Jennifer Stephens - Academia.edu (original) (raw)
Papers by Jennifer Stephens
Critical Care Medicine, 2010
To compare the intensive care unit costs and determine factors influencing these costs in mechani... more To compare the intensive care unit costs and determine factors influencing these costs in mechanically ventilated patients randomized to dexmedetomidine or midazolam by continuous infusion. Design: Cost minimization analysis of a double-blind, multicenter clinical trial randomizing patients 2:1 to receive dexmedetomidine or midazolam from the institutional perspective. Setting: Sixty-eight intensive care units in the United States,
Journal of Medical Economics, 2021
Background: NYVEPRIA, a pegfilgrastim (a long-acting granulocyte colony-stimulating factor [G-CSF... more Background: NYVEPRIA, a pegfilgrastim (a long-acting granulocyte colony-stimulating factor [G-CSF]) biosimilar, was recently recommended for marketing authorization in Europe for decreasing the incidence of febrile neutropenia (FN) in patients with non-myeloid malignancies receiving myelosuppressive anti-cancer drugs. The present study aimed to evaluate the financial impact of introducing a new pegfilgrastim biosimilar from a French healthcare system perspective. Methods: An Excel-based budget impact model was developed to estimate the financial impact by introducing a new pegfilgrastim biosimilar (NYVEPRIA) to France over a 5-year time horizon. Comparators included existing long-acting and short-acting G-CSFs. The burden of FN was obtained from existing literature. Costs (2021 Euros) included drug acquisition and administration, estimated based on drug dosage in both clinical trial and real-world settings. Scenario analyses were conducted to examine the robustness of key model assumptions. Results: In a total French population of 67.19 million, 79,873 patients were estimated to be treated with G-CSFs annually. The annual number of patients to be treated with NYVEPRIA was estimated to be 1593, 3195, 3674, 3782, and 4052 in years 1 to 5, respectively. Using real-world data, NYVEPRIA resulted in total annual cost savings of e8,620, e868,498, e868,498, e814,102, and e958,952 over years 1 to 5, respectively, leading to a cumulative 5-year cost savings of e3,518,669. Using data from clinical trials, NYVEPRIA resulted in total annual cost savings of e14,366, e1,447,496, e1,447,496, e1,356,836, and e1,598,253 over years 1 to 5, respectively, leading to a cumulative 5-year cost savings of e5,864,448. Conclusions: The introduction of a new pegfilgrastim biosimilar (NYVEPRIA) is potentially associated with substantial cost savings for the French healthcare system.
European heart journal. Quality of care & clinical outcomes, Jan 11, 2018
The association between depression care adequacy and the risk of subsequent adverse cardiovascula... more The association between depression care adequacy and the risk of subsequent adverse cardiovascular disease (CVD) outcomes among patients with a previous diagnosis of myocardial infarction (MI) or stroke is not well defined. This retrospective cohort study used commercial claims data (2010-2015) and included adults with newly diagnosed and treated MDD following an initial MI or stroke diagnosis. Depression care adequacy was assessed during the 3-month period following the MDD diagnosis index date using two measures: antidepressant dosage adequacy and duration adequacy. Cox models adjusted for the propensity of receiving adequate depression care were used to compare the risk of a composite CVD outcome (MI, stroke, congestive heart failure [CHF], and angina) as well as each individual CVD event between patients receiving adequate versus inadequate depression care. 1568 patients were included in the final cohort. Of these, 937 (59.8%) were categorized as receiving inadequate depression ...
Value in Health, 2009
Diabetes-related minor hypoglycemic episodes (MHEs) have been found to be significantly related t... more Diabetes-related minor hypoglycemic episodes (MHEs) have been found to be significantly related to decreased treatment satisfaction. Unfortunately little is known regarding the impact of MHEs on work productivity and costs for people who work. METHODS: A US web-based survey of persons with diabetes was conducted. RESULTS: 6,756 persons with diabetes were surveyed. Of these 830 had at least one MHE in the past month, of whom 411 indicated working for pay, which is the population used for this analysis. Of the 411, 200 (48.7%) respondents had type 1 and 211 (51.3%) had type 2 diabetes. 290 (70.6%) were taking insulin and 121 (29.4%) used only oral hypoglycemic agents. The mean age was 49.5 13.2, 64.0% were females and average duration of diabetes was 15.8 12.7 years. 385 (94%) reported MHEs, either at work or during sleep which affected their work, in the past year. For their latest MHE at work, the average amount of time respondents reported not functioning at their usual work productivity level (presenteeism) was 9.1 hours. 34 subjects reported 1.0 days of absence from work after a MHE at the work place (e.g. leaving early or missing meetings). Additionally, 31 respondents had MHE during the night which resulted in 1.7 days of absence the following days. On average, these respondents used 6.9 extra blood sugar monitoring tests per MHE and $66.25 out-of-pocket was spent on foods, glucose products, changes in transportation, etc. in the past month due to MHEs. CONCLUSIONS: It appears that lost productivity (presenteeism and absenteeism) and the costs of MHEs have been underestimated and should be considered an important part of diabetes management. Treatments which reduce MHEs would increase work productivity and decrease cost of care.
Value in Health, 2002
To construct a health economic model for a chronic condition with slow irreversible disease progr... more To construct a health economic model for a chronic condition with slow irreversible disease progression (slow process) and recurrent periods of severe symptoms (rapid process), processes which are dependent. We wish to study changes to either process or both simultaneously. METHODS: The processes are dependent; more progressed patients have more frequent and worse attacks, more frequent attacks lead to accelerated progress. Estimating short-term transition probabilities for the slow process is difficult, suggesting a timescale with long cycles. However, long cycles are irrelevant for the rapid process, thus suggesting short cycles. Denote the progress with a discrete scale of increasing progress, 1, 2,. .. , and attacks 0 = no attack, and 1 = ongoing attack. RESULTS: We use a two-dimensional discrete time Markov model, disease progression in dimension Y and attacks in dimension X. The probability of X depends on the previous X and Y, and vice versa for Y. Hence the dependence between X and Y can be modeled. Costs and outcomes are estimated using state and transition rewards, enabling health economic analysis. Updating X more frequently (e.g. weekly) than Y (e.g. yearly) gives relevant cycle lengths. Y updates in outer cycles, and X updates in inner cycles. X's dependence on Y is straightforward, but Y's dependence of X makes it necessary to summarise outcomes in the inner cycle, to inform update in the outer cycles. The type of summary depends on the evaluation method, e.g. Monte Carlo simulation requires total time in X = 0 and X = 1 to estimate the progression risk since it depends on X. CONCLUSIONS: Using cycle lengths relevant for each of the processes improves transition probability estimates in terms of predicting observed outcomes. This compensates for increased error due to different update rates. The face validity of the model may be improved by using relevant cycle lengths for the processes.
Current Medical Research and Opinion, 2004
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NH... more This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.
Current Medical Research and Opinion, 2008
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NH... more This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.
Value in Health, 2002
OBJECTIVES: With advances in blood ketone testing methodology, diabetic patients can now monitor ... more OBJECTIVES: With advances in blood ketone testing methodology, diabetic patients can now monitor the predominant ketone body (beta-hydroxybutyrate) at home in addition to their standard glucose monitoring. This ketone monitoring may permit early detection and treatment of ketosis and diabetic ketoacidosis (DKA). This study compares the cost consequences of blood vs. urine ketone testing and of optimal vs. normal glycemic control in diabetes management. METHODS: First, a decision tree model was developed to estimate costs of testing ketone levels and managing acute metabolic complications for patients with insulin dependent diabetes mellitus (IDDM). Home blood ketone testing or urine ketone testing was utilized during patients' sick-day management. Second, a Markov process was applied to project progression of diabetic complications based on HbA1c levels over 5 years using the published Diabetes Control and Complications Trial data. Cost analyses in 2001 U.S. dollars were performed from the payer's perspective using data from published literature and applying a 3% discount rate. Assumptions were tested in one-way sensitivity analyses. RESULTS: In the base case, the decision tree model showed that blood ketone testing could prevent 7.2 DKA events per 1,000 IDDM patients per year, yielding a net savings of 51,982comparedtourineketonetesting,mainlyduetoreducedmedicalcarecostsfortreatingDKA,ketosisandhypoglycemia.Inaddition,theMarkovmodelpredictedthatover5years,improvedglycemiccontrolasshownbyloweredHbA1clevelsfrom951,982 compared to urine ketone testing, mainly due to reduced medical care costs for treating DKA, ketosis and hypoglycemia. In addition, the Markov model predicted that over 5 years, improved glycemic control as shown by lowered HbA1c levels from 9% to 7% could save 51,982comparedtourineketonetesting,mainlyduetoreducedmedicalcarecostsfortreatingDKA,ketosisandhypoglycemia.Inaddition,theMarkovmodelpredictedthatover5years,improvedglycemiccontrolasshownbyloweredHbA1clevelsfrom9253,322 per 1,000 IDDM patients for treating diabetic complications, including 69,116forretinopathy,69,116 for retinopathy, 69,116forretinopathy,122,762 for nephropathy, and $61,444 for neuropathy. The results were robust in sensitivity analyses. CONCLUSIONS: Under a range of assumptions blood ketone testing could reduce ketosis and DKA events, thereby lowering medical expenditures. Potentially improved glycemic control through lowered HbA1c levels could decrease treatment costs for long-term diabetic complications.
Advances in Therapy
Introduction: To date, there are limited realworld studies published on the use of infliximab-dyy... more Introduction: To date, there are limited realworld studies published on the use of infliximab-dyyb, a biosimilar to reference product (RP) infliximab approved for the treatment of moderate to severe inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC) in North America. This study examined utilization patterns and the effects of infliximab-dyyb on clinical outcomes, patient-reported outcomes (PROs), and healthcare resource use (HCRU) in IBD patients in a real-world setting. Methods: In this prospective, observational study, adult IBD patients in the US and Canada were recruited to initiate treatment with infliximab-dyyb and followed for 12 months. Patients included biologic-naïve users of infliximab-dyyb and patients switching from RP infliximab or other biologics to infliximabdyyb. Partial Mayo (pMAYO) and Harvey Bradshaw Index (HBI) scores measured clinical outcomes for the UC and CD cohorts, respectively. Key PRO measures included the SIBDQ, EQ-VAS, and psychological outcomes. In addition, work productivity, HCRU, and adverse events (AEs) were assessed.
ClinicoEconomics and Outcomes Research, 2020
Objective: This study describes treatment patterns, healthcare resource utilization (HCRU), and c... more Objective: This study describes treatment patterns, healthcare resource utilization (HCRU), and costs associated with persistence, switching, and dosing of branded celecoxib in osteoarthritis (OA) patients. Methods: This retrospective claims database analysis used MarketScan ® Commercial Claims and Encounters (MarketScan) data from 2009 to 2013. Included patients were adult (≥ 18 years), incident celecoxib users with ≥ 1 OA claim. The treatment switch analysis analyzed outcomes in patients persistent on celecoxib versus switched to a generic nonsteroidal anti-inflammatory drug (NSAID). The dosing analysis stratified patients as under-dose (<200 mg per day) and standard dose (≥200 mg per day). HCRU, costs, and treatment duration were compared in persistent versus switched and standard dose versus under-dose patients using descriptive, multivariate logistic regression, and Kaplan-Meier analysis. Results: A total of 65,530 patients met the inclusion criteria. During follow-up, 83% discontinued celecoxib without switching, 10% were persistent, and 5% switched to a generic NSAID. Ninety percent received a standard dose of celecoxib. Switched (versus persistent) patients had significantly higher all-cause hospital admissions, length of stay, emergency room (ER) visits, and office visits per person year (PPY), all P <0.001; and under-dosed (versus standard dose) patients had significantly higher hospital admissions (P<0.001), length of stay (P<0.001), and ER visits (P= 0.
![Research paper thumbnail of Value of hospital antimicrobial stewardship programs [ASPs]: a systematic review](https://attachments.academia-assets.com/96507890/thumbnails/1.jpg)
](Antimicrobial Resistance & Infection Control, 2019
Background: Hospital antimicrobial stewardship programs (ASPs) aim to promote judicious use of an... more Background: Hospital antimicrobial stewardship programs (ASPs) aim to promote judicious use of antimicrobials to combat antimicrobial resistance. For ASPs to be developed, adopted, and implemented, an economic value assessment is essential. Few studies demonstrate the cost-effectiveness of ASPs. This systematic review aimed to evaluate the economic and clinical impact of ASPs. Methods: An update to the Dik et al. systematic review (2000-2014) was conducted on EMBASE and Medline using PRISMA guidelines. The updated search was limited to primary research studies in English (30 September 2014-31 December 2017) that evaluated patient and/or economic outcomes after implementation of hospital ASPs including length of stay (LOS), antimicrobial use, and total (including operational and implementation) costs. Results: One hundred forty-six studies meeting inclusion criteria were included. The majority of these studies were conducted within the last 5 years in North America (49%), Europe (25%), and Asia (14%), with few studies conducted in Africa (3%), South America (3%), and Australia (3%). Most studies were conducted in hospitals with 500-1000 beds and evaluated LOS and change in antibiotic expenditure, the majority of which showed a decrease in LOS (85%) and antibiotic expenditure (92%). The mean cost-savings varied by hospital size and region after implementation of ASPs. Average cost savings in US studies were 732perpatient(range:732 per patient (range: 732perpatient(range:2.50 to $2640), with similar trends exhibited in European studies. The key driver of cost savings was from reduction in LOS. Savings were higher among hospitals with comprehensive ASPs which included therapy review and antibiotic restrictions. Conclusions: Our data indicates that hospital ASPs have significant value with beneficial clinical and economic impacts. More robust published data is required in terms of implementation, LOS, and overall costs so that decision-makers can make a stronger case for investing in ASPs, considering competing priorities. Such data on ASPs in lower-and middle-income countries is limited and requires urgent attention.
Medical devices (Auckland, N.Z.), 2017
Needlestick injuries (NSIs) from a contaminated needle put healthcare workers (HCWs) at risk of b... more Needlestick injuries (NSIs) from a contaminated needle put healthcare workers (HCWs) at risk of becoming infected with a blood-borne virus and suffering serious short- and long-term medical consequences. Hypodermic injections using disposable syringes and needles are the most frequent cause of NSIs. To perform a systematic literature review on NSI and active safety-engineered devices for hypodermic injection. MEDLINE, EMBASE, and COCHRANE databases were searched for studies that evaluated the clinical, economic, or humanistic outcomes of NSI or active safety-engineered devices. NSIs have been reported by 14.9%-69.4% of HCWs with the wide range due to differences in countries, settings, and methodologies used to determine rates. Exposure to contaminated sharps is responsible for 37%-39% of the worldwide cases of hepatitis B and C infections in HCWs. HCWs may experience serious emotional effects and mental health disorders after a NSI, resulting in work loss and post-traumatic stress ...
Value in Health, 2003
study were 1) to determine whether there was an association between drug costs and medical costs ... more study were 1) to determine whether there was an association between drug costs and medical costs for type 1 diabetes patients and, 2) to develop a regression model that predicts medical costs from drug costs. METHODS: The records of 315 patients enrolled in a large mid-western health care plan were reviewed for a 1-year period. The drug costs included insulin costs and oral diabetes drug costs. The medical costs included all paid services for primary and secondary diagnosis of type 1 diabetes identified by ICD-9-CM codes. The data were analyzed using SPSS 10.0. The association between drug and medical costs was determined using Pearson correlation. The significance level was set at the 95% confidence interval. Linear regression analysis was conducted to predict medical costs from drug costs. The dependent variable was the logarithm of medical costs. The independent variables were drug costs, length of service, additional therapy, age and gender. RESULTS: There was a statistically significant inverse correlation between drug costs and medical costs (r =-0.229,
Rheumatology, 2003
Pain has been recognized as a problem of global proportions, and postoperative pain is one of the... more Pain has been recognized as a problem of global proportions, and postoperative pain is one of the most common types of pain. Postoperative pain is acute and, although it is preventable and/or treatable, it is often undertreated. Lack of appropriate analgesic management has significant impact on clinical and economic outcomes. Negative clinical outcomes of inadequately managed acute postoperative pain include extended hospitalization, compromised prognosis, higher morbidity and mortality, and the development of a chronic pain state as a result of neuronal plasticity. Although estimating the economic burden of postoperative pain is difficult, this burden is considerable and results from direct costs due to excess health-care resource use, as well as indirect costs due to reduced patient functionality and productivity. These latter factors also have a significant adverse impact on patients' quality of life and may be associated with the development of depression and anxiety. Thus, improved clinical outcomes are dependent not only on the availability of effective drugs but also on their appropriate utilization. A multimodal approach incorporating different drugs and techniques is effective in reducing postoperative pain but is limited by the currently available therapies. The efficacy of opioids is well established, but there are concerns about dependency, respiratory depression and side-effects, which patients often find intolerable. Non-steroidal anti-inflammatory drugs (NSAIDs) are effective as adjunctive medication in a multimodal regimen but are associated with side-effects, such as platelet dysfunction and renal and gastrointestinal toxicity, that have special clinical significance in patients undergoing surgical procedures. Cyclooxygenase-2-specific inhibitors such as celecoxib, rofecoxib and valdecoxib, were developed to provide the efficacy of non-specific NSAIDs while limiting associated toxicity. These agents have demonstrated analgesic efficacy and an opioid-sparing effect in a variety of surgical procedures, suggesting their value as an alternative to non-specific NSAIDs. Further studies are needed to determine the impact of these drugs on clinical and economic outcomes when used in a programme of postsurgical pain management.
PloS one, 2015
The number of ambulatory patients seeking treatment for skin and skin structure infections (SSSI)... more The number of ambulatory patients seeking treatment for skin and skin structure infections (SSSI) are increasing. The objective of this study is to determine recent trends in hospital admissions and healthcare resource utilization and identify covariates associated with hospital costs and mortality for hospitalized adult patients with a primary SSSI diagnosis in the United States. We performed a retrospective cross-sectional analysis (years 2005-2011) of data from the US Healthcare Cost and Utilization Project National Inpatient Sample. Recent trends, patient characteristics, and healthcare resource utilization for patients hospitalized with a primary SSSI diagnosis were evaluated. Descriptive and bivariate analyses were conducted to assess patient and hospital characteristics. A total of 1.8% of hospital admissions for the years 2005 through 2011 were for adult patients with a SSSI primary diagnosis. SSSI-related hospital admissions significantly changed during the study period (P ...
Value in Health, 2001
also resulted in a positive short-and long-term health economic benefit in acutely ill medical pa... more also resulted in a positive short-and long-term health economic benefit in acutely ill medical patients. The health-economic benefit of enoxaparin was positively related with the length of the follow-up period and a higher risk for recurrence of VTE and mortality in asymptomatic patients.
Critical Care Medicine, 2010
To compare the intensive care unit costs and determine factors influencing these costs in mechani... more To compare the intensive care unit costs and determine factors influencing these costs in mechanically ventilated patients randomized to dexmedetomidine or midazolam by continuous infusion. Design: Cost minimization analysis of a double-blind, multicenter clinical trial randomizing patients 2:1 to receive dexmedetomidine or midazolam from the institutional perspective. Setting: Sixty-eight intensive care units in the United States,
Journal of Medical Economics, 2021
Background: NYVEPRIA, a pegfilgrastim (a long-acting granulocyte colony-stimulating factor [G-CSF... more Background: NYVEPRIA, a pegfilgrastim (a long-acting granulocyte colony-stimulating factor [G-CSF]) biosimilar, was recently recommended for marketing authorization in Europe for decreasing the incidence of febrile neutropenia (FN) in patients with non-myeloid malignancies receiving myelosuppressive anti-cancer drugs. The present study aimed to evaluate the financial impact of introducing a new pegfilgrastim biosimilar from a French healthcare system perspective. Methods: An Excel-based budget impact model was developed to estimate the financial impact by introducing a new pegfilgrastim biosimilar (NYVEPRIA) to France over a 5-year time horizon. Comparators included existing long-acting and short-acting G-CSFs. The burden of FN was obtained from existing literature. Costs (2021 Euros) included drug acquisition and administration, estimated based on drug dosage in both clinical trial and real-world settings. Scenario analyses were conducted to examine the robustness of key model assumptions. Results: In a total French population of 67.19 million, 79,873 patients were estimated to be treated with G-CSFs annually. The annual number of patients to be treated with NYVEPRIA was estimated to be 1593, 3195, 3674, 3782, and 4052 in years 1 to 5, respectively. Using real-world data, NYVEPRIA resulted in total annual cost savings of e8,620, e868,498, e868,498, e814,102, and e958,952 over years 1 to 5, respectively, leading to a cumulative 5-year cost savings of e3,518,669. Using data from clinical trials, NYVEPRIA resulted in total annual cost savings of e14,366, e1,447,496, e1,447,496, e1,356,836, and e1,598,253 over years 1 to 5, respectively, leading to a cumulative 5-year cost savings of e5,864,448. Conclusions: The introduction of a new pegfilgrastim biosimilar (NYVEPRIA) is potentially associated with substantial cost savings for the French healthcare system.
European heart journal. Quality of care & clinical outcomes, Jan 11, 2018
The association between depression care adequacy and the risk of subsequent adverse cardiovascula... more The association between depression care adequacy and the risk of subsequent adverse cardiovascular disease (CVD) outcomes among patients with a previous diagnosis of myocardial infarction (MI) or stroke is not well defined. This retrospective cohort study used commercial claims data (2010-2015) and included adults with newly diagnosed and treated MDD following an initial MI or stroke diagnosis. Depression care adequacy was assessed during the 3-month period following the MDD diagnosis index date using two measures: antidepressant dosage adequacy and duration adequacy. Cox models adjusted for the propensity of receiving adequate depression care were used to compare the risk of a composite CVD outcome (MI, stroke, congestive heart failure [CHF], and angina) as well as each individual CVD event between patients receiving adequate versus inadequate depression care. 1568 patients were included in the final cohort. Of these, 937 (59.8%) were categorized as receiving inadequate depression ...
Value in Health, 2009
Diabetes-related minor hypoglycemic episodes (MHEs) have been found to be significantly related t... more Diabetes-related minor hypoglycemic episodes (MHEs) have been found to be significantly related to decreased treatment satisfaction. Unfortunately little is known regarding the impact of MHEs on work productivity and costs for people who work. METHODS: A US web-based survey of persons with diabetes was conducted. RESULTS: 6,756 persons with diabetes were surveyed. Of these 830 had at least one MHE in the past month, of whom 411 indicated working for pay, which is the population used for this analysis. Of the 411, 200 (48.7%) respondents had type 1 and 211 (51.3%) had type 2 diabetes. 290 (70.6%) were taking insulin and 121 (29.4%) used only oral hypoglycemic agents. The mean age was 49.5 13.2, 64.0% were females and average duration of diabetes was 15.8 12.7 years. 385 (94%) reported MHEs, either at work or during sleep which affected their work, in the past year. For their latest MHE at work, the average amount of time respondents reported not functioning at their usual work productivity level (presenteeism) was 9.1 hours. 34 subjects reported 1.0 days of absence from work after a MHE at the work place (e.g. leaving early or missing meetings). Additionally, 31 respondents had MHE during the night which resulted in 1.7 days of absence the following days. On average, these respondents used 6.9 extra blood sugar monitoring tests per MHE and $66.25 out-of-pocket was spent on foods, glucose products, changes in transportation, etc. in the past month due to MHEs. CONCLUSIONS: It appears that lost productivity (presenteeism and absenteeism) and the costs of MHEs have been underestimated and should be considered an important part of diabetes management. Treatments which reduce MHEs would increase work productivity and decrease cost of care.
Value in Health, 2002
To construct a health economic model for a chronic condition with slow irreversible disease progr... more To construct a health economic model for a chronic condition with slow irreversible disease progression (slow process) and recurrent periods of severe symptoms (rapid process), processes which are dependent. We wish to study changes to either process or both simultaneously. METHODS: The processes are dependent; more progressed patients have more frequent and worse attacks, more frequent attacks lead to accelerated progress. Estimating short-term transition probabilities for the slow process is difficult, suggesting a timescale with long cycles. However, long cycles are irrelevant for the rapid process, thus suggesting short cycles. Denote the progress with a discrete scale of increasing progress, 1, 2,. .. , and attacks 0 = no attack, and 1 = ongoing attack. RESULTS: We use a two-dimensional discrete time Markov model, disease progression in dimension Y and attacks in dimension X. The probability of X depends on the previous X and Y, and vice versa for Y. Hence the dependence between X and Y can be modeled. Costs and outcomes are estimated using state and transition rewards, enabling health economic analysis. Updating X more frequently (e.g. weekly) than Y (e.g. yearly) gives relevant cycle lengths. Y updates in outer cycles, and X updates in inner cycles. X's dependence on Y is straightforward, but Y's dependence of X makes it necessary to summarise outcomes in the inner cycle, to inform update in the outer cycles. The type of summary depends on the evaluation method, e.g. Monte Carlo simulation requires total time in X = 0 and X = 1 to estimate the progression risk since it depends on X. CONCLUSIONS: Using cycle lengths relevant for each of the processes improves transition probability estimates in terms of predicting observed outcomes. This compensates for increased error due to different update rates. The face validity of the model may be improved by using relevant cycle lengths for the processes.
Current Medical Research and Opinion, 2004
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NH... more This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.
Current Medical Research and Opinion, 2008
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NH... more This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.
Value in Health, 2002
OBJECTIVES: With advances in blood ketone testing methodology, diabetic patients can now monitor ... more OBJECTIVES: With advances in blood ketone testing methodology, diabetic patients can now monitor the predominant ketone body (beta-hydroxybutyrate) at home in addition to their standard glucose monitoring. This ketone monitoring may permit early detection and treatment of ketosis and diabetic ketoacidosis (DKA). This study compares the cost consequences of blood vs. urine ketone testing and of optimal vs. normal glycemic control in diabetes management. METHODS: First, a decision tree model was developed to estimate costs of testing ketone levels and managing acute metabolic complications for patients with insulin dependent diabetes mellitus (IDDM). Home blood ketone testing or urine ketone testing was utilized during patients' sick-day management. Second, a Markov process was applied to project progression of diabetic complications based on HbA1c levels over 5 years using the published Diabetes Control and Complications Trial data. Cost analyses in 2001 U.S. dollars were performed from the payer's perspective using data from published literature and applying a 3% discount rate. Assumptions were tested in one-way sensitivity analyses. RESULTS: In the base case, the decision tree model showed that blood ketone testing could prevent 7.2 DKA events per 1,000 IDDM patients per year, yielding a net savings of 51,982comparedtourineketonetesting,mainlyduetoreducedmedicalcarecostsfortreatingDKA,ketosisandhypoglycemia.Inaddition,theMarkovmodelpredictedthatover5years,improvedglycemiccontrolasshownbyloweredHbA1clevelsfrom951,982 compared to urine ketone testing, mainly due to reduced medical care costs for treating DKA, ketosis and hypoglycemia. In addition, the Markov model predicted that over 5 years, improved glycemic control as shown by lowered HbA1c levels from 9% to 7% could save 51,982comparedtourineketonetesting,mainlyduetoreducedmedicalcarecostsfortreatingDKA,ketosisandhypoglycemia.Inaddition,theMarkovmodelpredictedthatover5years,improvedglycemiccontrolasshownbyloweredHbA1clevelsfrom9253,322 per 1,000 IDDM patients for treating diabetic complications, including 69,116forretinopathy,69,116 for retinopathy, 69,116forretinopathy,122,762 for nephropathy, and $61,444 for neuropathy. The results were robust in sensitivity analyses. CONCLUSIONS: Under a range of assumptions blood ketone testing could reduce ketosis and DKA events, thereby lowering medical expenditures. Potentially improved glycemic control through lowered HbA1c levels could decrease treatment costs for long-term diabetic complications.
Advances in Therapy
Introduction: To date, there are limited realworld studies published on the use of infliximab-dyy... more Introduction: To date, there are limited realworld studies published on the use of infliximab-dyyb, a biosimilar to reference product (RP) infliximab approved for the treatment of moderate to severe inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC) in North America. This study examined utilization patterns and the effects of infliximab-dyyb on clinical outcomes, patient-reported outcomes (PROs), and healthcare resource use (HCRU) in IBD patients in a real-world setting. Methods: In this prospective, observational study, adult IBD patients in the US and Canada were recruited to initiate treatment with infliximab-dyyb and followed for 12 months. Patients included biologic-naïve users of infliximab-dyyb and patients switching from RP infliximab or other biologics to infliximabdyyb. Partial Mayo (pMAYO) and Harvey Bradshaw Index (HBI) scores measured clinical outcomes for the UC and CD cohorts, respectively. Key PRO measures included the SIBDQ, EQ-VAS, and psychological outcomes. In addition, work productivity, HCRU, and adverse events (AEs) were assessed.
ClinicoEconomics and Outcomes Research, 2020
Objective: This study describes treatment patterns, healthcare resource utilization (HCRU), and c... more Objective: This study describes treatment patterns, healthcare resource utilization (HCRU), and costs associated with persistence, switching, and dosing of branded celecoxib in osteoarthritis (OA) patients. Methods: This retrospective claims database analysis used MarketScan ® Commercial Claims and Encounters (MarketScan) data from 2009 to 2013. Included patients were adult (≥ 18 years), incident celecoxib users with ≥ 1 OA claim. The treatment switch analysis analyzed outcomes in patients persistent on celecoxib versus switched to a generic nonsteroidal anti-inflammatory drug (NSAID). The dosing analysis stratified patients as under-dose (<200 mg per day) and standard dose (≥200 mg per day). HCRU, costs, and treatment duration were compared in persistent versus switched and standard dose versus under-dose patients using descriptive, multivariate logistic regression, and Kaplan-Meier analysis. Results: A total of 65,530 patients met the inclusion criteria. During follow-up, 83% discontinued celecoxib without switching, 10% were persistent, and 5% switched to a generic NSAID. Ninety percent received a standard dose of celecoxib. Switched (versus persistent) patients had significantly higher all-cause hospital admissions, length of stay, emergency room (ER) visits, and office visits per person year (PPY), all P <0.001; and under-dosed (versus standard dose) patients had significantly higher hospital admissions (P<0.001), length of stay (P<0.001), and ER visits (P= 0.
Antimicrobial Resistance & Infection Control, 2019
Background: Hospital antimicrobial stewardship programs (ASPs) aim to promote judicious use of an... more Background: Hospital antimicrobial stewardship programs (ASPs) aim to promote judicious use of antimicrobials to combat antimicrobial resistance. For ASPs to be developed, adopted, and implemented, an economic value assessment is essential. Few studies demonstrate the cost-effectiveness of ASPs. This systematic review aimed to evaluate the economic and clinical impact of ASPs. Methods: An update to the Dik et al. systematic review (2000-2014) was conducted on EMBASE and Medline using PRISMA guidelines. The updated search was limited to primary research studies in English (30 September 2014-31 December 2017) that evaluated patient and/or economic outcomes after implementation of hospital ASPs including length of stay (LOS), antimicrobial use, and total (including operational and implementation) costs. Results: One hundred forty-six studies meeting inclusion criteria were included. The majority of these studies were conducted within the last 5 years in North America (49%), Europe (25%), and Asia (14%), with few studies conducted in Africa (3%), South America (3%), and Australia (3%). Most studies were conducted in hospitals with 500-1000 beds and evaluated LOS and change in antibiotic expenditure, the majority of which showed a decrease in LOS (85%) and antibiotic expenditure (92%). The mean cost-savings varied by hospital size and region after implementation of ASPs. Average cost savings in US studies were 732perpatient(range:732 per patient (range: 732perpatient(range:2.50 to $2640), with similar trends exhibited in European studies. The key driver of cost savings was from reduction in LOS. Savings were higher among hospitals with comprehensive ASPs which included therapy review and antibiotic restrictions. Conclusions: Our data indicates that hospital ASPs have significant value with beneficial clinical and economic impacts. More robust published data is required in terms of implementation, LOS, and overall costs so that decision-makers can make a stronger case for investing in ASPs, considering competing priorities. Such data on ASPs in lower-and middle-income countries is limited and requires urgent attention.
Medical devices (Auckland, N.Z.), 2017
Needlestick injuries (NSIs) from a contaminated needle put healthcare workers (HCWs) at risk of b... more Needlestick injuries (NSIs) from a contaminated needle put healthcare workers (HCWs) at risk of becoming infected with a blood-borne virus and suffering serious short- and long-term medical consequences. Hypodermic injections using disposable syringes and needles are the most frequent cause of NSIs. To perform a systematic literature review on NSI and active safety-engineered devices for hypodermic injection. MEDLINE, EMBASE, and COCHRANE databases were searched for studies that evaluated the clinical, economic, or humanistic outcomes of NSI or active safety-engineered devices. NSIs have been reported by 14.9%-69.4% of HCWs with the wide range due to differences in countries, settings, and methodologies used to determine rates. Exposure to contaminated sharps is responsible for 37%-39% of the worldwide cases of hepatitis B and C infections in HCWs. HCWs may experience serious emotional effects and mental health disorders after a NSI, resulting in work loss and post-traumatic stress ...
Value in Health, 2003
study were 1) to determine whether there was an association between drug costs and medical costs ... more study were 1) to determine whether there was an association between drug costs and medical costs for type 1 diabetes patients and, 2) to develop a regression model that predicts medical costs from drug costs. METHODS: The records of 315 patients enrolled in a large mid-western health care plan were reviewed for a 1-year period. The drug costs included insulin costs and oral diabetes drug costs. The medical costs included all paid services for primary and secondary diagnosis of type 1 diabetes identified by ICD-9-CM codes. The data were analyzed using SPSS 10.0. The association between drug and medical costs was determined using Pearson correlation. The significance level was set at the 95% confidence interval. Linear regression analysis was conducted to predict medical costs from drug costs. The dependent variable was the logarithm of medical costs. The independent variables were drug costs, length of service, additional therapy, age and gender. RESULTS: There was a statistically significant inverse correlation between drug costs and medical costs (r =-0.229,
Rheumatology, 2003
Pain has been recognized as a problem of global proportions, and postoperative pain is one of the... more Pain has been recognized as a problem of global proportions, and postoperative pain is one of the most common types of pain. Postoperative pain is acute and, although it is preventable and/or treatable, it is often undertreated. Lack of appropriate analgesic management has significant impact on clinical and economic outcomes. Negative clinical outcomes of inadequately managed acute postoperative pain include extended hospitalization, compromised prognosis, higher morbidity and mortality, and the development of a chronic pain state as a result of neuronal plasticity. Although estimating the economic burden of postoperative pain is difficult, this burden is considerable and results from direct costs due to excess health-care resource use, as well as indirect costs due to reduced patient functionality and productivity. These latter factors also have a significant adverse impact on patients' quality of life and may be associated with the development of depression and anxiety. Thus, improved clinical outcomes are dependent not only on the availability of effective drugs but also on their appropriate utilization. A multimodal approach incorporating different drugs and techniques is effective in reducing postoperative pain but is limited by the currently available therapies. The efficacy of opioids is well established, but there are concerns about dependency, respiratory depression and side-effects, which patients often find intolerable. Non-steroidal anti-inflammatory drugs (NSAIDs) are effective as adjunctive medication in a multimodal regimen but are associated with side-effects, such as platelet dysfunction and renal and gastrointestinal toxicity, that have special clinical significance in patients undergoing surgical procedures. Cyclooxygenase-2-specific inhibitors such as celecoxib, rofecoxib and valdecoxib, were developed to provide the efficacy of non-specific NSAIDs while limiting associated toxicity. These agents have demonstrated analgesic efficacy and an opioid-sparing effect in a variety of surgical procedures, suggesting their value as an alternative to non-specific NSAIDs. Further studies are needed to determine the impact of these drugs on clinical and economic outcomes when used in a programme of postsurgical pain management.
PloS one, 2015
The number of ambulatory patients seeking treatment for skin and skin structure infections (SSSI)... more The number of ambulatory patients seeking treatment for skin and skin structure infections (SSSI) are increasing. The objective of this study is to determine recent trends in hospital admissions and healthcare resource utilization and identify covariates associated with hospital costs and mortality for hospitalized adult patients with a primary SSSI diagnosis in the United States. We performed a retrospective cross-sectional analysis (years 2005-2011) of data from the US Healthcare Cost and Utilization Project National Inpatient Sample. Recent trends, patient characteristics, and healthcare resource utilization for patients hospitalized with a primary SSSI diagnosis were evaluated. Descriptive and bivariate analyses were conducted to assess patient and hospital characteristics. A total of 1.8% of hospital admissions for the years 2005 through 2011 were for adult patients with a SSSI primary diagnosis. SSSI-related hospital admissions significantly changed during the study period (P ...
Value in Health, 2001
also resulted in a positive short-and long-term health economic benefit in acutely ill medical pa... more also resulted in a positive short-and long-term health economic benefit in acutely ill medical patients. The health-economic benefit of enoxaparin was positively related with the length of the follow-up period and a higher risk for recurrence of VTE and mortality in asymptomatic patients.