Background Behavioral symptoms are common in patients with dementia. However, there is limited evidence of their economic burden. Among commercially insured patients with dementia in the United States, this study assessed the prevalence of diagnosed behavioral symptoms and whether healthcare resources utilization and costs were associated with these symptoms. Methods This retrospective observational study was conducted using the IBM® MarketScan® Commercial Claims and Encounters and Medicare Supplemental database from October 1, 2015, to September 30, 2019. Diagnoses of dementia and behavioral symptoms were identified using the International Classification of Diseases, 10th Modification codes. To test differences in patient characteristics among those with and without diagnosed behavioral symptoms, t-tests were used for continuous variables, and chi-square tests were used for categories. Generalized linear models were used to compare healthcare resource utilization and costs between patients with and without diagnosed behavioral symptoms, adjusted for baseline characteristics. Results Of the 62,901 patients with dementia included in the analysis, 16.5% had diagnosed behavioral symptoms 12 months post dementia diagnosis. Patients with diagnosed behavioral symptoms used more health care resources (mean annual pharmacy visits per patient: 39.83 vs. 33.08, mean annual outpatient visits per patient: 24.20 vs. 16.94, mean annual inpatient visits per patient: 0.98 vs. 0.47, mean annual ER visits per patient: 2.45 vs. 1.21) and incurred higher cost of care than those without diagnosed behavioral symptoms (mean annual total health care costs per patients: $63,268 versus $33,383). Inpatient care was the most significant contributor to total costs (adjusted annual mean cost per patient: $28,195 versus $12,275). Conclusion Behavioral symptoms were significantly associated with higher healthcare resource utilization and costs among patients with dementia. Further research is warranted to address the unmet medical needs of this patient population.
BACKGROUND In the real-world clinical setting, patients with moderate-to-severe ulcerative colitis (UC) may undergo dose escalation when they lose response to their prescribed biologic treatment. Such dose escalation of biologic agents has an impact on healthcare utilization and costs and may have an impact on patient outcomes. Currently, limited real-world data exist that compare rates of dose escalation between anti-tumor necrosis factor (anti-TNF) biologic therapies and vedolizumab, a gut-selective integrin antagonist, in patients with UC who have not previously been treated with biologic therapies (bio-naïve patients). METHODS ODESSA (real wOrld Dose EScalation and outcomeS with biologics in IBD pAtients) was a retrospective cohort study investigating dose escalation in bio-naïve patients with UC receiving vedolizumab or anti-TNFs (adalimumab, golimumab, and infliximab) using data from the IBM MarketScan Commercial Claims and Encounters and Medicare Supplemental Databases. Adult patients with ≥1 claim for a study drug between January 1, 2017 and December 31, 2018 were selected for inclusion, with the first claim date defined as index date 1 (Figure). Patients were eligible if they had a diagnosis of UC, identified based on UC diagnosis codes, had ≥2 claims for the study drug ≥10 days apart with ≥1 claim on or before index date 1, and had received the study drug for ≥60% of days in the first 6 months after index date 1. Patients were excluded if they had received any biologic treatment before index date 1. The maintenance period began on the date of the third (adalimumab or golimumab) or fourth (infliximab or vedolizumab) pharmacy claim. Dose escalation was defined as a ≥20% increase in mean average daily dose relative to expected daily dose based on the approved prescribing information for UC. The primary endpoint was to compare the proportions of patients experiencing dose escalation of each of the study drugs in the first 6 and 12 months after initiation of maintenance dosing and in the entire maintenance period. RESULTS The final analysis cohort included 2,628 patients (vedolizumab, n=554; infliximab, n=758; adalimumab, n=1,316). As a consequence of low patient count, patients treated with golimumab were excluded. At 12 months, the proportion of patients experiencing dose escalation was lowest in the vedolizumab group (36%) and highest in the adalimumab group (44%) (Table). CONCLUSION In this retrospective, real-world cohort of bio-naïve patients with UC receiving vedolizumab or anti-TNFs, rates of dose escalation were lowest among patients receiving vedolizumab during the maintenance period. These data seem to indicate that vedolizumab maintains efficacy with less need for dose escalation; however, additional studies are required to investigate dose-escalation requirements for all biologic treatments.
Background: Neurofibromatosis type 1 (NF1)-related plexiform neurofibromas (PN) can cause substantial morbidity by disfigurement and compression of vital structures. Real-world data on the burden and cost of disease among pediatric patients with NF1 and PN is limited. The objectives of this study were to describe the characteristics, treatment patterns, healthcare resource use (HCRU), and costs of these patients.Results: A total of 383 patients were included in the retrospective analysis of patients aged ≤18 with at least 1 ICD-10-CM diagnosis code for both NF1 and PN enrolled in the MarketScan® Multistate Medicaid database from October 1, 2014 to December 31, 2017. The mean follow-up was 448 days. The mean age was 11.4 years and 52.0% of patients were male. Most patients were diagnosed by a specialist (63.5%). During the follow-up period, pain medications were used by 58.5% of patients, 25.1% were treated with chemotherapy, 7.1% received surgery for PN, 1.6% received MEK inhibitors, and 0.8% received radiation. Mean per patient per year inpatient, outpatient, emergency room, pharmacy, and other visits were 1.4, 17.3, 1.6, 13.6, and 25.8, respectively. Mean ±SD (median) total per patient per year healthcare costs (2018 USD) were $17,275 ±$61,903 ($2,889), with total medical costs of $14,628 ±$56,203 ($2,334) and pharmacy costs of $2,646 ±$13,303 ($26). Inpatient costs were the largest drivers of medical cost, with a mean per patient per year cost of $6,739.Conclusions: This study showed that many pediatric patients diagnosed with NF1 and PN were treated with supportive care only, highlighting a substantial unmet medical need. This study also highlights the considerable economic burden among patients with NF1 and PN.
Table 1. (continued) Placebo (N561) GUS 200 mg IV q4w à100 mg SC q8w (N561) GUS 600 mg IV q4w à200 mg SC q4w (N563) GUS 1200 mg IV q4w à 200 mg SC q4w (N561) UST ;6 mg/kg IV à90 mg SC q8w (N563) Wk 12 Wk 48 -0.73 (8.872), N556 -4.63 (8.869),* N558 -5.66 (10.437), N556 -3.43 (9.178),* N561 -4.85 (8.831), N558 -6.78 (7.805),** N557 -6.34 (10.188), N549 -3.86 (7.908), N563 -5.09 (6.624), N559
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