PurposeAtrial fibrillation/flutter (AF) is frequently associated with cardiovascular comorbidities. Observational health care databases are commonly used for research purposes in studies of quality of care, health economics, outcomes research, drug safety, and epidemiology. This retrospective cohort study applied a common data model to administrative claims data (Truven Health Analytics MarketScan® claims databases [MS-Claims]) and electronic medical records data (Geisinger Health System’s MedMining electronic medical record database [MG-EMR]) to examine the risk of cardiovascular hospitalization and all-cause mortality in relation to clinical risk factors in recent-onset AF and to assess the consistency of analyses for each data source.MethodsCohorts of patients with newly diagnosed AF (n=105,262 [MS-Claims] and n=3,919 [MG-EMR]) and demographically similar patients without AF (n=105,262 [MS-Claims] and n=3,872 [MG-EMR]) were followed from the qualifying AF diagnosis until cardiovascular hospitalization, death, database disenrollment, or study completion. A common data model standardized the data in structure, format, content, and nomenclature to allow for systematic assessment and comparison of outcomes from two disparate data sets.ResultsIn both databases, AF patients had greater overall baseline comorbidity and higher incidence rates of cardiovascular hospitalization (threefold higher) and all-cause mortality (46% higher) than non-AF patients. For AF patients, incidence rates of cardiovascular hospitalization and all-cause mortality were increased by the concomitant presence of coronary disease, chronic obstructive pulmonary disease, and stroke at baseline. Overall, the pattern of cardiovascular hospitalization in the MS-Claims database was similar to that in the MG-EMR database. Compared with the MS-Claims database, the use of cardiovascular medications and the capture of certain comorbidities among AF patients appeared to be higher in the MG-EMR data set.ConclusionSimilar standardized analyses across EMR and Claims databases were consistent in the association of AF with acute morbidity and an increased risk of all-cause mortality. Areas of inconsistency were due to differences in underlying population demographics and cardiovascular risks and completeness of certain data fields.
Objectives: To assess pill burden, health care resource utilization (HRU), and costs among patients with long-term immediate release (IR) hydrocodone use. MethOds: We performed a retrospective analysis of health care claims from 2011-2012 Truven MarketScan® Commercial, Medicare supplemental, and Medicaid Multistate databases. Patients with IR hydrocodone prescription for ≥ 90 days during 6 month baseline period (July 2011-December 2011) with continuous enrollment during baseline and 12 month follow-up periods were selected. The final population was sub-categorized by prescribed coverage days (PCD) of IR hydrocodone during baseline into 90-119, 120-179, and ≥ 180 days. Chi-square or ANOVA analyses were used to test pill burden, HRU and costs (standardized to 2013 US dollars) during baseline and follow-up periods across subpopulations. Results: A total of 36,174 commercial, 32,699 Medicaid, and 8,873 Medicare IR hydrocodone users were selected. In the baseline period, subgroups with longer PCD had significantly more average hydrocodone pills per month yet fewer HRU and medical costs (all p< 0.05). However, during the follow-up period, groups with longer PCD had greater increase in number of inpatient hospitalizations and other types of HRU (length of stay, outpatient hospital visits, office visits, and emergency room visits). The subgroup of patients with PCD < 120 days had lower annual all-cause medical costs during follow-up compared with baseline (decreasing $2,624, $2,955, $4,209 per patient per year in Medicaid, Medicare and commercial patients, respectively), while patients with longer PCD during baseline had increased costs (p< 0.05). For example, Medicaid patients with 120-179 PCD had an increase of $1,874 and those with ≥ 180 PCD had an increase of $4,348. These trends were similar for all insurance types. cOnclusiOns: Extended length of PCD, particularly after 120 days, corresponds with higher patient burden including elevated pill burden and rising HRU and costs in both commercial and public insurance patients with long-term IR hydrocodone use.
OBJECTIVES:To identify and characterize publicly available cases and related trends for performance-based schemes. METHODS: We performed a systematic review of performance-based schemes over the past 15 years (1996 -2011) using publicly available databases and reports from colleagues and health care experts. These were categorized according to a previously published taxonomy of scheme types and assessed in terms of the underlying product and market attributes for each scheme. Macro-level trends were identified related to the timing of scheme adoption, countries involved, types of schemes, and product and market factors. RESULTS: Our search yielded in excess of 110 schemes. From this set, we identified:
subgroup of patients (Nϭ473) eligible for evaluation under Method II was also evaluated under Method I, to assess differences in results compared with the overall population. Method I yielded higher dose estimates when compared to Method II. This was consistent for the total sample and subgroup. Ustekinumab cost per injection in Method I was estimated up to 68.2% higher than in Method II. Variability in cost estimates across doses was up to 18 times higher in Method I than Method II. CONCLUSIONS: Conducting ustekinumab drug utilization assessments with pharmacy claims requires a methodological adjustment to address multiple doses dispensed on the same claim. Unadjusted assessment may yield artificially high dose and cost estimates. Adjusted assessments offer a more realistic distribution of dose and less variability in cost estimates. The ability to conduct adjusted assessments requires the sample to have Ն 2 ustekinumab prescriptions and sufficient follow-up time.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.