continuous healthplan enrollment for 12 months pre-index date and a schizophrenia diagnosis(International Classification of Diseases, 9th Revision, Clinical Modification [ICD9-CM] code 295.xx) during the study period. Patient data was observed until theearlier date of death or the end of the study period, and patients were assigned totypical LAI (fluphenazine, haloperidol, perphenazine) or atypical LAI (aripiprazole,olanzapine, paliperidone, risperidone) antipsychotic cohorts. All-cause (follow-up)and psychiatric disorder-related healthcare resource utilization and costs wereassessed. Follow-up health care costs were adjusted to per-patient-per-month.The generalized linear model (GLM) was used to assess cost and utilization differences among the cohorts. RESULTS: A total of 4,796 patients were identified(Typical LAI cohort: N=1,941; Atypical LAI cohort: N=2,855). Typical LAI patientswere older (age 53.81 vs. 50.94 years, p<0.0001) and more likely to be black (34.47%vs. 28.27%, p<0.0001) than atypical LAI patients. After adjusting for baseline differences using GLM, more patients prescribed typical LAIs had all-cause emergencyroom [ER] visits (61.66% vs. 58.11%, p=0.024) and inpatient stays (63.11% vs. 59.00%, p=0.008) and psychiatric disorder-related ER visits (33.83% vs. 30.05%, p=0.011)than those prescribed atypical LAIs. However, typical LAI patients incurred lowerall-cause pharmacy ($197 vs. $433, p<0.001), total ($2,850 vs. $3,073, p=0.048) andpsychiatric disorder-related total costs ($1,615 vs. $1,624, p=0.908) than atypical LAIpatients. CONCLUSIONS: Although patients who initiated typical LAIs had highhealthcare resource utilization, their economic burden was lower compared to thosewho initiated atypical LAIs.
  • Conference Object
    Pih13 - Examining the Fracture-Related Cost Burden and Health Care Resource Utilization Post-Menopause in the Us Medicare Population
    (Elsevier Science Inc, 2015-05-01) 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.
  • Conference Object
    Demographic Distribution and Health Care Burden of Patients Diagnosed With Ankylosing Spondylitis in the Us Medicare Population
    (Elsevier Science Inc, 2015-05-01) 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.