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Papers by Katalin Bognar

Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, Sep 1, 2017

To estimate the impact of increased glycated hemoglobin (A1C) monitoring and treatment intensific... more To estimate the impact of increased glycated hemoglobin (A1C) monitoring and treatment intensification for patients with type 2 diabetes (T2D) on quality measures and reimbursement within the Medicare Advantage Star (MA Star) program. The primary endpoint was the share of patients with T2D with adequate A1C control (A1C ≤ 9%). We conducted a simulation of how increased A1C monitoring and treatment intensification affected this end point using data from the National Health and Nutrition Examination Survey and clinical trials. Using the estimated changes in measured A1C levels, we calculated corresponding changes in the plan-level A1C quality measure, overall star rating, and reimbursement. At baseline, 24.4% of patients with T2D in the average plan had poor A1C control. The share of plans receiving the highest A1C rating increased from 27% at baseline to 49.5% (increased monitoring), 36.2% (intensification), and 57.1% (joint implementation of both interventions). However, overall sta...

Journal of Comparative Effectiveness Research

Aim: To compare rates of biologic initiation after commencing treatment with apremilast (APR) ver... more Aim: To compare rates of biologic initiation after commencing treatment with apremilast (APR) versus methotrexate (MTX) in systemic-naive patients with psoriasis (PsO). Methods: This was a retrospective cohort study of systemic-naive patients with PsO who initiated treatment with APR or MTX between 1 January 2015 and 31 March 2018. Outcomes: Adjusted rates of biologic initiation during follow-up were compared by logistic and Cox regressions. Results: APR initiators had 58% lower likelihood of biologic initiation (odds ratio: 0.42; 95% CI: 0.37–0.48; p < 0.001), lower adjusted biologic initiation rate (14.4% [95% CI: 13.2–15.7%] vs 28.6% [95% CI: 26.8–30.5%]), lower risk of biologic initiation (hazard ratio: 0.45; 95% CI: 0.40–0.51; p < 0.001) compared with MTX initiators. Conclusion: Systemic-naive patients with PsO have a lower rate of biologic initiation over 1 year following APR initiation.

Blood

INTRODUCTION: The amyloidoses are a group of protein-folding disorders characterized by extracell... more INTRODUCTION: The amyloidoses are a group of protein-folding disorders characterized by extracellular tissue deposition of aggregated proteins as ß-pleated sheet fibrils. One of the most common and severe types is immunoglobulin light chain (AL), or "primary", amyloidosis. Prior studies of healthcare cost and resource use were hampered by the absence of an International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code specific to AL amyloidosis. Since 10/1/2017, the ICD-10-CM has included a diagnosis code for AL amyloidosis (E85.81). We believe the current study is the first to report healthcare cost and resource use using this new code. METHODS: To understand characteristics, healthcare resource utilization, costs, and clinical outcomes associated with AL amyloidosis for patients treated in US hospitals, this retrospective analysis used 2017-2020 data from the Premier Perspective® Database. The study population comprised of hospitalized pati...

Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 2021

OBJECTIVES To compare the ex ante willingness to pay (WTP) of healthy individuals for generous in... more OBJECTIVES To compare the ex ante willingness to pay (WTP) of healthy individuals for generous insurance coverage of novel lung cancer treatments to the WTP for coverage of such treatment among individuals with lung cancer. METHODS A survey was administered to 2 cohorts of US adults: (1) healthy individuals without cancer and (2) individuals diagnosed with lung cancer. A multiple random staircase survey design was used to elicit respondent WTP for coverage of novel lung cancer therapy associated with survival gains. RESULTS Of the 84 937 healthy individuals invited, 300 completed the survey. Of the 36 249 in the lung cancer cohort invited, 250 completed the survey. Mean age by cohort was 50.0 (SD 14.6) and 48.4 (SD 16.8) years, and 55.2% and 47.2% were female, respectively. Respondents in the healthy and lung cancer cohorts were willing to pay 97.52(9597.52 (95% confidence interval (CI) 97.52(9589.89-$105.15) and 22304(9522 304 (95% CI 22304(9520 194-$24 414) per month, respectively, for coverage of a novel th...

The American Journal of Managed Care, 2013

Stroke

Background: Geographic variation in healthcare quality, including an urban-rural difference, is w... more Background: Geographic variation in healthcare quality, including an urban-rural difference, is well recognized. For stroke care, we were interested in the relationship with stroke center certification and access to neurological services. Hypothesis: We assessed the hypothesis that the use of thrombolytic therapy (t-PA) is associated with stroke certification level and access to neurological services. Methods: Performance measure data in the 2015 Hospital Compare, a CMS quality reporting system, were used to document the gap in care quality among hospitals according to large, medium, small-metro, and non-metro areas and Joint Commission (JC) certification. Regression analysis was used to estimate the association between t-PA use and certification level or access to neurological services. Results: On average, non-metro hospitals performed worse than metro hospitals on JC-endorsed stroke quality measures; the biggest disparity was in the use of t-PA for eligible patients arriving with...

Purpose. To develop a risk-scoring tool to identify in a base year patients likely to have high m... more Purpose. To develop a risk-scoring tool to identify in a base year patients likely to have high medical .spending in the subsequent year and to understand the role obesity and obesity reduction may play in mitigating this risk. Design. Cross-sectional analysis, using commercial claims and health risk assessment data. Setting. United States, 2004-2009. Subjects. Panel of 192, 750 person-year observations from 116,868 unique working-age employees of large companies. Measures. Probability of high medical expenses (80th percentile or above) in the following year; adjusted body mass index (BMI). Analysis. Generate risk scores by modeling the likelihood of high next-year expenses as a function of base-year age, sex, medical utilization, comorbidities, and BMI. Estimate the effect of simulated bariatric intervention on patient risk scores. Results. Individuals with higher BMI were more likely to be categorized in the very high risk group, in luhich the average annual medical expense ivas $...

We explore a model of costly dynamic deliberation in which two partiallyinformed jurors with comm... more We explore a model of costly dynamic deliberation in which two partiallyinformed jurors with common interests try to arrive at a common binary verdict by coarse binary communication. They can only communicate their information through a dynamic voting process which terminates when both jurors sequentially vote for the same verdict. We prove that all equilibria are represented in cut-off strategies. We show that efficient equilibria must allow for non-terminal communication when the strength of their information is unbounded. Still, we argue that any equilibrium may lead to verdicts for which the jurors’ joint information may be unboundedly unfavorable. We then consider asymptotic properties of efficient equilibria as the costs of communication κ vanish. We show that total costs are linear in κ 2 3 , and that expected waiting costs are twice as large as the expected costs from taking the wrong verdict.

We consider the design of an optimal voting system when voting is costly. For a private values mo... more We consider the design of an optimal voting system when voting is costly. For a private values model with two alternatives we show the optimality of a voting system that combines three elements: (i) there is an arbitrarily chosen default decision and non-participation is interpreted as a vote in favor of the default; (ii) voting is sequential; (iii) not all voters are invited to participate in the vote. We show the optimality of such a voting system by first arguing that it is first best, that is, it maximizes welfare when incentive compatibility constraints are ignored, and then showing that individual incentives and social welfare are sufficiently aligned to make the first best system incentive compatible. The analysis in this paper involves some methods that are new to the theory of mechanism design, and it is also a purpose of this paper to explore these new methods.

Circulation-cardiovascular Quality and Outcomes, 2014

Background: Because atrial fibrillation (AF) is often asymptomatic, clinically silent and therefo... more Background: Because atrial fibrillation (AF) is often asymptomatic, clinically silent and therefore undiagnosed, the prevalence of AF is difficult to estimate. In fact, ischemic stroke is often the first clinical sign of AF among previously undiagnosed patients. In this study, we estimated the prevalence of undiagnosed AF using a back-calculation approach that relies on the fact that AF causes stroke but causality generally does not run from stroke to AF. Methods: We first estimated the prevalence of diagnosed non-valvular AF in the elderly (65+) and working age (18-64) U.S. population from a 5% Medicare sample and an OptumInsight commercial claims database from 2004-2010 using validated ICD9 algorithms. To estimate the prevalence of undiagnosed non-valvular AF, our back-calculation methodology used two measured inputs: (i) the number of patients who are diagnosed with new non-valvular AF in the current or subsequent quarter after a stroke; (ii) the probability that patients with no...

We explore costly dynamic deliberation by two like-minded but di↵erentially informed individuals ... more We explore costly dynamic deliberation by two like-minded but di↵erentially informed individuals who must agree on a common verdict. We o↵er two seemingly opposed findings. As the conversation transpires and increasingly strong types of the players concede to their opponent’s verdict it becomes more and more likely that the conversation is moot ex post. Yet, ex ante, among all equilibria of the game, the one with the longest possible conversation is most ecient and uniquely obeys forward induction. As communication costs  vanish, information is aggregated perfectly in this equilibrium; while the conversation persists for an exploding number of periods, total waiting costs also vanish at rate  2/3 .

We study costly voting as a dynamic mechanism design problem and identify three characteristics o... more We study costly voting as a dynamic mechanism design problem and identify three characteristics of any optimal mechanism in a highly stylized setting: (1) sequential participation decisions, (2) interpreting non-participation as a vote for some default, and (3) delegating the vote to a committee that excludes some voters.

Journal of Clinical Oncology

144 Background: Traditional approaches to capturing health-related productivity loss--e.g. the hu... more 144 Background: Traditional approaches to capturing health-related productivity loss--e.g. the human capital method--focus only on the foregone wages of affected patients, overlooking the losses caregivers can incur. Thus, the value of lost productivity is often underestimated. This study comprehensively estimates and describes work-related productivity losses due to a cancer diagnosis among working-age (18-65) breast cancer (BC) and non-small cell lung cancer (NSCLC) patients and their unpaid caregivers in the United States. Methods: A cross-sectional survey of BC and NSCLC patients and caregivers measured loss associated with time absent from work (absenteeism) and reduced effectiveness (presenteeism). Respondents reported pre- and post-cancer diagnosis income, hours worked, and time to complete tasks. Exploratory multivariable analyses examined correlations between respondents’ clinical and demographic characteristics—including industry of employment—and post-diagnosis productivi...

Journal of Clinical Oncology

e19381 Background: Although cancer is a leading cause of illness in the United States, its true i... more e19381 Background: Although cancer is a leading cause of illness in the United States, its true impact on productivity is poorly understood. Traditional approaches to capturing health-related productivity loss—e.g., the human capital method—focus on patients’ foregone wages, overlooking fringe benefits and the impacts incurred by caregivers and co-workers. Thus, the value of lost productivity is often underestimated. We sought to comprehensively estimate productivity loss incurred by working-age cancer patients and unpaid caregivers in the United States. Methods: We conducted a cross-sectional survey study of (i) non-small cell lung cancer (NSCLC) and breast cancer (BC) patients, and (ii) unpaid caregivers. To measure loss associated with absenteeism and presenteeism, participants reported pre- and post-cancer diagnosis income, hours worked, and time to complete tasks. The “multiplier effect” method was used to measure productivity loss incurred by co-workers due to patient or careg...

ClinicoEconomics and outcomes research : CEOR, 2018

New digital technologies offer providers the promise of more accurately tracking patients' me... more New digital technologies offer providers the promise of more accurately tracking patients' medication adherence. It is unclear, however, whether access to such information will affect provider treatment decisions in the real world. Using prescriber-reported information on patient non-compliance from health insurance claims data between 2008 and 2014, we examined whether prescribers' knowledge of non-compliance was associated with different prescribing patterns for patients with serious mental illness (SMI). We examined patients who initiated an oral atypical antipsychotic, but were later objectively non-adherent to this treatment, defined as proportion of days covered (PDC) <0.8. We examined how a physician's awareness of patient non-compliance (ICD-9 diagnosis code: V15.81) was correlated with the physician's real-world treatment decisions for that patient. Treatment decisions studied included the share of patients who increased antipsychotic dose, augmented trea...

PloS one, 2018

As atrial fibrillation (AF) is often asymptomatic, it may remain undiagnosed until or even after ... more As atrial fibrillation (AF) is often asymptomatic, it may remain undiagnosed until or even after development of complications, such as stroke. Consequently the observed prevalence of AF may underestimate total disease burden. To estimate the prevalence of undiagnosed AF in the United States, we performed a retrospective cohort modeling study in working age (18-64) and elderly (≥65) people using commercial and Medicare administrative claims databases. We identified patients in years 2004-2010 with incident AF following an ischemic stroke. Using a back-calculation methodology, we estimated the prevalence of undiagnosed AF as the ratio of the number of post-stroke AF patients and the CHADS2-specific stroke probability for each patient, adjusting for age and gender composition based on United States census data. The estimated prevalence of AF (diagnosed and undiagnosed) was 3,873,900 (95%CI: 3,675,200-4,702,600) elderly and 1,457,100 (95%CI: 1,218,500-1,695,800) working age adults, repr...

Journal of medical economics, Jan 18, 2018

Improvements in information technology have granted the recent development of rapid, cloud-enable... more Improvements in information technology have granted the recent development of rapid, cloud-enabled, onsite laboratory testing for rheumatoid arthritis (RA). This study aims to quantify the value to payers of such technologies. To calculate the value of rapid, cloud-enabled, onsite laboratory testing to diagnose RA relative to traditional, centralized laboratory testing, we created an Excel-based decision tree model that simulated potential cost-savings to payers who cover routine evaluations of RA patients in the United States. First, we created a conceptual framework to identify the value components of rapid, cloud-enabled onsite testing. Second, we measured value associated with patient time savings, savings on visit fees, change in treatment costs, and QALY improvements leveraging existing literature and information from an observational study. Lastly, we combined these value components to estimate the total incremental value accruing to payers per patient-year relative to centra...

The American journal of emergency medicine, Jan 19, 2017

There is widespread geographic variation in healthcare quality, but we often lack clear strategie... more There is widespread geographic variation in healthcare quality, but we often lack clear strategies for improving quality in underserved areas. This study characterized geographic disparities in stroke care quality to assess whether improved access to neurological services has the potential to bridge the care quality gap, particularly in terms of alteplase (rt-PA) administration. This was a retrospective study using quality performance data from the 2015 Hospital Compare database linked to information on certification status from the Joint Commission and information on local access to neurological services from the Area Health Resources File. We used these data to compare stroke care quality according to geographic area, certification, and neurologist access. Non-metropolitan hospitals performed worse than metropolitan hospitals on all assessed stroke care quality measures. The most prevalent disparity occurred in the use of rt-PA for eligible patients (52.2% versus 82.7%, respective...

Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, Sep 1, 2017

To estimate the impact of increased glycated hemoglobin (A1C) monitoring and treatment intensific... more To estimate the impact of increased glycated hemoglobin (A1C) monitoring and treatment intensification for patients with type 2 diabetes (T2D) on quality measures and reimbursement within the Medicare Advantage Star (MA Star) program. The primary endpoint was the share of patients with T2D with adequate A1C control (A1C ≤ 9%). We conducted a simulation of how increased A1C monitoring and treatment intensification affected this end point using data from the National Health and Nutrition Examination Survey and clinical trials. Using the estimated changes in measured A1C levels, we calculated corresponding changes in the plan-level A1C quality measure, overall star rating, and reimbursement. At baseline, 24.4% of patients with T2D in the average plan had poor A1C control. The share of plans receiving the highest A1C rating increased from 27% at baseline to 49.5% (increased monitoring), 36.2% (intensification), and 57.1% (joint implementation of both interventions). However, overall sta...

Journal of Comparative Effectiveness Research

Aim: To compare rates of biologic initiation after commencing treatment with apremilast (APR) ver... more Aim: To compare rates of biologic initiation after commencing treatment with apremilast (APR) versus methotrexate (MTX) in systemic-naive patients with psoriasis (PsO). Methods: This was a retrospective cohort study of systemic-naive patients with PsO who initiated treatment with APR or MTX between 1 January 2015 and 31 March 2018. Outcomes: Adjusted rates of biologic initiation during follow-up were compared by logistic and Cox regressions. Results: APR initiators had 58% lower likelihood of biologic initiation (odds ratio: 0.42; 95% CI: 0.37–0.48; p < 0.001), lower adjusted biologic initiation rate (14.4% [95% CI: 13.2–15.7%] vs 28.6% [95% CI: 26.8–30.5%]), lower risk of biologic initiation (hazard ratio: 0.45; 95% CI: 0.40–0.51; p < 0.001) compared with MTX initiators. Conclusion: Systemic-naive patients with PsO have a lower rate of biologic initiation over 1 year following APR initiation.

Blood

INTRODUCTION: The amyloidoses are a group of protein-folding disorders characterized by extracell... more INTRODUCTION: The amyloidoses are a group of protein-folding disorders characterized by extracellular tissue deposition of aggregated proteins as ß-pleated sheet fibrils. One of the most common and severe types is immunoglobulin light chain (AL), or "primary", amyloidosis. Prior studies of healthcare cost and resource use were hampered by the absence of an International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code specific to AL amyloidosis. Since 10/1/2017, the ICD-10-CM has included a diagnosis code for AL amyloidosis (E85.81). We believe the current study is the first to report healthcare cost and resource use using this new code. METHODS: To understand characteristics, healthcare resource utilization, costs, and clinical outcomes associated with AL amyloidosis for patients treated in US hospitals, this retrospective analysis used 2017-2020 data from the Premier Perspective® Database. The study population comprised of hospitalized pati...

Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 2021

OBJECTIVES To compare the ex ante willingness to pay (WTP) of healthy individuals for generous in... more OBJECTIVES To compare the ex ante willingness to pay (WTP) of healthy individuals for generous insurance coverage of novel lung cancer treatments to the WTP for coverage of such treatment among individuals with lung cancer. METHODS A survey was administered to 2 cohorts of US adults: (1) healthy individuals without cancer and (2) individuals diagnosed with lung cancer. A multiple random staircase survey design was used to elicit respondent WTP for coverage of novel lung cancer therapy associated with survival gains. RESULTS Of the 84 937 healthy individuals invited, 300 completed the survey. Of the 36 249 in the lung cancer cohort invited, 250 completed the survey. Mean age by cohort was 50.0 (SD 14.6) and 48.4 (SD 16.8) years, and 55.2% and 47.2% were female, respectively. Respondents in the healthy and lung cancer cohorts were willing to pay 97.52(9597.52 (95% confidence interval (CI) 97.52(9589.89-$105.15) and 22304(9522 304 (95% CI 22304(9520 194-$24 414) per month, respectively, for coverage of a novel th...

The American Journal of Managed Care, 2013

Stroke

Background: Geographic variation in healthcare quality, including an urban-rural difference, is w... more Background: Geographic variation in healthcare quality, including an urban-rural difference, is well recognized. For stroke care, we were interested in the relationship with stroke center certification and access to neurological services. Hypothesis: We assessed the hypothesis that the use of thrombolytic therapy (t-PA) is associated with stroke certification level and access to neurological services. Methods: Performance measure data in the 2015 Hospital Compare, a CMS quality reporting system, were used to document the gap in care quality among hospitals according to large, medium, small-metro, and non-metro areas and Joint Commission (JC) certification. Regression analysis was used to estimate the association between t-PA use and certification level or access to neurological services. Results: On average, non-metro hospitals performed worse than metro hospitals on JC-endorsed stroke quality measures; the biggest disparity was in the use of t-PA for eligible patients arriving with...

Purpose. To develop a risk-scoring tool to identify in a base year patients likely to have high m... more Purpose. To develop a risk-scoring tool to identify in a base year patients likely to have high medical .spending in the subsequent year and to understand the role obesity and obesity reduction may play in mitigating this risk. Design. Cross-sectional analysis, using commercial claims and health risk assessment data. Setting. United States, 2004-2009. Subjects. Panel of 192, 750 person-year observations from 116,868 unique working-age employees of large companies. Measures. Probability of high medical expenses (80th percentile or above) in the following year; adjusted body mass index (BMI). Analysis. Generate risk scores by modeling the likelihood of high next-year expenses as a function of base-year age, sex, medical utilization, comorbidities, and BMI. Estimate the effect of simulated bariatric intervention on patient risk scores. Results. Individuals with higher BMI were more likely to be categorized in the very high risk group, in luhich the average annual medical expense ivas $...

We explore a model of costly dynamic deliberation in which two partiallyinformed jurors with comm... more We explore a model of costly dynamic deliberation in which two partiallyinformed jurors with common interests try to arrive at a common binary verdict by coarse binary communication. They can only communicate their information through a dynamic voting process which terminates when both jurors sequentially vote for the same verdict. We prove that all equilibria are represented in cut-off strategies. We show that efficient equilibria must allow for non-terminal communication when the strength of their information is unbounded. Still, we argue that any equilibrium may lead to verdicts for which the jurors’ joint information may be unboundedly unfavorable. We then consider asymptotic properties of efficient equilibria as the costs of communication κ vanish. We show that total costs are linear in κ 2 3 , and that expected waiting costs are twice as large as the expected costs from taking the wrong verdict.

We consider the design of an optimal voting system when voting is costly. For a private values mo... more We consider the design of an optimal voting system when voting is costly. For a private values model with two alternatives we show the optimality of a voting system that combines three elements: (i) there is an arbitrarily chosen default decision and non-participation is interpreted as a vote in favor of the default; (ii) voting is sequential; (iii) not all voters are invited to participate in the vote. We show the optimality of such a voting system by first arguing that it is first best, that is, it maximizes welfare when incentive compatibility constraints are ignored, and then showing that individual incentives and social welfare are sufficiently aligned to make the first best system incentive compatible. The analysis in this paper involves some methods that are new to the theory of mechanism design, and it is also a purpose of this paper to explore these new methods.

Circulation-cardiovascular Quality and Outcomes, 2014

Background: Because atrial fibrillation (AF) is often asymptomatic, clinically silent and therefo... more Background: Because atrial fibrillation (AF) is often asymptomatic, clinically silent and therefore undiagnosed, the prevalence of AF is difficult to estimate. In fact, ischemic stroke is often the first clinical sign of AF among previously undiagnosed patients. In this study, we estimated the prevalence of undiagnosed AF using a back-calculation approach that relies on the fact that AF causes stroke but causality generally does not run from stroke to AF. Methods: We first estimated the prevalence of diagnosed non-valvular AF in the elderly (65+) and working age (18-64) U.S. population from a 5% Medicare sample and an OptumInsight commercial claims database from 2004-2010 using validated ICD9 algorithms. To estimate the prevalence of undiagnosed non-valvular AF, our back-calculation methodology used two measured inputs: (i) the number of patients who are diagnosed with new non-valvular AF in the current or subsequent quarter after a stroke; (ii) the probability that patients with no...

We explore costly dynamic deliberation by two like-minded but di↵erentially informed individuals ... more We explore costly dynamic deliberation by two like-minded but di↵erentially informed individuals who must agree on a common verdict. We o↵er two seemingly opposed findings. As the conversation transpires and increasingly strong types of the players concede to their opponent’s verdict it becomes more and more likely that the conversation is moot ex post. Yet, ex ante, among all equilibria of the game, the one with the longest possible conversation is most ecient and uniquely obeys forward induction. As communication costs  vanish, information is aggregated perfectly in this equilibrium; while the conversation persists for an exploding number of periods, total waiting costs also vanish at rate  2/3 .

We study costly voting as a dynamic mechanism design problem and identify three characteristics o... more We study costly voting as a dynamic mechanism design problem and identify three characteristics of any optimal mechanism in a highly stylized setting: (1) sequential participation decisions, (2) interpreting non-participation as a vote for some default, and (3) delegating the vote to a committee that excludes some voters.

Journal of Clinical Oncology

144 Background: Traditional approaches to capturing health-related productivity loss--e.g. the hu... more 144 Background: Traditional approaches to capturing health-related productivity loss--e.g. the human capital method--focus only on the foregone wages of affected patients, overlooking the losses caregivers can incur. Thus, the value of lost productivity is often underestimated. This study comprehensively estimates and describes work-related productivity losses due to a cancer diagnosis among working-age (18-65) breast cancer (BC) and non-small cell lung cancer (NSCLC) patients and their unpaid caregivers in the United States. Methods: A cross-sectional survey of BC and NSCLC patients and caregivers measured loss associated with time absent from work (absenteeism) and reduced effectiveness (presenteeism). Respondents reported pre- and post-cancer diagnosis income, hours worked, and time to complete tasks. Exploratory multivariable analyses examined correlations between respondents’ clinical and demographic characteristics—including industry of employment—and post-diagnosis productivi...

Journal of Clinical Oncology

e19381 Background: Although cancer is a leading cause of illness in the United States, its true i... more e19381 Background: Although cancer is a leading cause of illness in the United States, its true impact on productivity is poorly understood. Traditional approaches to capturing health-related productivity loss—e.g., the human capital method—focus on patients’ foregone wages, overlooking fringe benefits and the impacts incurred by caregivers and co-workers. Thus, the value of lost productivity is often underestimated. We sought to comprehensively estimate productivity loss incurred by working-age cancer patients and unpaid caregivers in the United States. Methods: We conducted a cross-sectional survey study of (i) non-small cell lung cancer (NSCLC) and breast cancer (BC) patients, and (ii) unpaid caregivers. To measure loss associated with absenteeism and presenteeism, participants reported pre- and post-cancer diagnosis income, hours worked, and time to complete tasks. The “multiplier effect” method was used to measure productivity loss incurred by co-workers due to patient or careg...

ClinicoEconomics and outcomes research : CEOR, 2018

New digital technologies offer providers the promise of more accurately tracking patients' me... more New digital technologies offer providers the promise of more accurately tracking patients' medication adherence. It is unclear, however, whether access to such information will affect provider treatment decisions in the real world. Using prescriber-reported information on patient non-compliance from health insurance claims data between 2008 and 2014, we examined whether prescribers' knowledge of non-compliance was associated with different prescribing patterns for patients with serious mental illness (SMI). We examined patients who initiated an oral atypical antipsychotic, but were later objectively non-adherent to this treatment, defined as proportion of days covered (PDC) <0.8. We examined how a physician's awareness of patient non-compliance (ICD-9 diagnosis code: V15.81) was correlated with the physician's real-world treatment decisions for that patient. Treatment decisions studied included the share of patients who increased antipsychotic dose, augmented trea...

PloS one, 2018

As atrial fibrillation (AF) is often asymptomatic, it may remain undiagnosed until or even after ... more As atrial fibrillation (AF) is often asymptomatic, it may remain undiagnosed until or even after development of complications, such as stroke. Consequently the observed prevalence of AF may underestimate total disease burden. To estimate the prevalence of undiagnosed AF in the United States, we performed a retrospective cohort modeling study in working age (18-64) and elderly (≥65) people using commercial and Medicare administrative claims databases. We identified patients in years 2004-2010 with incident AF following an ischemic stroke. Using a back-calculation methodology, we estimated the prevalence of undiagnosed AF as the ratio of the number of post-stroke AF patients and the CHADS2-specific stroke probability for each patient, adjusting for age and gender composition based on United States census data. The estimated prevalence of AF (diagnosed and undiagnosed) was 3,873,900 (95%CI: 3,675,200-4,702,600) elderly and 1,457,100 (95%CI: 1,218,500-1,695,800) working age adults, repr...

Journal of medical economics, Jan 18, 2018

Improvements in information technology have granted the recent development of rapid, cloud-enable... more Improvements in information technology have granted the recent development of rapid, cloud-enabled, onsite laboratory testing for rheumatoid arthritis (RA). This study aims to quantify the value to payers of such technologies. To calculate the value of rapid, cloud-enabled, onsite laboratory testing to diagnose RA relative to traditional, centralized laboratory testing, we created an Excel-based decision tree model that simulated potential cost-savings to payers who cover routine evaluations of RA patients in the United States. First, we created a conceptual framework to identify the value components of rapid, cloud-enabled onsite testing. Second, we measured value associated with patient time savings, savings on visit fees, change in treatment costs, and QALY improvements leveraging existing literature and information from an observational study. Lastly, we combined these value components to estimate the total incremental value accruing to payers per patient-year relative to centra...

The American journal of emergency medicine, Jan 19, 2017

There is widespread geographic variation in healthcare quality, but we often lack clear strategie... more There is widespread geographic variation in healthcare quality, but we often lack clear strategies for improving quality in underserved areas. This study characterized geographic disparities in stroke care quality to assess whether improved access to neurological services has the potential to bridge the care quality gap, particularly in terms of alteplase (rt-PA) administration. This was a retrospective study using quality performance data from the 2015 Hospital Compare database linked to information on certification status from the Joint Commission and information on local access to neurological services from the Area Health Resources File. We used these data to compare stroke care quality according to geographic area, certification, and neurologist access. Non-metropolitan hospitals performed worse than metropolitan hospitals on all assessed stroke care quality measures. The most prevalent disparity occurred in the use of rt-PA for eligible patients (52.2% versus 82.7%, respective...