Bradley S. Stolshek

A Multicenter Retrospective Cohort Study of Practice Patterns and Clinical Outcomes of the Use of Darbepoetin Alfa and Epoetin Alfa for Chemotherapy-Induced Anemia

BACKGROUND Darbepoetin alfa is the second erythropoietic protein to be approved for the treatment of chemotherapy-induced anemia (CIA). In the clinical setting, darbepoetin alfa can be administered less frequently than epoetin alfa with similar efficacy. Practice patterns and outcomes associated with the use of darbepoetin alfa and epoetin alfa in the clinical setting have not been reported. OBJECTIVE This study compared practice patterns and clinical outcomes of the use of darbepoetin alfa and epoetin alfa for CIA at oncology practices in the United States. METHODS This was a multicenter retrospective cohort study. Data were abstracted from the medical charts of consecutive patients who began darbepoetin alfa treatment between August 1 and October 4, 2002, or epoetin alfa treatment between April 1 and July 31, 2002, and were receiving concurrent chemotherapy. These data were used to determine the initial dose and dosing schedule, dose changes, and changes in hemoglobin concentrations after 4, 8, and 12 weeks of treatment, adjusted for red blood cell (RBC) transfusions, and the incidence of RBC transfusions over time. To minimize potential bias, the study protocol defined specific end points and prespecified analytic techniques for assessing clinical outcomes with the 2 agents. RESULTS The records of 1391 patients from 16 community and hospital outpatient oncology clinics were abstracted. Of these, 1293 patients (93.0%) received only 1 erythropoietic agent (darbepoetin alfa, 735 [56.8%]; epoetin alfa, 558 [43.2%]); the remainder received both agents. In the patients who received darbepoetin alfa, most (553 [75.2%]) received an initial dosage of 200 microg q2wk. A similar proportion (414 [74.2%]) received epoetin alfa at an initial dosage of 40,000 U qwk. As these were the regimens for the majority of patients whose records were abstracted, the results reported here are for these patients. The dose was increased in 63 darbepoetin alfa recipients (11.4%) and 58 epoetin alfa recipients (14.0%) at a median of 7 weeks. After 12 weeks, the 2 groups had an identical mean imputed change from baseline in hemoglobin concentration (1.0 g/dL), and the incidence of RBC transfusions during treatment was also similar between groups (darbepoetin alfa, 44553 [8.0%]; epoetin alfa, 39414 [9.4%]). CONCLUSIONS Darbepoetin alfa 200 microg q2wk was used as a standard regimen for CIA at the 16 US oncology practices participating in this study. It appeared to be as effective as epoetin alfa 40,000 U qwk, with a reduced frequency of dosing.

Direct healthcare costs of osteoporosis-related fractures in managed care patients receiving pharmacological osteoporosis therapy

BackgroundOsteoporosis is a common condition and the economic burden of osteoporosis-related fractures is significant. While studies have reported the incremental or attributable costs of osteoporosis-related fracture, data on the economic impact of osteoporosis-related fractures in commercial health plan populations are limited.ObjectiveTo estimate the direct costs of osteoporosis-related fractures among pharmacologically treated patients in a large, commercially insured population between 2005 and 2008.MethodsIn this retrospective cohort study, patients were identified from a large, commercially insured population with integrated pharmacy and medical claims. Inclusion criteria were age 45–64 years; one or more osteoporosis medication claim(s) with first (index) claim between 1 January 2005 and 30 April 2008; and continuous insurance coverage for ≥12 months pre-index and ≥6 months post-index. Patients with pre-index Paget’s disease or malignant neoplasm; skilled nursing facility stay; combination therapy at index; or fracture ≤6 months post-index were excluded. A generalized linear model compared differences in 6-month pre-/post-event costs for patients with and without fracture. Propensity score weighting was used to ensure comparability of fracture and non-fracture patients. Generalized estimating equations accounted for repeated measures.ResultsThe study included 49 680 patients (2613 with fracture) with a mean (SD) age of 56.4 (4.7) years; 95.9% were female. Mean differences between pre- and post-event direct costs were

Impact of Osteoporosis on High-Cost Chronic Diseases

US14049 (95% CI 7670, 20 428) for patients with vertebral fractures,

Patterns of osteoporosis treatment change and treatment discontinuation among commercial and Medicare Advantage Prescription Drug members in a national health plan

US16 663 (95% CI 11690, 21636) for patients with hip fractures, and

Osteoporosis Prevalence and Characteristics of Treated and Untreated Nursing Home Residents With Osteoporosis

US7582 (95% CI 6532, 8632) for patients with other fractures. After adjusting for covariates, osteoporosis-related fractures were associated with an additional

Cost-effectiveness of sequenced treatment of rheumatoid arthritis with targeted immune modulators

US9996 (95% CI 8838, 11154; p< 0.0001) in direct costs per patient across all fracture types during the 6 months following fracture.ConclusionPatients with osteoporosis-related fractures were found to incur nearly

Osteoporosis Diagnosis and Management in Long-Term Care Facility

US10 000 in estimated additional direct healthcare costs in the 6 months post-fracture, compared with patients with no fracture. Reduced fracture risk may lower associated direct healthcare costs.

Rebound in Measures of Disease Activity and Symptoms in Corrona Registry Patients with Psoriatic Arthritis Who Discontinue Tumor Necrosis Factor Inhibitor Therapy after Achieving Low Disease Activity

OBJECTIVE To assess the impact of osteoporosis on health care costs for patients with chronic disease (CD): cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), depression, diabetes mellitus (DM), or two or more of these CDs. METHODS This retrospective analysis included commercially insured or Medicare Advantage male and female members aged 50 years or older with medical and pharmacy benefits who had evidence of osteoporosis and/or one of the CDs during the identification period (January 1, 2007, to October 31, 2009). Cohorts were defined by the presence or absence of osteoporosis and CD (osteoporosis ONLY, CD ONLY, and CD plus osteoporosis) and, for osteoporosis cohorts, by incident (recent diagnosis) or prevalent osteoporosis (long-standing). Primary outcome was total health care costs during 1-year follow-up. Costs, adjusted for baseline characteristics, were analyzed with a generalized linear model with log link and gamma distribution. RESULTS Of the 494,160 patients, the majority had evidence of CD with or without osteoporosis: CVD (54%), two or more CDs (24%), DM (8%), depression (4%), COPD (1%); 9% had osteoporosis ONLY. The range of actual mean costs was as follows: CD ONLY,

THU0423 Time To Rebound in Joint Symptoms Following Discontinuation of TNFI Therapy after Achieving Low Disease Activity or Remission in Psoriatic Arthritis Patients Enrolled in The US Corrona Registry

8,377 (CVD) to

AB1109 A Retrospective Analysis on Predictors of Disease-Modifying Anti-Rheumatic Drug Initiation Among a Cohort of Patients with Newly Diagnosed Rheumatoid Arthritis

12,801 (two or more CDs); CD plus incident osteoporosis,