I.M. Breunig

Delivering cost–effective care for COPD in the USA: recent progress and current challenges

Chronic obstructive pulmonary disease (COPD) imposes a significant and growing economic burden on the US health care system. A brief exploration of reviews on the therapeutic management of COPD reveals a range of pharmacologic and nonpharmacologic options for reducing deleterious and costly exacerbations. Consensus is that both forms of therapy provide the greatest benefit to all patients. However, prescribing physicians must account for availability of resources and patients’ ability to pay, as well as patient response and their likely persistence or adherence to recommended therapies. The ongoing challenge is to overcome barriers to comprehensive, real-world economic evaluations in order to establish the most cost-effective mix of therapies for every patient in the heterogeneous COPD population. Only then can evidence-based guidelines be translated into the most cost-effective delivery of care.

Maternal exposure to hurricane destruction and fetal mortality

Background The majority of research documenting the public health impacts of natural disasters focuses on the well-being of adults and their living children. Negative effects may also occur in the unborn, exposed to disaster stressors when critical organ systems are developing and when the consequences of exposure are large. Methods We exploit spatial and temporal variation in hurricane behaviour as a quasi-experimental design to assess whether fetal death is dose-responsive in the extent of hurricane damage. Data on births and fetal deaths are merged with Parish-level housing wreckage data. Fetal outcomes are regressed on housing wreckage adjusting for the maternal, fetal, placental and other risk factors. The average causal effect of maternal exposure to hurricane destruction is captured by difference-in-differences analyses. Results The adjusted odds of fetal death are 1.40 (1.07–1.83) and 2.37 (1.684–3.327) times higher in parishes suffering 10–50% and >50% wreckage to housing stock, respectively. For every 1% increase in the destruction of housing stock, we observe a 1.7% (1.1–2.4%) increase in fetal death. Of the 410 officially recorded fetal deaths in these parishes, between 117 and 205 may be attributable to hurricane destruction and postdisaster disorder. The estimated fetal death toll is 17.4–30.6% of the human death toll. Conclusions The destruction caused by Hurricanes Katrina and Rita imposed significant measurable losses in terms of fetal death. Postdisaster migratory dynamics suggest that the reported effects of maternal exposure to hurricane destruction on fetal death may be conservative.

Transarterial Chemoembolization Treatment: Association between Multiple Treatments, Cumulative Expenditures, and Survival

OBJECTIVES To examine cumulative survival and Medicaid-paid expenses associated with multiple courses of transarterial chemoembolization (TACE) as primary treatment for hepatocellular carcinoma (HCC). METHODS Medicare enrollees diagnosed with primary HCC from 2000 to 2007, ever treated with TACE, but not transplant/resection, followed through 2009 by using the Surveillance, Epidemiology and End-Results Program and linked Medicare databases. Cumulative all-cause/HCC-related survival was estimated by using multivariate Cox proportional hazards models stratified by the total number of TACE treatments. Multivariate weighted Cox regressions estimated the average risk of mortality faced with nonproportional hazards. Lins inverse probability-weighted least squares regression method estimated cumulative Medicare expenditures adjusted for censoring and covariates. RESULTS Of 1228 patients, 34% were stage 1, 16% stage 2, 19% stage 3, 6% stage 4, and 26% unstaged. About 44% were aged 65 to 75 years, 69% were men, and 72% were Caucasian. Over half (57%) of the patients received one course, 24% two, 11% three, and 8% four courses of TACE. One-course patients incurred an average

Clinical value of tapentadol extended-release in painful diabetic peripheral neuropathy

74,788 (95% confidence interval [CI]

Maternal exposure to neighborhood soil Pb and eclampsia risk in new Orleans, Louisiana (USA): Evidence from a natural experiment in flooding

71,890-

A Quasi-Experimental Analysis of Maternal Altitude Exposure and Infant Birth Weight

77,686), two-course patients

The use of age-period-cohort analysis to determine the impact of economic development on COPD mortality in Hong Kong.

101,126 (95% CI

Incident depression increases medical utilization in Medicaid patients with hypertension.

94,395-

In response: Incident depression increases medical utilization in Medicaid patients with hypertension

107,856), three-course patients

Comparative and cost effectiveness of treatment modalities for hepatocellular carcinoma in SEER-Medicare.

111,776 (95% CI