Eileen Farrelly

Burden of Deep Vein Thrombosis in the Outpatient Setting Following Major Orthopedic Surgery

Background Venous thromboembolism (VTE) is a known complication of major orthopedic surgery (MOS) with important clinical and economic consequences. Recently published orthopedic guidelines have focused on prevention of pulmonary embolism as a primary outcome, but deep vein thrombosis (DVT) occurrence should not be readily dismissed. Objective To describe the burden of DVT following hospital discharge for MOS by assessing the impact of DVT on costs and resource utilization from the Third-party payer perspective. Methods Retrospective analysis used outpatient medical and pharmacy data from the PharMetrics Patient-Centric Database (January 1, 2002–March 31. 2006). Patients 18 years of age or older with a record of MOS were eligible for inclusion. Included patients were stratified based on the presence of a DVT during the first month after hospital discharge. Characteristics of the samples were described. The impact of DVT on total 6–month costs and resource utilization (readmissions, outpatient, emergency department visits) was assessed through statistical models. Results: Of the 32,899 patients in the analysis, 1221 (3.71%) had a record of DVT during the first month following discharge for MOS. Compared with patients who did not develop DVT, patients who developed DVT postdischarge were slightly older (56.5 vs 55.8 y; p = 0.0127), had a higher occurrence of prior VTE (26.2% vs 3.4%; p < 0.0001), and had undergone recent surgical procedures other than MOS (73.0% vs 69.6%; p = 0.0116). After controlling for potential confounders, DVT was associated with a 22% and 74% increase in the average number of expected outpatient and emergency department visits, respectively, during the 6-month postdischarge period but did not significantly impact the number of readmissions. Furthermore, total 6-month costs were significantly higher for patients who developed DVT with an incremental increase of over

Decreased Venous Thromboembolism with Injectable Vs Oral Anticoagulation After Discharge for Major Orthopedic Surgery

2000. Conclusions: The burden of DVT following hospital discharge for MOS is substantial. Specifically, DVT increases total costs and outpatient and emergency department visits.

Postdischarge Oral Versus Injectable Anticoagulation Following Major Orthopedic Surgery

The use of outpatient anticoagulation after major orthopedic surgery with oral or injectable anticoagulants is recommended by national guidelines. A retrospective analysis of medical and pharmacy claims data using the PharMetrics Patient-Centric Database Inc, Watertown, Mass, was conducted. After adjusting for covariates, patients receiving warfarin were approximately 30% more likely to experience a venous thromboembolism than those receiving an injectable anticoagulant (6.3% vs 4.8%; adjusted odds ratio, 1.3; 95% confidence interval, 1.1-1.5) by 30 days. The data at 90 days showed similar results. No significant differences in the incidence of major bleeding events between the cohorts were observed (incidence of major bleed <0.4%). These findings support the randomized controlled studies and expand the data to the real-world perspective. Clinicians should evaluate these data alongside the clinical trial data when selecting the safest and most effective prophylactic therapy for postdischarge anticoagulation.

Comparison of injectable anticoagulants for thromboprophylaxis after cancer-related surgery.

Background Multiple clinical studies have shown postdischarge anticoagulation to bo beneficial following major orthopedic surgery (MOS); however, outpatient prophylaxis is not widely practiced. Objective To quantify, from a third-party payer perspective, real-world clinical and economic outcomes tor patients receiving injectable or oral anticoagulation as prophylaxis for venous thromboembolism (VTE) following discharge after MOS. Methods A retrospective database analysis was conducted using outpatient medical and pharmacy data from the PharMetrics Patient-Centric Database (January 1, 2002, to March 31, 2006). Patients greater than 18 years of age with 9 months of continuous eligibility who received an anticoagulant in the outpatient setting following MOS were eligible. Patients were stratified into 2 cohorts; injectable (dalteparin, enoxaparin, fondaparinux) and oral (warfarin), and were matched 1:1 on demographic and clinical characteristics. Results: A total of 12,724 patients were included (injectable, 6362; oral, 6362). At 90 days, patients receiving oral anticoagulation were 20% more likely to experience a VTE than were those receiving an injectable agent (7.4% vs 6.3%; p = 0.02, OR 1.18; 95% CI 1.03 to 1.36). No significant differences in bleeding were observed (<0.4%). The average adjusted total 6-month costs were significantly (p < 0.001) higher for the oral versus injectable cohort (

The prevalence and burden of systemic lupus erythematosus in a medicare population: retrospective analysis of medicare claims

18,039 vs

Fall-related healthcare use and costs in neurogenic orthostatic hypotension with Parkinson’s disease

16,429). Medical costs in the oral cohort offset the higher pharmacy costs in the injectable cohort. Conclusions: This study demonstrates that the risk of VTE extends to the outpatient setting following MOS, even with postdischarge anticoagulation. Injectable agents used in the outpatient setting may result in fewer clinical VTEs without increasing the risk for major bleeding. These findings support 1he data from controlled clinical studies and expand the evidence to the real-world setting. Despite higher pharmacy acquisition costs for injectable anticoagulants, injectable agents may offer significant per patient savings to third party payers.

Elevated Cardiovascular Disease Risk in Patients With Chronic Myelogenous Leukemia Seen in Community-based Oncology Practices in the United States

PURPOSE The clinical and economic outcomes associated with using injectable anticoagulants for thromboprophylaxis after cancer-related surgery are evaluated. METHODS This retrospective cohort analysis was conducted from an institutional perspective using hospital administrative data and examined patients age 18 years or older who received unfractionated heparin (UFH), enoxaparin, dalteparin, or fondaparinux after undergoing cancer-related surgery. Outcomes assessed included venous thromboembolism (VTE) and major bleeding (MB) rates; VTE-related, MB-related, and all-cause readmission rates; mean length of stay (LOS); and mean total cost of care during hospitalization. RESULTS In the 4068 patients evaluated (1017 per group), VTE rates were similar for fondaparinux compared with the other anticoagulants. The risk of MB was 80% higher for enoxaparin (p = 0.035) and 2.5 times higher for UFH (p = 0.0004) but not significantly higher for dalteparin compared with fondaparinux. The mean LOS was 8% longer for patients taking enoxaparin (p = 0.03) and dalteparin (p = 0.0494) and 21% longer for those treated with UFH (p < 0.0001) compared with fondaparinux. The unadjusted mean ± S.D. total cost of care per patient was lower in the fondaparinux group compared with the enoxaparin and UFH groups but higher compared with dalteparin. CONCLUSION A retrospective evaluation of hospital administrative data for patients who had received thromboprophylaxis after cancer-related surgery revealed a similar risk of VTE with fondaparinux compared with other injectable anticoagulants. Fondaparinux was associated with a lower risk of MB compared with enoxaparin and UFH but did not differ significantly from dalteparin in this regard. A shorter LOS was observed for patients who received fondaparinux compared with dalteparin, enoxaparin, and UFH. The total cost of care for patients who received fondaparinux was lower compared with enoxaparin or UFH but higher compared with dalteparin.

Treatment patterns and outcomes among patients with high-intermediate/high-risk diffuse large B-cell lymphoma in the USA

BackgroundSystemic lupus erythematosus (SLE) is a chronic autoimmune disorder which can affect multiple organs of the body, requiring ongoing disease management and healthcare resource utilization. The economic impact of SLE has not been evaluated in a Medicare population to date. This study was conducted to assess the prevalence of SLE and its burden in terms of healthcare resource utilization and costs in a US Medicare population.MethodsThis was a retrospective observational study using Medicare medical claims data (5% random sample) for the period spanning 2003 to 2007. SLE patients were identified by having ≥2 medical claims with a primary or secondary diagnosis of ICD-9 code 710.0X. The earliest quarter of SLE diagnosis was defined as the index quarter. Prevalence of SLE, the proportion of SLE cases on disability benefits, and the contribution of SLE to new disability cases were evaluated. Healthcare resource utilization and direct medical costs (2008 US dollars) over 12 months were compared between a cohort of patients with SLE and a cohort without SLE matched on key demographics. Differences in outcomes between cohorts were assessed using McNemar’s test for dichotomous variables and paired t-tests for continuous variables.ResultsA total of 13,348 patients with SLE were identified. The prevalence of SLE was approximately 3 per 1000 Medicare beneficiaries. After matching, the sample consisted of 6,707 SLE and 13,414 non-SLE patients. On average, the SLE cohort compared with the non-SLE cohort had 2.4 times more physician visits, 2.7 times more hospitalizations, 2.2 times more outpatient visits, and 2.1 times more emergency room visits. A medical cost surplus of approximately

Clinical and economic outcomes associated with the use of fluticasone propionate 250 mcg and salmeterol 50 mcg combination versus tiotropium bromide 18 mcg as initial maintenance treatment for chronic obstructive pulmonary disease in managed care

10,229 per patient per year in the SLE cohort relative to the non-SLE cohort was driven largely by inpatient hospitalization costs (p < 0.001).ConclusionsSLE prevalence was 3 per 1,000 Medicare patients. Patients with SLE consumed significantly more health care resources with significantly greater costs compared with those without SLE. Added costs were largely attributable to inpatient hospitalizations. The Medicare population is an important target for efforts to improve SLE disease management and reduce costs.

Venous thromboembolism after orthopedic surgery: Implications of the choice for prophylaxis

Abstract Aims: To compare patient characteristics, rates, and costs of medically attended falls among patients with Parkinson’s disease (PD) and probable PD plus neurogenic orthostatic hypotension (PD + nOH). Materials and methods: MarketScan Commercial and Medicare Supplemental databases (January 1, 2009–December 31, 2013) were used to identify PD and probable PD + nOH patients. The first medical or prescription claim suggesting these diagnoses served as the index date. Baseline characteristics and post-index all-cause and fall-related healthcare utilization and costs were compared between patient groups. Results: A total of 17,421 PD and 281 PD + nOH patients were identified. Compared with PD patients, PD + nOH patients were older (77 vs 74 years; p < .0001) and had more comorbidities. Pre- and post-index date, more PD + nOH patients had a medically attended fall than PD patients (25% vs 20% [p = .0159] and 30% vs 21% [p = 0.0002], respectively). Fallers in both groups had similar numbers of medically attended falls 12-months pre-index (mean =1.9), but PD + nOH fallers had more falls post-index (2.5 vs 2.0; p = .0176). Compared with PD patients, more PD + nOH patients (all p < .01) had fall-related emergency department (ED) visits (18% vs 10%), hospitalizations (7% vs 3%), and non-office visit outpatient services (15% vs 10%). Adjusted total post-index medical costs for falls (