We examined whether outcomes of care (amputation and hospitalisation) among patients with diabetes and foot ulcer differ between those who received pre-ulcer care from podiatrists and those who did not. Adult patients with diabetes and a diagnosis of a diabetic foot ulcer were found in the MarketScan Databases, 2005-2008. Multivariate Cox proportional hazard models estimated the hazard of amputation and hospitalisation. Logistic regression estimated the likelihood of these events. Propensity score weighting and regression adjustment were used to adjust for potentially different characteristics of patients who did and did not receive podiatric care. The sample included 27 545 patients aged greater than 65+ years (Medicare-eligible patients with employer-sponsored supplemental insurance) and 20 208 patients aged lesser than 65 years (non Medicare-eligible commercially insured patients). Care by podiatrists in the year prior to a diabetic foot ulcer was associated with a lower hazard of lower extremity amputation, major amputation and hospitalisations in both non Medicare-eligible commercially insured and Medicare-eligible patient populations. Systematic differences between patients with diabetes and foot ulcer, receiving and not receiving care from podiatrists were also observed; specifically, patients with diabetes receiving care from podiatrists tend to be older and sicker.
6553 Background: Several long-standing chemotherapy regimens are available to treat metastatic colorectal cancer (mCRC) including: oxaliplatin plus 5-fluorouracil (5-FU) and leucovorin (FOLFOX); and Irinotecan plus 5-FU and leucovorin (FOLFIRI). More recently, new biologic therapies were approved for use in mCRC. This cohort study examines trends in first-line chemotherapy treatments for newly diagnosed mCRC patients after the introduction of capecitabine (CAP) in 2001 and the biologic therapies in 2004. Methods: Using a large, US-based administrative medical claims database of a national commercially insured population, patients with newly diagnosed mCRC were identified from 2001 to 2005. At least 6-months of patient history prior to mCRC diagnosis were required to confirm patients were newly diagnosed. Patients were followed from initial mCRC diagnosis to death, disenrollment, or 12/31/2006. Results: Total of 3,781 newly diagnosed mCRC patients were identified between 2001–2005. On average over the 5 years, 58% of patients (with annual variation ± 4% points) received chemotherapy/biologic treatment in the year following their mCRC diagnosis; mean days to initiation of chemotherapy treatment decreased from 135 to 62 between 2001–2005. In 2001, FOLFIRI (40%), 5-FU (30%), and CAP (20%) were the most prevalent first-line treatments. In 2005, first-line treatment regimens were more diverse: FOLFOX plus bevacizumab (35%), FOLFOX alone (15%), 5-FU (15%), and CAP (15%) were the most prevalent, while 33% of patients used other treatment combinations. Among mCRC patients diagnosed in 2005, 63% were treated with at least one biologic therapy in the first year after diagnosis (57% received bevacizumab; 26% received cetuximab). Conclusions: While rates of chemotherapy use remained relatively constant between 2001–2005, patients initiated chemotherapy treatment sooner after their initial diagnosis and the standard course of therapy shifted from being FOLFIRI-based to FOLFOX-based. A rapid uptake in biologic therapies occurred. The majority of newly diagnosed mCRC patients were users of biologic therapy within one year following their introduction. [Table: see text]
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