Eskinder Tafesse

The Impact of Chronic Hepatitis B on Quality of Life: A Multinational Study of Utilities from Infected and Uninfected Persons

OBJECTIVES Chronic hepatitis B (CHB) is a condition that results in substantial morbidity and mortality worldwide because of progressive liver damage. Investigators undertaking economic evaluations of new therapeutic agents require estimates of health-related quality of life (HRQOL). Recently, evidence has begun to accumulate that differences in cultural backgrounds have a quantifiable impact on perceptions of health. The objective was to elicit utilities for six health states that occur after infection with the hepatitis B virus from infected and uninfected respondents living in jurisdictions with low and with high CHB endemicity. METHODS Standard gamble utilities were elicited from hepatitis patients and uninfected respondents using an interviewer-administered survey in the United States, Canada, United Kingdom, Spain, Hong Kong, and mainland China. Generalized linear models were used to the effect on utilities of current health, age and sex, jurisdiction and, for infected respondents, current disease state. RESULTS The sample included 534 CHB-infected patients and 600 uninfected respondents. CHB and compensated cirrhosis had a moderate impact on HRQOL with utilities ranging from 0.68 to 0.80. Decompensated cirrhosis and hepatocellular carcinoma had a stronger impact with utilities ranging from 0.35 to 0.41. Significant variation was observed between countries, with both types of respondents in mainland China and Hong Kong reporting systematically lower utilities. CONCLUSIONS Health states related to CHB infection have substantial reductions in HRQOL and the utilities reported in this study provide valuable information for comparing new treatment options. The observed intercountry differences suggest that economic evaluations may benefit from country-specific utility estimates. The extent that systematic intercountry differences in utilities hold true for other infectious and chronic diseases remains an open question and has considerable implications for the proper conduct and interpretation of economic evaluations.

Weight gain and new onset diabetes associated with olanzapine and risperidone

OBJECTIVE: To assess whether newer antipsychotic medications are associated with weight gain and development of diabetes.DESIGN: Retrospective cohort study.SETTING: Data from a comprehensive electronic medical record serving an urban public hospital and a citywide network of mental health clinics.PATIENTS/PARTICIPANTS: Three thousand one hundred fifteen patients at least 18 years old who were prescribed a single antipsychotic drug for at least 1 year.METHODS: We identified independent predictors of significant weight gain (≥7%) and new onset of diabetes mellitus in the first year of antipsychotic drug treatment, using logistic regression adjusted for demographic characteristics, obesity, preexisting psychiatric diagnoses, alcohol and drug abuse, number of primary care, psychiatric clinic, and emergency department visits, and pretreatment weight.MEASUREMENTS AND MAIN RESULTS: Twenty-five percent of patients taking older phenothiazines developed significant weight gain in the first year of treatment compared to 40% of the patients taking olanzapine (adjusted odds ratio [OR], 2.8; 95% confidence interval [CI], 1.7 to 4.6; P<.0001) and 37% of patients taking risperidone (adjusted OR, 2.3; 95% CI, 1.5 to 3.4; P<.0001). New diabetes developed in 3% of patients taking older phenothiazines was new onset diabetes compared to 8.0% of patients taking olanzapine (adjusted OR, 1.9; 95% CI, 1.1 to 3.3; P=.03) and 3.5% of patients taking risperidone (adjusted OR, 0.7; 95% CI, 0.4 to 1.4; P=.3). No association was found between significant weight gain and developing diabetes (adjusted OR, 0.7; 95% CI, 0.4 to 1.4; P=.4).CONCLUSIONS: Olanzapine and risperidone use was associated with gaining weight in the first year, but only olanzapine was associated with developing diabetes mellitus.

Cost Effectiveness of Entecavir versus Lamivudine with Adefovir Salvage in HBeAg-Positive Chronic Hepatitis B

Objective: To evaluate the cost effectiveness of treatment of hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) with entecavir compared with lamivudine with adefovir salvage, based primarily on the results of a recent 2-year, randomised, multicentre, clinical trial (n = 709). Previous economic analyses have been limited by the lack of comparative clinical data for entecavir and lamivudine beyond 1-year duration and for salvage therapy.Methods: We conducted a cost-utility analysis using a Markov model from a USpayer perspective over a lifetime time horizon. The hypothetical cohort was 35-year-old patients with HBeAg-positive CHB. We evaluated 2 years of treatment with entecavir 0.5mg/day versus lamivudine 100mg/day, plus addition of adefovir 10mg/day for patients who developed virologic breakthrough due to resistance to either drug. In a scenario analysis, we considered adefovir plus lamivudine combination therapy for treatment-naive patients. Clinical and economic inputs (

Systems Factors in the Reporting of Serious Medication Errors in Hospitals

US, year 2006 values) were derived from publicly available data, and probabilistic sensitivity analyses were conducted to evaluate uncertainty in the results.Results: The estimated 10-year cumulative incidence of cirrhosis for patients initiated on entecavir was 2.3% lower than for those on lamivudine (20.5% vs 22.8%). The discounted incremental cost per QALY gained was

Association between antipsychotic treatment and hyperlipidemia among California Medicaid patients with schizophrenia.

US7600 in the base-case analysis, and the 95% central range from probabilistic sensitivity analysis was

Male sexual dysfunction and quality of life in schizophrenia.

US2500–

Antipsychotic exposure and type 2 diabetes among patients with schizophrenia: a matched case-control study of California Medicaid claims.

US19 100. Combination therapy for treatment-naive patients led to an increase in costs without improvement in patient outcomes compared with entecavir monotherapy.Conclusions: Our analysis suggests entecavir improves health outcomes in a cost-effective manner compared with lamivudine with adefovir salvage or combination therapy, and highlights the importance of using evidence-based effectiveness estimates in economic studies of CHB therapies.

PIN15 IMPACT ON QUALITY OF LIFE OF HEALTH STATES INDUCED BY CHRONIC HEPATITIS B INFECTION: ESTIMATES FROM UNINFECTEDAND INFECTED PERSONS IN THE UK

Underreporting of medication errors poses a threat to quality improvement initiatives. Hospital risk management programs encourage medication error reporting for effective management of systems failures. This study involved a survey of 156 medical-surgical hospitals in the United States to evaluate systems factors associated with the reporting of serious medication errors. Prior to controlling for bed size, a multivariate logistic regression model showed increased reporting of medication errors in hospitals with 24-h pharmacy services, presumably because of better error reporting systems. When number of occupied beds was included, the final model demonstrated bed size to be the only statistically significant factor. Increased reporting rates for serious medication errors warrant further evaluation, but higher error reporting may paradoxically indicate improved error surveillance. Results suggest that increased availability of pharmacist services results in opportunities for more diligent systematic efforts in detecting and reporting medication errors, which should lead to improved patient safety.

The Reliability and Validity of the Impact on Lifestyle Questionnaire in Patients with Acromegaly

Objective: To examine the risk of hyperlipidemia among people with schizophrenia exposed to new antipsychotics (clozapine, olanzapine, quetiapine, risperidone) compared with those exposed to older generation antipsychotics. Methods: A case-control study of Medi-Cal claims. Cases developed hyperlipidemia after being diagnosed with schizophrenia (ICD-9: 295) and were exposed to only one antipsychotic drug at some point within 12 weeks prior to the hyperlipidemia diagnosis. Hyperlipidemia was defined by diagnostic claim (ICD-9: 272.1-272.4) or prescription claim for antilipemic agents. Cases were matched on gender and age ± 3 years to patients with schizophrenia who did not develop hyperlipidemia. Conditional logistic regression assessed the risk of antipsychotic exposure, controlling for age, ethnicity, prior type 2 diabetes or hypothyroidism, and exposure to other medications that may cause hyperlipidemia. Analyses were repeated using a 24- and 52-week retrospective exposure windows. Results: For the 12-week exposure window, olanzapine (OR = 1.20, 95% CI 1.08-1.33) was associated with increased risk of developing hyperlipidemia compared with older antipsychotic medications. Exposure to clozapine (OR = 1.16, 95% CI 0.99-1.37), risperidone (OR = 1.00, 95% CI 0.90-1.12), and quetiapine (OR = 1.01, 95% CI 0.78-1.32) was not. Hypothesis tests comparing the 4 atypicals to one another revealed that the odds ratio for olanzapine was greater than that for risperidone (P = 0.002). Other than clozapines odds ratio being significant at 24 weeks (OR = 1.22, 95% CI 1.03-1.45), increasing the exposure window to 24 or 52 weeks did not substantially alter the results. Conclusions: Compared with older generation antipsychotics, exposure to olanzapine and, somewhat less consistently, to clozapine is associated with an increased risk of hyperlipidemia among people with schizophrenia.