Derek H. Tang

Impact of urinary incontinence on healthcare resource utilization, health-related quality of life and productivity in patients with overactive bladder

To evaluate the impact of urinary incontinence (UI) on healthcare resource utilization (HRU), health‐related quality of life (HRQoL) and productivity measures in patients with overactive bladder (OAB).

A Network Meta-Analysis on the Efficacy of Serotonin Type 3 Receptor Antagonists Used in Adults During the First 24 Hours for Postoperative Nausea and Vomiting Prophylaxis

BACKGROUND The serotonin type 3 receptor antagonists (5-HT(3) antagonists) ondansetron, granisetron, tropisetron, and dolasetron are potential prophylactic agents for patients with mild to moderate risk of postoperative nausea and vomiting (PONV). A few trials have been conducted to compare the efficacy among 2 to 3 of these 4 agents. However, the comparative efficacy of all four 5-HT(3) antagonists has not yet been quantitatively investigated. OBJECTIVE The goal of this study was to investigate whether the 5-HT(3) antagonists--ondansetron, granisetron, tropisetron, and dolasetron-differ in efficacy when used for the prevention of PONV. METHODS PubMed and the Cochrane Library were searched for randomized controlled, double-blind studies measuring efficacy in terms of PONV prophylaxis. A Bayesian meta-analysis was conducted using published studies of 5-HT(3) antagonists for PONV prophylaxis. The odds of patients with no PONV and postoperative vomiting (POV) within each study arm 24 hours after surgery were the primary indices of drug efficacy. Data were extracted and analyzed via indirect comparisons using random effects Bayesian models in WinBUGS version 1.4.3. RESULTS A total of 85 studies were identified, representing 15,269 patients. The results indicate that granisetron was significantly better than ondansetron (odds ratio [OR] = 1.53 [95% credible interval (CI), 1.15-2.00]) and dolasetron (OR = 1.67 [95% CI, 1.12-2.38]) in preventing PONV. Four antiemetic drugs had comparable efficacy in terms of preventing POV: granisetron showed similar efficacy compared with ondansetron (OR = 1.49 [95% CI, 0.90-2.43]), tropisetron (OR = 1.69 [95% CI, 0.92-3.13]), and dolasetron (OR = 1.32 [95% CI, 0.71-2.38]). Ondansetron exhibited comparable efficacy compared with tropisetron (OR = 1.14 [95% CI, 0.66-1.96]) and dolasetron (OR = 0.88 [95% CI, 0.51-1.47]). Tropisetron and dolasetron were also similar in efficacy (OR = 0.78 [95% CI, 0.40-1.45]). All 5-HT(3) antagonists were statistically significantly better at preventing PONV or POV than placebo. CONCLUSIONS With respect to PONV prophylaxis, granisetron was significantly better than ondansetron and dolasetron; ondansetron, tropisetron, and dolasetron exhibited similar efficacy. With respect to POV prophylaxis, ondansetron, granisetron, tropisetron, and dolasetron seemed to have comparable efficacy.

A Systematic Review of Economic Studies on Biological Agents Used to Treat Crohn’s Disease

Background:Identifying clinical scenarios that maximize the cost-effectiveness of biological treatments can lead to optimized health care cost-saving and clinical effectiveness from a society’s perspective. Methods:Published articles between January 1995 and June 2012 were searched in PubMed, EMBASE, ABI/INFORM, Tuft’s Cost-Effectiveness Analysis Registry Database, Cochrane National Health Service Economic Evaluation Database, International Pharmaceutical Abstracts, Web of Science, and Google Scholar. Studies of interest included the following: (1) cost studies, (2) economic evaluations, or (3) narrative or systematic reviews related to economic evaluations of biological treatments for moderate-to-severe Crohn’s disease (CD). The primary outcomes of interest included costs associated with biological treatments and cost-effectiveness measures, including incremental cost-effectiveness ratios. A threshold of

Cost‐Utility Analysis of Biologic Treatments for Moderate‐to‐Severe Crohn's Disease

100,000/quality-adjusted life year (£60,000/quality-adjusted life year) gained was used for treatment cost-effectiveness. Results:Thirty-eight studies were identified, including 15 economic evaluations and 23 cost studies or reviews of economic evaluations. Economic evaluations found that infliximab and adalimumab were more cost-effective than standard therapy for luminal CD when provided as an induction therapy followed by episodic therapy over 5 or more years. The cost-effectiveness of infliximab and adalimumab versus standard therapy for luminal CD was less certain when used as 1-year maintenance treatment with or without previous induction therapy. Cost studies revealed that infliximab therapy reduced health care resource utilization and cost. Older reviews were inconclusive about the cost-effectiveness of biological treatments used for CD. Conclusions:Current evidence suggests that biological treatments may be cost-effective for CD under certain clinical scenarios. Future studies evaluating all biological treatments are needed to compare their respective benefits and costs.

Cost-effectiveness of biological agents used in ulcerative colitis

To compare the cost versus utility of four guideline‐recommended biologic treatments—infliximab, adalimumab, certolizumab pegol, and natalizumab—for the treatment of Crohns disease from a United States payer perspective.

Health care expenditures, hospitalizations, and productivity associated with cancer in US employer settings.

Ulcerative colitis (UC) produces bloody diarrhoea, severe abdominal pain, and need for clinic visits, hospitalizations, and surgeries. UC results in reduced health-related quality of life for patients and large direct medical and indirect costs for health systems and employers. Patients with the most severe disease require the most medical services, and these patients have larger costs than patients with mild or moderate disease. Despite biological therapies being quite expensive, they are indicated for patients unresponsive to initial standard therapies. Future hospitalizations may be reduced by starting a biological treatment. Cost-effectiveness results vary between countries, health systems, and model designs. Since restorative proctocolectomy can be curative, this surgery dominates biological therapy by being both less costly and more effective when measuring health system costs and patient quality-adjusted life years for 20 years. However the dose, duration, and effectiveness of biological treatments significantly impact estimates of their cost-effectiveness.

An Exploratory, Population-Based, Mixed-Methods Program Evaluation of User Satisfaction of Services Provided by a Regional Extension Center (REC)

Objective:To assess outcomes of health care expenditures, hospitalizations, and productivity among employed persons with cancer in the United States from 2004 to 2008. Methods:Agency for Healthcare Research and Qualitys Medical Expenditure Panel Survey data were used in this retrospective cross-sectional study of employed adults aged 18 years or older with any diagnosis of malignant neoplasms. Multivariate regression analyses assessed the studys outcomes according to prominent cancer types and other factors. Results:Overall, 3.31 million employed persons had cancer annually, incurring productivity losses of approximately 33.4 million disability days. Womens cancers and melanoma were associated with higher burdens of illness relative to other forms. Conclusions:This nationally representative investigation found that disability days in employed persons with cancer equates to 20% of health care expenditures. Resources present within small organizational settings may be especially important to consider when implementing programs to prevent and cure cancer.

Science of Safety Topic Coverage in Experiential Education in US and Taiwan Colleges and Schools of Pharmacy

OBJECTIVES To evaluate user satisfaction among practices receiving services provided by the Arizona Regional Extension Center (REC). METHODS This program evaluation utilized a mixed-methods approach including: 1) a mail-based survey targeting all 489 REC member practices; and 2) a series of telephone-based focus groups using a convenience sample of rural and urban REC member practices. Targeted respondents were key contacts who handle interactions with the REC at each practice. Program evaluators at the University of Arizona and experts at Arizona Health-e Connection (AzHeC) created the questionnaires, focus group script, participant invitation and follow up documents via a collaborative process. Regression and Rasch analyses were used to identify key factors associated with satisfaction with REC and to assess questionnaire validity, respectively. RESULTS Responses from both the focus groups and survey revealed that most of the respondents were satisfied with the current services, despite the presence of satisfaction gaps between practices of various characteristics: respondents that were clinicians, practices using web-based electronic health record systems (EHRs), and practices that had achieved Stage 1 Meaningful Use had a higher level of satisfaction compared with their respective counterparts. Focus group participants provided suggestions for improving REC services. CONCLUSIONS Most respondents reported being satisfied with REC services. Specialized representatives may be needed for practices at different stages of Meaningful Use to further improve REC satisfaction in order to facilitate more efficient adoption of EHRs.

Impact of urinary incontinence on health-related quality of life, daily activities, and healthcare resource utilization in patients with neurogenic detrusor overactivity

Objective. To compare the science of safety (SoS) topic coverage and associated student competencies in the experiential education curricula of colleges and schools of pharmacy in the United States and Taiwan. Methods. The experiential education director, assistant director, or coordinator at a random sample of 34 US colleges and schools of pharmacy and all 7 Taiwan schools of pharmacy were interviewed and then asked to complete an Internet-based survey instrument. Results. Faculty members in both countries perceived that experiential curricula were focused on the postmarketing phase of the SoS, and that there is a need for the pharmacy experiential curricula to be standardized in order to fill SoS coverage gaps. Inter-country differences in experiential SoS coverage were noted in topics included for safety biomarkers that signal potential for drug-induced problems and pharmacogenomics. Conclusions. Experiential SoS topic coverage and student ability gaps were perceived within and between US and Taiwan colleges and schools of pharmacy.