Gerry Oster - Academia.edu (original) (raw)
Papers by Gerry Oster
Value in Health, 2002
Objective: To examine whether sepsis is accurately coded on hospital bills. Methods: Hospital inp... more Objective: To examine whether sepsis is accurately coded on hospital bills. Methods: Hospital inpatient uniform bills (UB-92) for 122 patients with clinically documented severe sepsis of presumed infectious origin were retrospectively examined. Final UB-92 hospital bills were obtained for all study subjects. ICD-9-CM diagnosis codes from these bills were then reviewed to ascertain the number of subjects for whom one or more diagnostic codes for septicemia and/or bacteremia were present. Results: A total of 92 hospital bills (75.4%) contained one or more ICD-9-CM diagnostic codes for septicemia and/or bacteremia. Of the 30 that did not, 15 (12.3%) had codes for major systemic infection and organ failure. No diagnoses indicative of sepsis (i.e., organ failure and major infection) were present on the remaining 15 (12.3%) bills. Conclusions: Our findings suggest that use of ICD-9-CM codes for identifying patients with sepsis using hospital bills is only moderately sensitive. Strict reliance on administrative data sources for sepsis surveillance or research planning may therefore be prone to substantial error.
Prostate, 1993
Using claims data for a 5% random sample of Medicare beneficiaries, we estimated the costs of sur... more Using claims data for a 5% random sample of Medicare beneficiaries, we estimated the costs of surgical treatment for benign prostatic hyperplasia (BPH), including those related to the initial prostatectomy, the treatment of postsurgical complications, and reoperation within one year. We identified 14,480 men who underwent prostatectomy for BPH during 1986–1987, including 13,730 transurethral and 750 open procedures. Mean total inpatient costs (including all hospital charges and professional service fees) for these procedures were estimated to be 6,501and6,501 and 6,501and10,223, respectively. Among patients who underwent transurethral and open prostatectomy, we identified 938 (6.8%) and 39 (5.2%) individuals who had at least one readmission for postsurgical complications or reoperation. Total expected costs of transurethral and open prostatectomy, inclusive of readmissions for complications and reoperations within one year, were estimated to be 6,823and6,823 and 6,823and10,477, respectively. Our study indicates the economic burden represented by surgical treatment of BPH. © 1993 Wiley-Liss, Inc.
Vaccine, 2005
Using a stochastic simulation model of influenza transmission, clinical illness, and economic cos... more Using a stochastic simulation model of influenza transmission, clinical illness, and economic costs, we estimated the population-wide benefits of routinely vaccinating US children (ages 6 months to 18 years) against influenza. Disease burden was projected to decline as a result of both reduced susceptibility to infection among vaccinees and reductions in disease transmission to others in the community. Vaccination of 20% of children would reduce the total number of influenza cases in the US by 46%; 80% coverage would reduce the total number of cases by 91%. Similar reductions were estimated to occur in influenza-related mortality and economic costs.
Critical Care Medicine, 2003
To estimate long-term mortality and medical care charges among patients with severe sepsis. Retro... more To estimate long-term mortality and medical care charges among patients with severe sepsis. Retrospective cohort study. Large, integrated, geographically diverse, U.S. health-insurance claims database covering three million lives annually. All persons with bacterial or fungal infections and acute organ dysfunction (severe sepsis) who were hospitalized between January 1, 1991, and August 31, 2000. None. All patients were followed from the date of hospitalization with severe sepsis (index admission) to August 31, 2000, disenrollment from the health plan, or death, whichever occurred first. Measures of interest included mortality and medical care charges and were estimated for the index admission, the 90- and 180-day periods following the index admission, and annually thereafter (up to 5 yrs), using techniques of survival analysis. A total of 16,019 patients were identified who met study entrance criteria. Most patients (81.2%) were >/=65 yrs of age; 53.4% were men. Mortality was 21.2% for the index admission, 51.4% at 1 yr, and 74.2% at 5 yrs. Mean cumulative total medical care charges were 44,600 US dollars for the index admission, 78,500 US dollars at 1 yr, and 118,800 US dollars at 5 yrs. Hospitalization accounted for the largest component of total medical care charges. Mortality and economic costs are high in patients with severe sepsis, during the period of acute illness as well as subsequently.
Osteoporosis International, 2007
Introduction Patient compliance with osteoporosis drug therapy is often poor in clinical practice... more Introduction Patient compliance with osteoporosis drug therapy is often poor in clinical practice and may be associated with higher risk of fracture. Methods A nested case-control study was undertaken using a US health insurance claims database. The source population included all women aged ≥45 years who began drug therapy for osteoporosis. Cases consisted of those who experienced an osteoporosis-related fracture; they were matched to controls without osteoporosis-related fracture. Compliance with osteoporosis drug treatment was assessed in terms of the number of therapy-days received and medication possession ratio (MPR). Conditional logistic regression was employed to examine the relationship between compliance and fracture risk. Results A total of 453 women with osteoporosis-related fracture were identified and matched to 2,160 controls. Fracture risk was significantly lower for patients with >180 days of therapy [181–360 days: odds ratio (OR) = 0.70, 95% CI = 0.49–0.99; >360 days: OR = 0.65, 95% CI = 0.43–0.99) versus those with ≤30 days. Risk was also lower for patients with MPR ≥90% (OR = 0.70, 95% CI = 0.52–0.93) versus those with MPR trend Conclusion Among women initiating drug therapy for osteoporosis, better compliance is associated with reduced risk of fracture.
Clinical Pulmonary Medicine, 2005
... Gregory Tino has served as a speaker and consultant for Chiron BioPharmaceuticals. ... ACKNOW... more ... Gregory Tino has served as a speaker and consultant for Chiron BioPharmaceuticals. ... ACKNOWLEDGMENTS. The authors thank Aaron Moynahan and May Hagiwara, PhD, of Policy Analysis Inc. (PAI) for their assistance with data management and data processing. ...
Journal of Pain, 2004
Using a large US health insurance claims database, we identified all persons aged 18 years or old... more Using a large US health insurance claims database, we identified all persons aged 18 years or older with 2 or more medical encounters in calendar year 2000 for painful neuropathic disorders (PNDs). We also identified an age-and gender-matched group of patients without PNDs (matched control subjects). We then compared the clinical characteristics and economic costs of PND patients with those of matched control subjects. There were a total of 55,686 patients with PNDs in the study database. The most frequently noted PNDs were back and neck pain with neuropathic involvement (62.3% of PND patients), causalgia (12.1%), and diabetic neuropathy (10.8%). In comparison with matched control subjects, PND patients were more likely to have other pain-related conditions, including fibromyalgia (6.0% vs 0.6% for control subjects), osteoarthritis (13.6% vs 3.6%), and other chronic comorbidities, such as coronary heart disease (13.6% vs 6.5%) and depression (6.4% vs 2.3%).
Osteoporosis International, 2006
Introduction Patient compliance with pharmacotherapy for osteoporosis is typically poor in clinic... more Introduction Patient compliance with pharmacotherapy for osteoporosis is typically poor in clinical practice; less frequent dosing with bisphosphonates may improve compliance. Methods Using data from 49 US health plans, we identified all women aged ≥45 years with osteoporosis who initiated therapy with a bisphosphonate, calcitonin, estrogen, or raloxifene. Compliance was examined alternatively in terms of incidence of adherence failure (medication days Results The study population included 18,822 women, 48% of whom initiated weekly bisphosphonate therapy. Overall risk of adherence failure was 47% at 3 months, 70% at 1 year, and 84% at 3 years. Risk of persistence failure was 47% at 1 year, and 77% at 3 years. In multivariate analyses, risk of adherence failure was higher for calcitonin (hazard ratio=2.7 vs weekly bisphosphonate therapy, p Conclusions Approximately three-quarters of women who initiate osteoporosis drug therapy are non-adherent with treatment within 12 months, and almost 50% have discontinued such therapy by this time. Compliance with weekly bisphosphonate therapy is generally no better than that with osteoporosis medications requiring more frequent dosing.
American Journal of Geriatric Pharmacotherapy, 2004
Background: Although older adults with painfid neuropathic disorders (PNDs) would appear to be at... more Background: Although older adults with painfid neuropathic disorders (PNDs) would appear to be at elevated risk ~br receiving potentially inappropriate pain-related medications, the extent of such drug use in this population is unlmown.
Oncology, 2004
Patients with bone metastases from lung cancer often experience skeletal-related events (SREs) in... more Patients with bone metastases from lung cancer often experience skeletal-related events (SREs) including pathological fracture, spinal cord compression, hypercalcemia or pain requiring surgery, radiotherapy or opioid analgesics. These complications result in impaired mobility and reduced quality of life and have a significant negative impact on survival. The economic consequences of SREs in patients with lung cancer have not been examined. We conducted a retrospective analysis using a large US health insurance claims database to estimate the incidence and costs of treatment of SREs in patients with bone metastases of lung cancer treated in a naturalistic setting. Study subjects had >/=2 encounters with a diagnosis of primary lung cancer and >/=2 encounters with a diagnosis of metastases to bone. SREs were identified based on the occurrence on or after the date of first diagnosis of bone metastases, of (1) >/=1 encounter with a diagnosis of pathological fracture, spinal cord compression or hypercalcemia, (2) >/=1 bone surgery or radiotherapy procedure, or (3) the initiation of opioid analgesic therapy. Survival and costs of SRE-related care in patients with SREs were estimated using Kaplan-Meier methods. We identified 534 patients with lung cancer and bone metastases, including 295 (55%) with >/=1 SRE. Radiotherapy (68%) and fracture (35%) were the most common SREs. Median survival after the first identified SRE was 4.1 months (95% confidence interval: 3.6-5.5 months). The estimated lifetime SRE-related cost per patient was USD 11,979 (95% confidence interval: USD 10,193-13,766). Radiotherapy accounted for the greatest proportion of cost (61%) by SRE type. The economic burden of SREs in patients with bone metastases of lung cancer is substantial. Intravenous bisphosphonates, such as zoledronic acid, which have been shown to prevent these events, may reduce these costs.
Journal of The American Dietetic Association, 1996
Objectives To estimate the effects of reducing dietary saturated fat intake on the incidence and ... more Objectives To estimate the effects of reducing dietary saturated fat intake on the incidence and economic costs of coronary heart disease (CHD) in the United States.Design Modeling techniques and data from secondary sources, including the Framingham Heart Study and the second and third National Health and Nutrition Examination Surveys, were used to estimate the effects on CHD incidence and associated costs of reducing dietary saturated fat intake as a percent of total energy by one to three percentage points.Subjects Persons aged 35 to 69 years who have total cholesterol levels of 5.17 rnmol/L or higher and are currently free of CHD.Results Approximately 3 million first-time coronary events are estimated to occur over a 10-year period among persons with total cholesterol levels exceeding 5.17 mmol/L. Reducing saturated fat intake by one to three percentage points would reduce CHD incidence by 32,000 to 99,700 events and yield combined savings in medical expenditures and lost earnings ranging from 4.1to4.1 to 4.1to12.7 billion over 10 years (estimates in 1993 US dollars).Conclusion Population-based interventions to encourage Americans to reduce dietary intake of saturated fat may prevent tens of thousands of cases of CHD and save billions of dollars in related costs. J Am Diet Assoc. 1996; 96: 127–131.
Controlled Clinical Trials, 1995
International Journal of Clinical Practice, 2007
Purpose: To examine the characteristics and healthcare costs of fibromyalgia syndrome (FMS) pati... more Purpose: To examine the characteristics and healthcare costs of fibromyalgia syndrome (FMS) patients in clinical practice.Materials and methods: Using a US health-insurance database, we identified all patients, aged ≥ 18 years, with any healthcare encounters for FMS (ICD-9-CM diagnosis code 729.1) in each year of the 3-year period, 1 July 2002 to 30 June 2005. A comparison group was then constituted, consisting of randomly selected patients without any healthcare encounters for FMS during this 3-year period. Comparison group patients were matched to FMS patients based on age and sex. Characteristics and healthcare costs of FMS patients and comparison group patients were then examined over the 1-year period, 1 July 2004 to 30 June 2005 (the most recent year for which data were available at the time of the study).Results: The study sample consisted of 33,176 FMS patients and an identical number in the comparison group. Mean age was 46 years, and 75% were women. FMS patients were more likely to have various comorbidities, including painful neuropathies (23% vs. 3% for comparison group), anxiety (5% vs. 1%), and depression (12% vs. 3%) (all p < 0.001); they also were more likely to have used pain-related pharmacotherapy (65% vs. 34% for comparison group; p < 0.001). Mean (SD) total healthcare costs over 12 months were about three times higher among FMS patients [$9573 ($20,135) vs. 3291(3291 (3291(13,643); p < 0.001]; median costs were fivefold higher ($4247 vs. $822; p < 0.001).Conclusions: Patients with FMS have comparatively high levels of comorbidities and high levels of healthcare utilization and cost.
Quality of Life Research, 1995
To explore the value of antiandrogen therapy for advanced prostate cancer, two clinical trials of... more To explore the value of antiandrogen therapy for advanced prostate cancer, two clinical trials of similar design were recently conducted in six countries throughout Europe. A total of 550 patients with previously untreated metastatic prostate cancer were randomized either to treatment with an antiandrogen or castration. While time to treatment failure, objective tumour response and survival were expected to be similar between study treatments, their effects on health-related quality of life (HRQOL) were expected to differ and were therefore a focus of concern in this trial. To assess these effects, we developed a brief self-administered patient questionnaire covering 10 domains of HRQOL (general health perceptions, pain, emotional well-being, vitality, social functioning, physical capacity, sexual interest, sexual functioning, activity limitation and bed disability), which we translated from English into several other languages. In this paper, we describe the development, content and translation of this survey instrument and report on its reliability and validity in six countries based on data collected for the first 487 patients to complete questionnaires at study entry.
Background: Obesity is an established risk factor for several chronic diseases. The lifetime heal... more Background: Obesity is an established risk factor for several chronic diseases. The lifetime health and economic consequences of obesity for individual patients have not been documented.
Journal of Pain, 2005
Persons aged >65 years with pain caused by postherpetic neuralgia (PHN) were recruited via advert... more Persons aged >65 years with pain caused by postherpetic neuralgia (PHN) were recruited via advertisements in 24 US newspapers and were mailed a questionnaire that addressed pain intensity (average, worst, least, current), pain interference (with general activity, mood, relations with other people, sleep, enjoyment of life), and health-related quality of life (using the EuroQoL health measure [EQ-5D] and a global rating scale). Respondents also were asked about their use of medication for shingles pain. A total of 385 persons completed the survey; 61% were >75 years of age. Mean (؎standard deviation) duration of PHN was 3.3 (؎4.0) years. Only about one half had taken prescription medication for shingles pain during the prior week; dosages were typically low. Mean average, worst, least, and current pain caused by shingles (0-to 10-point scale) was 4.6 (؎2.1), 6.0 (؎2.4), 2.9 (؎2.3), and 4.0 (؎2.7), respectively. Mean pain interference with general activity, mood, relations with other people, sleep, and enjoyment of life (0-to 10-point scale) was 3.7 (؎3.1), 4.3 (؎2.9), 3.0 (؎2.8), 3.8 (؎2.9), and 4.5 (؎3.1), respectively. The mean EQ-5D health index score was 0.61; respondents rated their overall health as 65.7 (؎21.1) on a 100-point scale. PHN causes substantial pain, dysfunction, and poor health-related quality of life in older persons, many of whom might be suboptimally treated.
To estimate the clinical and economic burden of obesity in a managed care setting. Prevalence-bas... more To estimate the clinical and economic burden of obesity in a managed care setting. Prevalence-based cost-of-illness evaluation using modeling techniques and data from secondary sources. The health and economic burden of obesity was estimated for a hypothetical health plan with 1 million members between the ages of 35 and 84 years, based on projections of the numbers of cases of 8 diseases for which obesity is an established risk factor (coronary heart disease, hypertension, hypercholesterolemia, gallbladder disease, stroke, type 2 diabetes, osteoarthritis of the knee, and endometrial cancer), obesity-attributable "etiologic fractions," and estimates of associated medical care costs. Our analysis was based on data from a variety of secondary sources, including a large managed care plan in the Pacific Northwest region of the United States. In a population of 1 million persons aged 35 to 84 years, it was estimated that obesity would account for approximately 132,900 cases of hypertension (45% of all cases), 58,500 cases of type 2 diabetes (85%), 51,500 cases of hypercholesterolemia (18%), and 16,500 cases of coronary heart disease (35%). Healthcare costs attributable to obesity were estimated to total $345.9 million annually (or 41% of the total for the 8 diseases of interest). The clinical and economic burden of obesity in a managed care setting is substantial.
International Journal of Technology Assessment in Health Care, 1992
We describe and illustrate the use of a generalizable model for evaluating the cost-effectiveness... more We describe and illustrate the use of a generalizable model for evaluating the cost-effectiveness of alternative cholesterol-lowering treatments. We combine standard incidence-based techniques for measuring the cost of illness with logistic risk functions from the Framingham Heart Study to project, for persons with known coronary risk characteristics, the likelihood of developing coronary heart disease (CHD) over a lifetime as well as a number of related outcomes, including the expected loss of years of life due to CHD, the expected lifetime direct and indirect costs of CHD, and the changes in these outcomes that would result from cholesterol-lowering treatment.
Pediatric Infectious Disease Journal, 1999
Otitis media is one of the most common office diagnoses among children in the US and the leading ... more Otitis media is one of the most common office diagnoses among children in the US and the leading reason for the use of antimicrobials in pediatric practice. We undertook this study to characterize medical and surgical management of otitis media. Using claims data from a large New England health insurer, we identified all children <10 years of age who had one or more episodes of acute otitis media between July, 1995, and June, 1996, and examined patterns of treatment for this condition. Study subjects (n = 22,004) averaged 2.9 physician office visits for management of otitis media; among children <2 years of age, one-fourth had 6 or more such visits. Amoxicillin was prescribed as initial therapy in more than one-half (56.6%) of all episodes of acute otitis media, followed by cephalosporins (18.3%), trimethoprim-sulfamethoxazole (12.3%), macrolides (6.4%) and amoxicillin-clavulanate (6.0%). Over multiple episodes, however, use of amoxicillin declined by about 50%. Antimicrobial prophylaxis was received by 7.3% of all study subjects for a mean of 61.3 days; the incidence of breakthrough episodes of acute otitis media during prophylaxis varied according to the antimicrobial used (13.9, 12.3 and 19.5% for amoxicillin, trimethoprim-sulfamethoxazole and sulfisoxazole, respectively). Surgical procedures related to otitis media were performed on 3.8% of all study subjects, including 4.6% of children <2 years of age. The health care burden of otitis media is large, particularly in the first 2 years of life.
Value in Health, 2002
Objective: To examine whether sepsis is accurately coded on hospital bills. Methods: Hospital inp... more Objective: To examine whether sepsis is accurately coded on hospital bills. Methods: Hospital inpatient uniform bills (UB-92) for 122 patients with clinically documented severe sepsis of presumed infectious origin were retrospectively examined. Final UB-92 hospital bills were obtained for all study subjects. ICD-9-CM diagnosis codes from these bills were then reviewed to ascertain the number of subjects for whom one or more diagnostic codes for septicemia and/or bacteremia were present. Results: A total of 92 hospital bills (75.4%) contained one or more ICD-9-CM diagnostic codes for septicemia and/or bacteremia. Of the 30 that did not, 15 (12.3%) had codes for major systemic infection and organ failure. No diagnoses indicative of sepsis (i.e., organ failure and major infection) were present on the remaining 15 (12.3%) bills. Conclusions: Our findings suggest that use of ICD-9-CM codes for identifying patients with sepsis using hospital bills is only moderately sensitive. Strict reliance on administrative data sources for sepsis surveillance or research planning may therefore be prone to substantial error.
Prostate, 1993
Using claims data for a 5% random sample of Medicare beneficiaries, we estimated the costs of sur... more Using claims data for a 5% random sample of Medicare beneficiaries, we estimated the costs of surgical treatment for benign prostatic hyperplasia (BPH), including those related to the initial prostatectomy, the treatment of postsurgical complications, and reoperation within one year. We identified 14,480 men who underwent prostatectomy for BPH during 1986–1987, including 13,730 transurethral and 750 open procedures. Mean total inpatient costs (including all hospital charges and professional service fees) for these procedures were estimated to be 6,501and6,501 and 6,501and10,223, respectively. Among patients who underwent transurethral and open prostatectomy, we identified 938 (6.8%) and 39 (5.2%) individuals who had at least one readmission for postsurgical complications or reoperation. Total expected costs of transurethral and open prostatectomy, inclusive of readmissions for complications and reoperations within one year, were estimated to be 6,823and6,823 and 6,823and10,477, respectively. Our study indicates the economic burden represented by surgical treatment of BPH. © 1993 Wiley-Liss, Inc.
Vaccine, 2005
Using a stochastic simulation model of influenza transmission, clinical illness, and economic cos... more Using a stochastic simulation model of influenza transmission, clinical illness, and economic costs, we estimated the population-wide benefits of routinely vaccinating US children (ages 6 months to 18 years) against influenza. Disease burden was projected to decline as a result of both reduced susceptibility to infection among vaccinees and reductions in disease transmission to others in the community. Vaccination of 20% of children would reduce the total number of influenza cases in the US by 46%; 80% coverage would reduce the total number of cases by 91%. Similar reductions were estimated to occur in influenza-related mortality and economic costs.
Critical Care Medicine, 2003
To estimate long-term mortality and medical care charges among patients with severe sepsis. Retro... more To estimate long-term mortality and medical care charges among patients with severe sepsis. Retrospective cohort study. Large, integrated, geographically diverse, U.S. health-insurance claims database covering three million lives annually. All persons with bacterial or fungal infections and acute organ dysfunction (severe sepsis) who were hospitalized between January 1, 1991, and August 31, 2000. None. All patients were followed from the date of hospitalization with severe sepsis (index admission) to August 31, 2000, disenrollment from the health plan, or death, whichever occurred first. Measures of interest included mortality and medical care charges and were estimated for the index admission, the 90- and 180-day periods following the index admission, and annually thereafter (up to 5 yrs), using techniques of survival analysis. A total of 16,019 patients were identified who met study entrance criteria. Most patients (81.2%) were &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;/=65 yrs of age; 53.4% were men. Mortality was 21.2% for the index admission, 51.4% at 1 yr, and 74.2% at 5 yrs. Mean cumulative total medical care charges were 44,600 US dollars for the index admission, 78,500 US dollars at 1 yr, and 118,800 US dollars at 5 yrs. Hospitalization accounted for the largest component of total medical care charges. Mortality and economic costs are high in patients with severe sepsis, during the period of acute illness as well as subsequently.
Osteoporosis International, 2007
Introduction Patient compliance with osteoporosis drug therapy is often poor in clinical practice... more Introduction Patient compliance with osteoporosis drug therapy is often poor in clinical practice and may be associated with higher risk of fracture. Methods A nested case-control study was undertaken using a US health insurance claims database. The source population included all women aged ≥45 years who began drug therapy for osteoporosis. Cases consisted of those who experienced an osteoporosis-related fracture; they were matched to controls without osteoporosis-related fracture. Compliance with osteoporosis drug treatment was assessed in terms of the number of therapy-days received and medication possession ratio (MPR). Conditional logistic regression was employed to examine the relationship between compliance and fracture risk. Results A total of 453 women with osteoporosis-related fracture were identified and matched to 2,160 controls. Fracture risk was significantly lower for patients with >180 days of therapy [181–360 days: odds ratio (OR) = 0.70, 95% CI = 0.49–0.99; >360 days: OR = 0.65, 95% CI = 0.43–0.99) versus those with ≤30 days. Risk was also lower for patients with MPR ≥90% (OR = 0.70, 95% CI = 0.52–0.93) versus those with MPR trend Conclusion Among women initiating drug therapy for osteoporosis, better compliance is associated with reduced risk of fracture.
Clinical Pulmonary Medicine, 2005
... Gregory Tino has served as a speaker and consultant for Chiron BioPharmaceuticals. ... ACKNOW... more ... Gregory Tino has served as a speaker and consultant for Chiron BioPharmaceuticals. ... ACKNOWLEDGMENTS. The authors thank Aaron Moynahan and May Hagiwara, PhD, of Policy Analysis Inc. (PAI) for their assistance with data management and data processing. ...
Journal of Pain, 2004
Using a large US health insurance claims database, we identified all persons aged 18 years or old... more Using a large US health insurance claims database, we identified all persons aged 18 years or older with 2 or more medical encounters in calendar year 2000 for painful neuropathic disorders (PNDs). We also identified an age-and gender-matched group of patients without PNDs (matched control subjects). We then compared the clinical characteristics and economic costs of PND patients with those of matched control subjects. There were a total of 55,686 patients with PNDs in the study database. The most frequently noted PNDs were back and neck pain with neuropathic involvement (62.3% of PND patients), causalgia (12.1%), and diabetic neuropathy (10.8%). In comparison with matched control subjects, PND patients were more likely to have other pain-related conditions, including fibromyalgia (6.0% vs 0.6% for control subjects), osteoarthritis (13.6% vs 3.6%), and other chronic comorbidities, such as coronary heart disease (13.6% vs 6.5%) and depression (6.4% vs 2.3%).
Osteoporosis International, 2006
Introduction Patient compliance with pharmacotherapy for osteoporosis is typically poor in clinic... more Introduction Patient compliance with pharmacotherapy for osteoporosis is typically poor in clinical practice; less frequent dosing with bisphosphonates may improve compliance. Methods Using data from 49 US health plans, we identified all women aged ≥45 years with osteoporosis who initiated therapy with a bisphosphonate, calcitonin, estrogen, or raloxifene. Compliance was examined alternatively in terms of incidence of adherence failure (medication days Results The study population included 18,822 women, 48% of whom initiated weekly bisphosphonate therapy. Overall risk of adherence failure was 47% at 3 months, 70% at 1 year, and 84% at 3 years. Risk of persistence failure was 47% at 1 year, and 77% at 3 years. In multivariate analyses, risk of adherence failure was higher for calcitonin (hazard ratio=2.7 vs weekly bisphosphonate therapy, p Conclusions Approximately three-quarters of women who initiate osteoporosis drug therapy are non-adherent with treatment within 12 months, and almost 50% have discontinued such therapy by this time. Compliance with weekly bisphosphonate therapy is generally no better than that with osteoporosis medications requiring more frequent dosing.
American Journal of Geriatric Pharmacotherapy, 2004
Background: Although older adults with painfid neuropathic disorders (PNDs) would appear to be at... more Background: Although older adults with painfid neuropathic disorders (PNDs) would appear to be at elevated risk ~br receiving potentially inappropriate pain-related medications, the extent of such drug use in this population is unlmown.
Oncology, 2004
Patients with bone metastases from lung cancer often experience skeletal-related events (SREs) in... more Patients with bone metastases from lung cancer often experience skeletal-related events (SREs) including pathological fracture, spinal cord compression, hypercalcemia or pain requiring surgery, radiotherapy or opioid analgesics. These complications result in impaired mobility and reduced quality of life and have a significant negative impact on survival. The economic consequences of SREs in patients with lung cancer have not been examined. We conducted a retrospective analysis using a large US health insurance claims database to estimate the incidence and costs of treatment of SREs in patients with bone metastases of lung cancer treated in a naturalistic setting. Study subjects had &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;/=2 encounters with a diagnosis of primary lung cancer and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;/=2 encounters with a diagnosis of metastases to bone. SREs were identified based on the occurrence on or after the date of first diagnosis of bone metastases, of (1) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;/=1 encounter with a diagnosis of pathological fracture, spinal cord compression or hypercalcemia, (2) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;/=1 bone surgery or radiotherapy procedure, or (3) the initiation of opioid analgesic therapy. Survival and costs of SRE-related care in patients with SREs were estimated using Kaplan-Meier methods. We identified 534 patients with lung cancer and bone metastases, including 295 (55%) with &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;/=1 SRE. Radiotherapy (68%) and fracture (35%) were the most common SREs. Median survival after the first identified SRE was 4.1 months (95% confidence interval: 3.6-5.5 months). The estimated lifetime SRE-related cost per patient was USD 11,979 (95% confidence interval: USD 10,193-13,766). Radiotherapy accounted for the greatest proportion of cost (61%) by SRE type. The economic burden of SREs in patients with bone metastases of lung cancer is substantial. Intravenous bisphosphonates, such as zoledronic acid, which have been shown to prevent these events, may reduce these costs.
Journal of The American Dietetic Association, 1996
Objectives To estimate the effects of reducing dietary saturated fat intake on the incidence and ... more Objectives To estimate the effects of reducing dietary saturated fat intake on the incidence and economic costs of coronary heart disease (CHD) in the United States.Design Modeling techniques and data from secondary sources, including the Framingham Heart Study and the second and third National Health and Nutrition Examination Surveys, were used to estimate the effects on CHD incidence and associated costs of reducing dietary saturated fat intake as a percent of total energy by one to three percentage points.Subjects Persons aged 35 to 69 years who have total cholesterol levels of 5.17 rnmol/L or higher and are currently free of CHD.Results Approximately 3 million first-time coronary events are estimated to occur over a 10-year period among persons with total cholesterol levels exceeding 5.17 mmol/L. Reducing saturated fat intake by one to three percentage points would reduce CHD incidence by 32,000 to 99,700 events and yield combined savings in medical expenditures and lost earnings ranging from 4.1to4.1 to 4.1to12.7 billion over 10 years (estimates in 1993 US dollars).Conclusion Population-based interventions to encourage Americans to reduce dietary intake of saturated fat may prevent tens of thousands of cases of CHD and save billions of dollars in related costs. J Am Diet Assoc. 1996; 96: 127–131.
Controlled Clinical Trials, 1995
International Journal of Clinical Practice, 2007
Purpose: To examine the characteristics and healthcare costs of fibromyalgia syndrome (FMS) pati... more Purpose: To examine the characteristics and healthcare costs of fibromyalgia syndrome (FMS) patients in clinical practice.Materials and methods: Using a US health-insurance database, we identified all patients, aged ≥ 18 years, with any healthcare encounters for FMS (ICD-9-CM diagnosis code 729.1) in each year of the 3-year period, 1 July 2002 to 30 June 2005. A comparison group was then constituted, consisting of randomly selected patients without any healthcare encounters for FMS during this 3-year period. Comparison group patients were matched to FMS patients based on age and sex. Characteristics and healthcare costs of FMS patients and comparison group patients were then examined over the 1-year period, 1 July 2004 to 30 June 2005 (the most recent year for which data were available at the time of the study).Results: The study sample consisted of 33,176 FMS patients and an identical number in the comparison group. Mean age was 46 years, and 75% were women. FMS patients were more likely to have various comorbidities, including painful neuropathies (23% vs. 3% for comparison group), anxiety (5% vs. 1%), and depression (12% vs. 3%) (all p < 0.001); they also were more likely to have used pain-related pharmacotherapy (65% vs. 34% for comparison group; p < 0.001). Mean (SD) total healthcare costs over 12 months were about three times higher among FMS patients [$9573 ($20,135) vs. 3291(3291 (3291(13,643); p < 0.001]; median costs were fivefold higher ($4247 vs. $822; p < 0.001).Conclusions: Patients with FMS have comparatively high levels of comorbidities and high levels of healthcare utilization and cost.
Quality of Life Research, 1995
To explore the value of antiandrogen therapy for advanced prostate cancer, two clinical trials of... more To explore the value of antiandrogen therapy for advanced prostate cancer, two clinical trials of similar design were recently conducted in six countries throughout Europe. A total of 550 patients with previously untreated metastatic prostate cancer were randomized either to treatment with an antiandrogen or castration. While time to treatment failure, objective tumour response and survival were expected to be similar between study treatments, their effects on health-related quality of life (HRQOL) were expected to differ and were therefore a focus of concern in this trial. To assess these effects, we developed a brief self-administered patient questionnaire covering 10 domains of HRQOL (general health perceptions, pain, emotional well-being, vitality, social functioning, physical capacity, sexual interest, sexual functioning, activity limitation and bed disability), which we translated from English into several other languages. In this paper, we describe the development, content and translation of this survey instrument and report on its reliability and validity in six countries based on data collected for the first 487 patients to complete questionnaires at study entry.
Background: Obesity is an established risk factor for several chronic diseases. The lifetime heal... more Background: Obesity is an established risk factor for several chronic diseases. The lifetime health and economic consequences of obesity for individual patients have not been documented.
Journal of Pain, 2005
Persons aged >65 years with pain caused by postherpetic neuralgia (PHN) were recruited via advert... more Persons aged >65 years with pain caused by postherpetic neuralgia (PHN) were recruited via advertisements in 24 US newspapers and were mailed a questionnaire that addressed pain intensity (average, worst, least, current), pain interference (with general activity, mood, relations with other people, sleep, enjoyment of life), and health-related quality of life (using the EuroQoL health measure [EQ-5D] and a global rating scale). Respondents also were asked about their use of medication for shingles pain. A total of 385 persons completed the survey; 61% were >75 years of age. Mean (؎standard deviation) duration of PHN was 3.3 (؎4.0) years. Only about one half had taken prescription medication for shingles pain during the prior week; dosages were typically low. Mean average, worst, least, and current pain caused by shingles (0-to 10-point scale) was 4.6 (؎2.1), 6.0 (؎2.4), 2.9 (؎2.3), and 4.0 (؎2.7), respectively. Mean pain interference with general activity, mood, relations with other people, sleep, and enjoyment of life (0-to 10-point scale) was 3.7 (؎3.1), 4.3 (؎2.9), 3.0 (؎2.8), 3.8 (؎2.9), and 4.5 (؎3.1), respectively. The mean EQ-5D health index score was 0.61; respondents rated their overall health as 65.7 (؎21.1) on a 100-point scale. PHN causes substantial pain, dysfunction, and poor health-related quality of life in older persons, many of whom might be suboptimally treated.
To estimate the clinical and economic burden of obesity in a managed care setting. Prevalence-bas... more To estimate the clinical and economic burden of obesity in a managed care setting. Prevalence-based cost-of-illness evaluation using modeling techniques and data from secondary sources. The health and economic burden of obesity was estimated for a hypothetical health plan with 1 million members between the ages of 35 and 84 years, based on projections of the numbers of cases of 8 diseases for which obesity is an established risk factor (coronary heart disease, hypertension, hypercholesterolemia, gallbladder disease, stroke, type 2 diabetes, osteoarthritis of the knee, and endometrial cancer), obesity-attributable "etiologic fractions," and estimates of associated medical care costs. Our analysis was based on data from a variety of secondary sources, including a large managed care plan in the Pacific Northwest region of the United States. In a population of 1 million persons aged 35 to 84 years, it was estimated that obesity would account for approximately 132,900 cases of hypertension (45% of all cases), 58,500 cases of type 2 diabetes (85%), 51,500 cases of hypercholesterolemia (18%), and 16,500 cases of coronary heart disease (35%). Healthcare costs attributable to obesity were estimated to total $345.9 million annually (or 41% of the total for the 8 diseases of interest). The clinical and economic burden of obesity in a managed care setting is substantial.
International Journal of Technology Assessment in Health Care, 1992
We describe and illustrate the use of a generalizable model for evaluating the cost-effectiveness... more We describe and illustrate the use of a generalizable model for evaluating the cost-effectiveness of alternative cholesterol-lowering treatments. We combine standard incidence-based techniques for measuring the cost of illness with logistic risk functions from the Framingham Heart Study to project, for persons with known coronary risk characteristics, the likelihood of developing coronary heart disease (CHD) over a lifetime as well as a number of related outcomes, including the expected loss of years of life due to CHD, the expected lifetime direct and indirect costs of CHD, and the changes in these outcomes that would result from cholesterol-lowering treatment.
Pediatric Infectious Disease Journal, 1999
Otitis media is one of the most common office diagnoses among children in the US and the leading ... more Otitis media is one of the most common office diagnoses among children in the US and the leading reason for the use of antimicrobials in pediatric practice. We undertook this study to characterize medical and surgical management of otitis media. Using claims data from a large New England health insurer, we identified all children <10 years of age who had one or more episodes of acute otitis media between July, 1995, and June, 1996, and examined patterns of treatment for this condition. Study subjects (n = 22,004) averaged 2.9 physician office visits for management of otitis media; among children <2 years of age, one-fourth had 6 or more such visits. Amoxicillin was prescribed as initial therapy in more than one-half (56.6%) of all episodes of acute otitis media, followed by cephalosporins (18.3%), trimethoprim-sulfamethoxazole (12.3%), macrolides (6.4%) and amoxicillin-clavulanate (6.0%). Over multiple episodes, however, use of amoxicillin declined by about 50%. Antimicrobial prophylaxis was received by 7.3% of all study subjects for a mean of 61.3 days; the incidence of breakthrough episodes of acute otitis media during prophylaxis varied according to the antimicrobial used (13.9, 12.3 and 19.5% for amoxicillin, trimethoprim-sulfamethoxazole and sulfisoxazole, respectively). Surgical procedures related to otitis media were performed on 3.8% of all study subjects, including 4.6% of children <2 years of age. The health care burden of otitis media is large, particularly in the first 2 years of life.