Study Design. Retrospective cohort study. Objective. To evaluate the impact of admission status on patient outcomes and healthcare costs in anterior cervical discectomy and fusion (ACDF). Summary of Background Data. Undergoing ACDF nonelectively has been associated with higher patient comorbidity burdens. However, the impact of non-elective status on the total cost of hospital stay has yet to be quantified. Methods. Patients undergoing ACDF at a single institution were placed into elective or non-elective cohorts. Propensity scorematching analysis in a 5:1 ratio controlling for insurance type and comorbidities was used to minimize selection bias. Demographics were compared by univariate analysis. Cost of care, length of stay (LOS), and clinical outcomes were compared between groups using multivariable linear and logistic regression with elective patients as reference cohort. All analyses controlled for sex, preoperative diagnosis, elixhauser comorbidity index (ECI), age, length of surgery, number of segments fused, and insurance type. Results. Of 708 patients in the final ACDF cohort, 590 underwent an elective procedure and 118 underwent a nonelective procedure. The non-elective group was significantly younger (53.7 vs. 49.5 yr; P ¼ 0.0007). Cohorts had similar proportions of private versus public health insurance, although elective had higher rates of commercial insurance (39.22% vs. 15.25%; P < 0.0001) and non-elective had higher rates of managed care (32.77% vs. 56.78%; P < 0.0001). Operation duration was significantly longer in non-elective patients (158 vs. 177 minutes; P ¼ 0.01). Adjusted analysis also demonstrated that admission status independently affected cost

BackgroundBiologic therapies have considerably improved clinical management of autoimmune diseases. Over the past few years, several biosimilars have been introduced in Europe for these conditions. Limited information is available evaluating the impact of switching stable patients from originators to their respective biosimilars in clinical practice for non-medical reasons.ObjectivesThis real-world study reported and compared patient characteristics, clinical outcomes, and healthcare resource utilization (HRU) associated with stable patients who switched from the originator biologic etanercept to its biosimilar (switchers) vs. those who stayed on the originator (non-switchers) in adults with a rheumatic condition such as ankylosing spondylitis (AS), psoriatic arthritis (PsA), or rheumatoid arthritis (RA).MethodsMedical record data were retrospectively collected anonymously from rheumatologists in the UK and Germany. Adult patients who were diagnosed with RA, AS, or PsA, treated with originator etanercept for at least 6 months with a stable dosing schedule, and had no emergency department visit or hospitalization for the disease of interest over the 6-month period were eligible for the study. The index date for a non-switcher was the prescription date closest to one year after the initiation of originator etanercept and with a stable dosing for at least 6 months. The index date for a switcher was the biosimilar initiation date. Chart data available for at least 12 months prior to and post the index date were required. Patient characteristics, disease severity, symptoms and signs, and HRU were extracted anonymously. Unadjusted and adjusted comparisons of the outcomes between non-switchers and switchers were conducted among all patients and for each individual disease.ResultsData were extracted from 242 patient records (non-switchers = 123, 50.8%; switchers = 119, 49.2%; AS=26.4%; PsA=26.0%; RA=47.5%) from 162 rheumatologists. At baseline, non-switchers were significantly younger than switchers (44.5 vs. 48.4 years, p<0.05), had a significantly shorter time on the originator etanercept (11.7 vs. 23.8 months), and more patients had been treated with NSAIDS (55.3% vs. 37.8%). Significantly more non-switchers had moderate, or severe disease (27.6% vs 16.0%, p<0.05; 26.8% vs 5.9%, p<0.01) and non-switchers on average had worse joint or spine pain (4.4 vs 2.4, p <0.01) than switchers. During the follow-up period, significantly more non-switchers’ disease status improved (58.5% vs. 25.2%. p<0.01), resulting comparable disease severity (moderate: 10.6% vs 10.9%; severe: 0% vs 0%) and joint or spine pain scale (2.0 vs 1.0) between the two cohorts. After adjusting for potential confounding factors, compared to switchers, more AS and PsA non-switchers improved in disease severity (AS: p<0.05; PsA: p<0.01), and RA non-switchers had a fewer number of swollen joints (0.5 vs 1.5, p<0.01). Non-switchers generally had numerically lower HRU than switchers during the one-year follow-up period (patients with outpatient visits: 76.4% vs...

ObjectivesTo provide up-to-date information on the use of long-term ventilation (LTV) in the UK paediatric population and to compare the results with data collected 10 and 20 years previously.DesignA single timepoint census completed by LTV centres in the UK, carried out via an online survey.Setting and patientsAll patients attending paediatric LTV services in the UK.ResultsData were collected from 25 LTV centres in the UK. The total study population was 2383 children and young people, representing a 2.5-fold increase in the last 10 years. The median age was 9 years (range 0–20 years). Notable changes since 2008 were an increase in the proportion of children with central hypoventilation syndrome using mask ventilation, an increase in overall numbers of children with spinal muscular atrophy (SMA) type 1, chronic lung disease of prematurity and cerebral palsy being ventilated, and a 4.2-fold increase in children using LTV for airway obstruction. The use of 24-hour ventilation, negative pressure ventilation and tracheostomy as an interface had declined. 115 children had received a disease-modifying drug. The use of ataluren and Myozyme did not influence the decision to treat with LTV, but in 35% of the children with SMA type 1 treated with nusinersin, the clinician stated that the use of this drug had or may have influenced their decision to initiate LTV.ConclusionThe results support the need for national database for children and young people using LTV at home to inform future recommendations and assist in resource allocation planning.

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