BackgroundAmong schizophrenia patients relapsed on an oral antipsychotic (AP), this study compared the impact of switching to atypical AP long-acting injectable therapy (LAT) versus continuing oral APs on hospitalization and emergency room (ER) visit recurrence.MethodsElectronic records from the Premier Hospital Database (2006-2010) were analyzed. Adult patients receiving oral APs during a schizophrenia-related hospitalization were identified and, upon relapse (i.e., rehospitalization for schizophrenia), were stratified into (a) patients switching to atypical LAT and (b) patients continuing with oral APs. Atypical LAT relapse patients were matched 1:3 with oral AP relapse patients, using a propensity score model. Andersen-Gill Cox proportional hazards models assessed the impact of atypical LAT versus oral AP on time to multiple recurrences of all-cause hospitalizations and ER visits. No adjustment was made for multiplicity.ResultsAtypical LAT (N = 1032) and oral AP (N = 2796) patients were matched and well-balanced with respect to demographic (mean age: 42.1 vs 42.4 years, p = .5622; gender: 43.6% vs 44.6% female, p = .5345), clinical, and hospital characteristics. Over a mean 30-month follow-up period, atypical LATs were associated with significantly lower mean number of rehospitalizations (1.25 vs 1.61, p < .0001) and ER visits (2.33 vs 2.67, p = .0158) compared with oral APs, as well as fewer days in hospital (mean days: 13.46 vs. 15.69, p = .0081). Rehospitalization (HR 0.81, 95% CI 0.76–0.87, p < .0001) and ER visit (HR 0.88, 95% CI 0.87–0.93, p < .0001) rates were significantly lower for patients receiving atypical LAT versus oral APs.ConclusionsThis hospital database analysis found that in relapsed schizophrenia patients, atypical LATs were associated with lower rehospitalization and ER visit rates than oral APs.
ObjectivesWe assess how different scenarios of cardiovascular disease (CVD) prevention, aimed at meeting targets set by the World Health Organization (WHO) for 2025), may impact healthcare spending in Quebec, Canada over the 2050 horizon.MethodsWe provide long-term forecasts of healthcare use and costs at the Quebec population level using a novel dynamic microsimulation model. Using both survey and administrative data, we simulate the evolution of the Quebec population’s health status until death, through a series of dynamic transitions that accounts for social and demographic characteristics associated with CVD risk factors.ResultsA 25% reduction in CVD mortality between 2012 and 2025 achieved through decreased incidence could contain the pace of healthcare cost growth towards 2050 by nearly 7 percentage points for consultations with a physician, and by almost 9 percentage points for hospitalizations. Over the 2012–2050 period, the present value of cost savings is projected to amount to C$13.1 billion in 2012 dollars. The years of life saved due to improved life expectancy could be worth another C$38.2 billion. Addressing CVD mortality directly instead would bring about higher healthcare costs, but would generate more value in terms of years of life saved, at C$69.6 billion.ConclusionsPotential savings associated with plausible reductions in CVD, aimed at reaching a World Health Organization target over a 12-year period, are sizeable and may help address challenges associated with an aging population.
We investigate the returns to college attendance in Canada in terms of health and mortality reduction. To do so, we first use a dynamic health microsimulation model to document how interventions which incentivize college attendance among high school graduates may impact their health trajectory, health care consumption and life expectancy. We find large returns both in terms of longevity (4.1 years additional years at age 51), reduction in the prevalence of various health conditions (10-15 percentage points reduction in diabetes and 5 percentage points for stroke) and health care consumption (27.3% reduction in lifetime hospital stays, 19.7 for specialists). We find that education impacts mortality mostly by delaying the incidence of health conditions as well as providing a survival advantage conditional on having diseases. Second, we provide quasi-experimental evidence on the impact of college attendance on longterm health outcomes by exploiting the Canadian Veteran's Rehabilitation Act, a program targeted towards returning WW-II veterans and which incentivized college attendance. The impact on mortality are found to be larger than those estimated from the health microsimulation model (hazard ratio of 0.216 compared to 0.6 in the simulation model) which suggest substantial returns to college education in terms of healthy life extension which we estimate around one million canadian dollars. JEL Codes: I14, I26
Quebecers are living longer than ever before as a result of better health as well as improved educational attainment and economic well-being. Using a dynamic microsimulation model, we show that an aging workforce will not necessarily mean a decline in Quebec employment levels in the coming years. Because future experienced workers will be more educated and more of them will remain in employment for longer, we project that annual growth rates in employment will stay positive, averaging between 0.2 and 0.3 percent over the next two decades. Between 2035 and 2050, employment could contribute nearly 0.3 percentage points to annual economic growth in Quebec.
adjusting for baseline factors (age, sex, race, region, metropolitan statistical area, family income, and health insurance coverage) using regression model statistics (adjusted R2). RESULTS: The overall prevalence of pediatric ADHD was 2.47% (n ϭ 5.82 million). Most of the children were boys (68%), White (84%) and had private health insurance (62%). Overall mean annual expenditure was $ 4145.87. Adjusted R2 for the baseline model was 0.1130. When different comorbidity measures were added to the baseline model the adjusted R2 increased to: 0.1230 (CIS), 0.1566 (D'Hoore version of CCI), 0.1534 (MECI), and 0.1372 (CDS-1). Among different combinations, a model consisting of patient baseline characteristics, MECI, and CIS explained the most variation in healthcare expenditure (adjusted R2 ϭ 0.1618). CONCLUSIONS: Models that include comorbidity and functional status measures performs best in risk adjusting health care expenditure in pediatric ADHD. There is a greater need to evaluate the use of CIS as a potential risk adjustment tool in mental and behavioral problems. OBJECTIVES:To assess the association of second-generation antipsychotics prescriptions (SGAs) with changes in body mass index (BMI) among adolescents compared to a randomly selected age and gender matched untreated comparison group. METHODS: A retrospective cohort study was conducted using an ambulatory electronic medical record database between January 2004 and July 2009. Antipsychotic naïve (no evidence of SGAs during 540 days pre index period) monotherapy adolescents 12-19 years with at least one prescription for any SGA during 395 days follow-up period were eligible. The comparison group without antipsychotic prescription was matched (3:1) to the antipsychotic group based on age, gender, and month of SGA. A maximum follow-up BMI 90 days post index date was evaluated and percentage change from baseline BMI was calculated. Multivariate linear regression was conducted to assess the percent change in follow-up BMI from baseline among antipsychotic users compared to the comparison group controlling for covariates. RESULTS: The mean age (15.35 years, SD 2.27) and gender (males, 53%) distribution among the antipsychotic group (nϭ793) was similar (pϾ0.05) to the comparison group (nϭ2,373). The mean percentage increase in follow-up BMI from baseline for antipsychotic group was significantly higher than the comparison group (pϽ0.01) except for ziprasidone (pϾ0.05). After adjusting for covariates, adolescents on olanzapine had the highest percentage increase in follow-up BMI from baseline (5.84%, 95% Confidence Interval [CI], 4.07-7.61) followed by aripiprazole (4.36%; 95% CI, 3.08 -5.64), risperidone (3.65%; 95% CI, 2.61-4.68), and quetiapine (1.53%; 95% CI, 0.53-2.52) compared to the comparison group. Normal weight adolescents on antipsychotics had higher percentage increase in follow-up BMI from baseline compared to overweight or obese. CONCLUSIONS: Treatment with SGAs is associated with significant increase in BMI among adolescents relative to a matched comp...
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