Eman Biltaji

The effect of pharmacogenetic profiling with a clinical decision support tool on healthcare resource utilization and estimated costs in the elderly exposed to polypharmacy

Abstract Objective: To compare healthcare resource utilization (HRU) and clinical decision-making for elderly patients based on cytochrome P450 (CYP) pharmacogenetic testing and the use of a comprehensive medication management clinical decision support tool (CDST), to a cohort of similar non-tested patients. Methods: An observational study compared a prospective cohort of patients ≥65 years subjected to pharmacogenetic testing to a propensity score (PS) matched historical cohort of untested patients in a claims database. Patients had a prescribed medication or dose change of at least one of 61 oral drugs or combinations of ≥3 drugs at enrollment. Four-month HRU outcomes examined included hospitalizations, emergency department (ED) and outpatient visits and provider acceptance of test recommendations. Costs were estimated using national data sources. Results: There were 205 tested patients PS matched to 820 untested patients. Hospitalization rate was 9.8% in the tested group vs 16.1% in the untested group (RR = 0.61, 95% CI = 0.39–0.95, p = 0.027), ED visit rate was 4.4% in the tested group vs 15.4% in the untested group (RR = 0.29, 95% CI = 0.15–0.55, p = 0.0002) and outpatient visit rate was 71.7% in the tested group vs 36.5% in the untested group (RR = 1.97, 95% CI = 1.74–2.23, p < 0.0001). The rate of overall HRU was 72.2% in the tested group vs 49.0% in the untested group (RR = 1.47, 95% CI = 1.32–1.64, p < 0.0001). Potential cost savings were estimated at

Cost-effectiveness analysis of fecal microbiota transplantation for recurrent Clostridium difficile infection.

218 (mean) in the tested group. The provider majority (95%) considered the test helpful and 46% followed CDST provided recommendations. Conclusion: Patients CYP DNA tested and treated according to the personalized prescribing system had a significant decrease in hospitalizations and emergency department visits, resulting in potential cost savings. Providers had a high satisfaction rate with the clinical utility of the system and followed recommendations when appropriate.

Real-World Evidence in Pain Research: A Review of Data Sources

OBJECTIVE Clostridium difficile infection (CDI) places a high burden on the US healthcare system. Recurrent CDI (RCDI) occurs frequently. Recently proposed guidelines from the American College of Gastroenterology (ACG) and the American Gastroenterology Association (AGA) include fecal microbiota transplantation (FMT) as a therapeutic option for RCDI. The purpose of this study was to estimate the cost-effectiveness of FMT compared with vancomycin for the treatment of RCDI in adults, specifically following guidelines proposed by the ACG and AGA. DESIGN We constructed a decision-analytic computer simulation using inputs from the published literature to compare the standard approach using tapered vancomycin to FMT for RCDI from the third-party payer perspective. Our effectiveness measure was quality-adjusted life years (QALYs). Because simulated patients were followed for 90 days, discounting was not necessary. One-way and probabilistic sensitivity analyses were performed. RESULTS Base-case analysis showed that FMT was less costly (

Can ad hoc analyses of clinical trials help personalize treatment decisions

1,669 vs

The clinical utility of pharmacometric models

3,788) and more effective (0.242 QALYs vs 0.235 QALYs) than vancomycin for RCDI. One-way sensitivity analyses showed that FMT was the dominant strategy (both less expensive and more effective) if cure rates for FMT and vancomycin were ≥70% and <91%, respectively, and if the cost of FMT was <

Outcomes associated with pharmacist‐led diabetes collaborative drug therapy management in a medicaid population

3,206. Probabilistic sensitivity analysis, varying all parameters simultaneously, showed that FMT was the dominant strategy over 10, 000 second-order Monte Carlo simulations. CONCLUSIONS Our results suggest that FMT may be a cost-saving intervention in managing RCDI. Implementation of FMT for RCDI may help decrease the economic burden to the healthcare system.

Using Electronic Medical Records to Assess the Effectiveness of Pharmacotherapy in Pain: A Review of Recent Observational Studies.

ABSTRACT Outcomes research studies use clinical and administrative data generated in the course of patient care or from patient surveys to examine the effectiveness of treatments. Health care providers need to understand the limitations and strengths of the real-world data sources used in outcomes studies to meaningfully use the results. This paper describes five types of databases commonly used in the United States for outcomes research studies, discusses their strengths and limitations, and provides examples of each within the context of pain treatment. The databases specifically discussed are generated from (1) electronic medical records, which are created from patient-provider interactions; (2) administrative claims, which are generated from providers’ and patients’ transactions with payers; (3) integrated health systems, which are generated by systems that provide both clinical care and insurance benefits and typically represent a combination of electronic medical record and claims data; (4) national surveys, which provide patient-reported responses about their health and behaviors; and (5) patient registries, which are developed to track patients with a given disease or exposure over time for specified purposes, such as population management, safety monitoring, or research.

Cost-effectiveness analysis of treatment strategies for initial Clostridium difficile infection

Division of Clinical Pharmacology, Department of Paediatrics, University of Utah, School of Medicine, Salt Lake City, Utah, USA, Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA, Program in Personalized Health, University of Utah, Salt Lake City, Utah, USA, and Department of Pathology, University of Utah, School of Medicine, Salt Lake City, Utah, USA

Value Assessment for Genetic Testing of Drug Variation In An Elderly Population

Division of Clinical Pharmacology, Department of Pediatrics, University of Utah, School of Medicine, Salt Lake City, UT, USA, Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA, and Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, Computational and Data Enabled Science and Engineering Program, State University of New York, Buffalo, NY, USA

Cost-effectiveness analysis of treatment strategies for initial clostridium difficile infection

Pharmacist‐led diabetes collaborative drug therapy management (CDTM) has been shown to improve outcomes. Whether such programmes are effective specifically in Medicaid patients, who face barriers to access and self‐management, has not been well characterized. This pilot study explores glycaemic control, utilization and costs associated with pharmacist‐led CDTM in a small population of Medicaid patients with type 2 diabetes mellitus (T2DM).