Chakkarin Burudpakdee

Economic burden of toxicities associated with metastatic colorectal cancer treatment regimens containing monoclonal antibodies.

Abstract Objectives: Little is known about toxicity-related costs of monoclonal antibody treatments in metastatic colorectal cancer. This study aimed to identify toxicities associated with bevacizumab, cetuximab, and panitumumab and estimate the direct costs of these toxicities. Methods: Grade 3 and 4 toxicities were identified by a comprehensive literature search. Inpatient costs were estimated using ICD-9 codes and 2007 Medicare payments from the Healthcare Cost and Utilization Project database; costs were converted to 2010 dollars. Outpatient costs were estimated by applying 2010 Medicare reimbursement rates to resource use assumptions (based on in-depth clinical interviews). Results: Toxicities associated with bevacizumab included hypertension, arterial thrombosis, hemorrhage, gastrointestinal (GI) perforation, fistula, and wound-healing complications; toxicities associated with cetuximab and panitumumab included skin rash, hypomagnesemia, and infusion reactions. The inpatient cost per event was highest for GI perforation (USD 32,443), followed by fistula (USD 29,062), arterial thrombosis (USD 20,346), and wound-healing complications (USD 13,240), while inpatient costs per event for hypomagnesemia and skin rash were among the lowest. The cost per event of toxicities treated in the outpatient setting included USD 185 for skin rash up to USD 585 for wound-healing complications. Limitations: Treatment costs of toxicities for the outpatient setting were determined using assumptions validated by clinicians, and unit costs were based on Medicare reimbursement rates, which are often lower than the reimbursement rates for commercial health insurance plans. Toxicities included were only grades 3 and 4 adverse events and might be limited by differences between clinical studies. Conclusions: Monoclonal antibodies have different toxicity profiles and the costs associated with managing these toxicities vary greatly.

Impact of patient programs on adherence and persistence in inflammatory and immunologic diseases: a meta-analysis

Objectives Patient adherence and persistence is important to improve outcomes in chronic conditions, including inflammatory and immunologic (I&I) diseases. Patient programs that aim at improving medication adherence or persistence play an essential role in optimizing care. This meta-analysis assessed the effectiveness of patient programs in the therapeutic area of I&I diseases. Methods A global systematic literature review was conducted with inclusion criteria of: patient programs in I&I diseases; published in English language between January 2008 and September 2013; and reporting measures of adherence or persistence, including medication possession ratio >80% and persistence rate. A meta-analysis was performed using a random effects model. Subgroup analyses based on the type of program was performed whenever feasible. Results Of 67 studies reviewed for eligibility, a total of 17 studies qualified for inclusion in the meta-analysis. Overall, patient programs increased adherence (odds ratio [OR]=2.48, 95% confidence interval [CI]=1.68–3.64, P<0.00001) as compared with standard of care. Combination patient programs that used both informational and behavioral strategies were superior in improving adherence (OR=3.68, 95% CI=2.20–6.16, P<0.00001) compared with programs that used only informational (OR=2.16, 95% CI=1.36–3.44, P=0.001) or only behavioral approaches (OR=1.85, 95% CI=1.00–3.45, P=0.05). Additionally, patients were more likely to be persistent (OR=2.26, 95% CI=1.16–4.39, P=0.02) in the intervention group as compared with the control group. Persistence (in days) was significantly (P=0.007) longer, by 42 additional days, in the intervention group than in the control group. Conclusions Patient programs can significantly improve adherence as well as persistence in the therapeutic area of I&I diseases. Programs employing a multimodal approach are more effective in improving adherence than programs with informational or behavioral strategies alone. This in turn may improve patient outcomes.

Clinical and economic burden of peripheral T-cell lymphoma in commercially insured patients in the United States: findings using real-world claims data.

Abstract Objective: This retrospective cohort study utilized real-world claims data to assess the clinical and economic burden of peripheral T-cell lymphoma (PTCL) over the continuum of care in the US. Methods: Data were extracted from US administrative claims databases to identify adult patients with PTCL (ICD-9-CM code 202.7X) diagnosed between October 2007 and June 2011. Patients had to have ≥6 months of continuous enrollment before and ≥12 months of continuous enrollment after their index date (date of first PTCL diagnosis). PTCL patients were matched (1:5) by age, sex, region, plan type, payer type, and length of continuous enrollment, to a control group of randomly selected patients without PTCL. Patient-level healthcare resource utilization data and associated costs (in US dollars) were measured. Mean costs per patient per month were determined. Results: Of 2820 patients with PTCL, 1000 met all inclusion criteria (median age = 57 years; 57.5% male) and were matched to the control group (n = 5000). On an average monthly basis, PTCL patients were hospitalized more frequently (0.07 vs 0.01 admissions; p < 0.0001) and had a longer length of hospital stay (6.4 vs 4.0 days; p < 0.0001) compared with controls. PTCL patients also had higher monthly utilization of pharmacy services (2.85 vs 0.97 prescriptions; p < 0.0001), office visits (1.35 vs 0.34 visits; p < 0.0001), ER visits (0.07 vs 0.02 visits; p < 0.0001), hospice stays (0.05 vs 0.01 stays; p < 0.0001) and other patient services/procedures. Overall, PTCL patients incurred higher average monthly costs per patient compared with control patients (

Adherence rates and health care costs in Crohn's disease patients receiving certolizumab pegol with and without home health nurse assistance: results from a retrospective analysis of patient claims and home health nurse data

6327.84 vs

Changes in healthcare resource use and costs associated with early versus delayed initiation of atypical antipsychotic adjunctive treatment in major depressive disorder

388.39; p < 0.0001), driven mainly by hospitalizations (32.2% of overall costs) and pharmacy services (19.6%). Conclusions: This is the first real-world study to quantify healthcare resource utilization, costly treatment, and overall medical expenditure in commercially insured PTCL patients. Better tolerated and more effective treatments may improve disease management and reduce the clinical and economic burden of PTCL.

The impact of non-medical switch on type 2 diabetes patients treated with canagliflozin in the commercially insured US population

Background Patient support programs have a positive effect on adherence to therapy. Certolizumab pegol (CZP) is a tumor necrosis factor antagonist for the treatment of Crohn’s disease. Objectives To assess, using real-world claims data, whether home health nurse assistance had an effect on patients’ adherence to CZP and to measure its impact on health care use and costs. Methods A retrospective analysis of medical and pharmacy claims data from the IQVIA Real-World Data Adjudicated Claims Database was conducted using data from January 1, 2007 through September 30, 2015. CZP patients with Crohn’s disease were eligible to receive self-administration instructions from a nurse or nurse-administered CZP injections, or both. These services were provided by CIMplicity®, a home health nurse program sponsored by UCB Pharma. Cohorts were based on patients with and without nurse assistance and were matched based on gender and categorical age. Adherence to CZP was determined using the medication possession ratio (MPR) and proportion of days covered (PDC). A Kaplan–Meier analysis was performed to compare time to discontinuation of CZP between the two cohorts. Multivariate regression analyses were performed, adjusting for additional covariates to compare the effect of CZP with and without nurse assistance on hospitalization and total health care costs. Results Patients with at least 12 months of continuous enrollment post-index date were evaluated for adherence to CZP (n=276 in each cohort). The mean and median PDC and MPR values were higher with nurse assistance than without. Time to discontinuation was significantly longer in patients who received CZP with nurse assistance than without (P=0.0004). Results from the multivariate analyses showed a significant reduction in all-cause hospitalization (−55.8%; P=0.0026) and total health care costs (−14.3%; P=0.0045) with nurse assistance. Conclusion This analysis suggests that home health nurse assistance increases adherence to CZP and reduces health care costs in patients with Crohn’s disease.

Evaluation of patient support program and adherence to long-acting injectable aripiprazole for patients utilizing injection local care centers

Abstract Aims: The study compared all-cause and major depressive disorder (MDD)-related healthcare resource use (HRU) and costs in patients with MDD treated with atypical antipsychotic (AAP) adjunctive therapy early or later in treatment. Materials and methods: Adults with MDD and antidepressant treatment (ADT) who newly initiated adjunctive aripiprazole, brexpiprazole, lurasidone, or quetiapine between October 1, 2014 and September 30, 2015 were identified in the IQVIA Real-World Data Adjudicated Claims database; the index date was the date of the first AAP claim. Patients were stratified into three cohorts: AAP initiated in the first year (Y1); in the second year (Y2); and more than 2 years (Y3) of first ADT use. Within each cohort, HRU and costs were compared between the 12 months before and after the index date. Pre–post changes in HRU and costs were then compared between cohorts. Results: Five hundred and six (36.7%) patients were categorized as Y1; 252 (18.3%) as Y2; and 622 (45.1%) as Y3. AAP use was associated with significantly decreased rates of all-cause and MDD-related hospitalization and emergency department visits, and increased rates of pharmacy fills and physician office visits; and the magnitude of changes was largest in cohort Y1. Cohort Y1 had the largest reductions in mean (±SD) all-cause medical costs per patient (−

A Real-World Study of 30-Day Exacerbation Outcomes in Chronic Obstructive Pulmonary Disease (COPD) Patients Managed with Aerobika OPEP

10,496 ± 

A Retrospective Study of the Effectiveness of the AeroChamber Plus® Flow-Vu® Antistatic Valved Holding Chamber for Asthma Control

85,022, p = .015) compared to Y2 (−

A Real-World Evidence Study Assessing the Impact of Adding the Aerobika Oscillating Positive Expiratory Pressure Device to Standard of Care Upon Healthcare Resource Utilization and Costs in Post-Operative Patients

2,474 ±