Donna McMorrow

Osteoporosis Medication Use After Hip Fracture in U.S. Patients Between 2002 and 2011

Hip fractures are common, morbid, costly, and associated with subsequent fractures. Historically, postfracture osteoporosis medication use rates have been poor, but have not been recently examined in a large‐scale study. We conducted a retrospective, observational cohort study based on U.S. administrative insurance claims data for beneficiaries with commercial or Medicare supplemental health insurance. Eligible participants were hospitalized for hip fracture between January 1, 2002, and December 31, 2011, and aged 50 years or older at admission. The outcome of interest was osteoporosis medication use within 12 months after discharge. Patients were censored after 12 months, loss to follow‐up, or a medical claim for cancer or Pagets disease, whichever event occurred first. During the study period, 96,887 beneficiaries met the inclusion criteria; they had a mean age of 80 years and 70% were female. A total of 34,389 (35.5%) patients were censored before reaching 12 months of follow‐up. The Kaplan‐Meier estimated probability of osteoporosis medication use within 12 months after discharge was 28.5%. The rates declined significantly from 40.2% in 2002, to 20.5% in 2011 (p for trend <0.001). In multivariable Cox proportional hazards models, a number of patient characteristics were associated with reduced likelihood of osteoporosis medication use, including older age and male gender. However, the predictor most strongly and most positively associated with osteoporosis medication use after fracture was osteoporosis medication use before the fracture (hazard ratio = 7.45; 95% confidence interval [CI], 7.23–7.69). Most patients suffering a hip fracture do not use osteoporosis medication in the subsequent year and treatment rates have worsened.

Patterns of treatment, healthcare utilization and costs by lines of therapy in metastatic breast cancer in a large insured US population

AIM Metastatic breast cancer guidelines contain multiple lines of treatment and regimens; however, little data on therapeutic patterns and costs is available from real-world clinical practice. This descriptive study reports chemotherapy and biologic use, healthcare utilization and costs by line of therapy in a large insured US population. MATERIALS & METHODS Adult women with newly diagnosed metastatic breast cancer (between 2005 and 2009) were identified from MarketScan® databases containing medical and pharmacy claims of >40 million enrollees insured with >100 US health plans. Descriptive statistics were reported for use, duration and mean per patient per month costs across four lines of therapy. RESULTS Out of 7767 patients identified (mean [standard deviation] age = 58.2 [12] years), ≥50% received a subsequent line of therapy across the four lines (line 2: n = 4077; line 3: n = 2033; line four: n = 1059). The top two chemotherapies were paclitaxel and capecitabine in lines one and two, and paclitaxel and gemcitabine in lines three and four. The top two biologics were trastuzumab and bevacizumab across the multiple lines of treatments. Duration (mean, standard deviation and median days) varied across multiple lines of treatments: 162.7, 176.9 and 108.0 in line one; 147.5, 146.7 and 99.0 in line two; 139.9, 131.1 and 99.0 in line three; and 130.9, 123.4 and 94.0 in line four, respectively. Mean per patient per month costs decreased with increasing follow-up from US

Characteristics, Treatment, and Health Care Expenditures of Medicare Supplemental‐Insured Patients with Painful Diabetic Peripheral Neuropathy, Post‐Herpetic Neuralgia, or Fibromyalgia

13,147 (<6 months) to US

Treatment effectiveness and treatment patterns among rheumatoid arthritis patients after switching from a tumor necrosis factor inhibitor to another medication

11,610 (7-12 months) to US

Association Between Weight Change, Clinical Outcomes, and Health Care Costs in Patients with Type 2 Diabetes

10,219 (12-24 months) to US

Real-World Economic Burden Associated with Transplantation-Related Complications

9,192 (24-36 months) to US

Association between teriparatide adherence and healthcare utilization and costs among hip fracture patients in the United States

7,384 (>36 months). Cumulative costs increased with follow-up, from US

SAT0566 Real World Study of Biologic Disease Modifying Antirheumatic Drug Persistence among Patients with Rheumatoid Arthritis who have Previously used at least One Other Biologic Agent: a U.S. Administrative Claims Database Analysis

78,882 (<6 months) to US

Comparing biologic persistence and healthcare costs in rheumatoid arthritis patients initiating subcutaneous biologics.

443,062 (>36 months). CONCLUSION Longer follow-up, regardless of number of lines of therapy, was associated with higher cumulative, but lower monthly, costs. Delaying progression and improving survival with more individualized treatment regimens may help slow the rate of increasing long-term costs of metastatic breast cancer treatment and care.

AB0359 Treatment Effectiveness for Rheumatoid Arthritis after Switching from A Tumor Necrosis Factor Inhibitor to Another Agent

OBJECTIVE To describe the characteristics, treatment, and health care expenditures of Medicare Supplemental-insured patients with painful diabetic peripheral neuropathy (pDPN), post-herpetic neuralgia (PHN), or fibromyalgia. DESIGN Retrospective cohort study. SETTING United States clinical practice, as reflected within a database comprising administrative claims from 2.3 million older adults participating in Medicare supplemental insurance programs. SUBJECTS Selected patients were aged ≥65 years, continuously enrolled in medical and prescription benefits throughout years 2008 and 2009, and had ≥1 medical claim with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for DPN, PHN, or fibromyalgia, followed within 60 days by a medication or pain intervention procedure used in treating pDPN, PHN, or fibromyalgia during 2008-2009. OUTCOME MEASURES Utilization of, and expenditures on, pain-related and all-cause pharmacotherapy and medical interventions in 2009. RESULTS The study included 25,716 patients with pDPN (mean age 75.2 years, 51.2% female), 4,712 patients with PHN (mean age 77.7 years, 63.9% female), and 25,246 patients with fibromyalgia (mean age 74.4 years, 73.0% female). Patients typically had numerous comorbidities, and many were treated with polypharmacy. Mean annual expenditures on total pain-related health care and total all-cause health care, respectively, (in 2010 USD) were: