Jason Dean

Impact of omalizumab on emergency-department visits, hospitalizations, and corticosteroid use among patients with uncontrolled asthma

BACKGROUND Omalizumab is a monoclonal antibody indicated for moderate to severe allergic asthma patients with inadequately controlled symptoms. OBJECTIVE To evaluate the impact of omalizumab on emergency department (ED) visits, hospitalizations, and corticosteroid use among patients with uncontrolled asthma using high-dose inhaled corticosteroids (ICS) and long-acting beta2-agonists (LABA). METHODS Health insurance claims from the MarketScan database (2002Q1-2009Q1) were analyzed. Patients with 12 months or more of continuous insurance coverage before and after the first omalizumab dispensing, 8 or more weeks of high-dose ICS use, 8 or more weeks of LABA use, and uncontrolled asthma at baseline were included. A retrospective analysis was conducted to quantify the impact of omalizumab on resource use by comparing ED visits, hospitalizations, and corticosteroid use 1 year before and after omalizumab initiation. A 1-year period was chosen to cover any potential seasonality impacts. RESULTS In total, 644 patients (mean age, 49.9; female, 59.2%) formed the study population. Omalizumab was associated with a 48.6% reduction in the proportion of patients with 1 or more asthma-related ED visits (pre vs post-omalizumab period: 21.4% vs 11.0%; P < .001) and a 40.8% reduction in asthma-related hospitalizations (25.0% vs 14.8%, respectively, P < .001). Compared with the pre-omalizumab period, the use of ICS decreased significantly after omalizumab initiation (7.8 vs 6.5 dispensings, P < .001; 41.9% of patients had a reduction in ICS use). A similar reduction in oral corticosteroid use was observed (5.0 vs 3.6 dispensings, P < .001; 53.3% of patients had a reduction in oral corticosteroid use). CONCLUSION The current analysis showed that omalizumab treatment initiation was associated with significant reductions in ED visits, hospitalizations, and corticosteroid use.

Systematic review of long-acting injectables versus oral atypical antipsychotics on hospitalization in schizophrenia

Abstract Objective: To assess the impact of long-acting injectables (LAIs) versus oral antipsychotics (OAs) on hospitalizations among patients with schizophrenia by conducting a systematic literature review of studies with different study designs and performing a meta-analysis. Methods: Using the PubMed database and major psychiatric conference proceedings, a systematic literature review for January 2000 to July 2013 was performed to identify English-language studies evaluating schizophrenia patients treated with atypical antipsychotics. Studies reporting hospitalization rates as a percentage of patients hospitalized or as the number of hospitalizations per person per year were selected. The primary meta-analysis assessed the percentage decrease in hospitalization rates before and after treatment initiation for matched time periods. The secondary meta-analysis assessed the absolute rate of hospitalization during follow-up. Pooled treatment-effect estimates were calculated using random-effects models. To account for differences in patient and study-level characteristics between studies, meta-regression analyses were used. Subset analyses further explored the heterogeneity across study designs. Results: Fifty-eight studies evaluating 25 arms (LAIs: 13 arms, 4516 patients; OAs: 12 arms, 23,516 patients) in the primary meta-analysis and 78 arms (LAIs: 12 arms, 4481 patients; OAs: 66 arms, 96,230 patients) in the secondary meta-analysis were identified. Reduction in hospitalization rates for LAIs was 20.7 percentage points higher than that of OAs (random-effects estimates: LAIs = 56.2% vs. OAs = 35.5%, P = 0.023). Controlling for patient and study characteristics, the adjusted percentage reduction in hospitalization rates for LAIs was 26.4 percentage points higher than for OAs (95% CI: 3.3–49.5, P = 0.027). As for the secondary meta-analysis, no significant difference between LAIs and OAs was observed (random-effects estimate: −8.6, 95% CI: −18.1–1.0, P = 0.077). Subset analyses across type of study yielded consistent results. Limitations of this analysis include the long observation period, which may not reflect current treatment patterns, the use of all-cause hospitalization, which may not be solely related to schizophrenia, and the fact that most studies in the LAI cohort evaluated risperidone. Conclusion: The primary results of this meta-analysis, including studies with both interventional and non-interventional designs and using meta-regressions, suggest that LAIs are associated with higher reductions in hospitalization rates for schizophrenia patients compared to OAs.

Burden of schizophrenia on selected comorbidity costs

Patients suffering from schizophrenia tend to have high rates of medical comorbidities and mortality.This study evaluated the healthcare costs of patients with schizophrenia and specific comorbidities relative to patients without schizophrenia with the same comorbidities, using Medicaid insurance claims databases from five states (from 2001–2010). The most common comorbidities were hypertension (48.8%), substance abuse (39.1%) and diabetes (28.4%). Patients with schizophrenia incurred greater all-cause monthly healthcare costs (cost difference [95% CI]: US

Religiosity and female labour market attainment in Canada: the Protestant exception

978 [933; 1024]) and comorbidity-related costs (cost difference [95% CI]: US

The Main Culprit behind Immigrant Wage Gaps in Canada: Lower Returns to Foreign Schooling or Work Experience?

288 [269; 307]). Schizophrenia was also associated with significantly higher comorbidity-related costs in each comorbidity subgroup (among the three most common comorbidities: 99% higher in hypertension, 293% in substance abuse, and 105% in diabetes). The results suggest that patients with schizophrenia and comorbidities common in patients with schizophrenia had higher all-cause and comorbidity-related healthcare costs compared with patients without schizophrenia with the same comorbidities.

Economic Integration of Pre-WWI Immigrants from the British Isles in the Canadian Labour Market

Purpose - – The relationship between religiosity and female labour market attainment has been widely investigated for the USA; however, no comparable study has been undertaken for the Canadian context. The purpose of this paper is to redress this critical oversight of the literature by examining the impact of religiosity on Canadian female labour supply, both at extensive and intensive margins. Design/methodology/approach - – Using data from the Canadian Ethnic Diversity Survey, the authors consider all the measurable dimensions of religiosity, for the pooled sample, as well as by religious group. A wide array of control variables is included in the regressions to insure the reliability of the estimates. Findings - – The authors find that overall religiosity inversely relates to female labour supply in Canada. When the impact of religiosity is assessed on a by religion basis, it is revealed that Protestant females are penalized, by far the most. Practical implications - – The result is comparable with the pattern uncovered in the USA for Conservative Protestant females. Unlike what can be expected, no statistically significant difference is detected between religious-nones and Catholics, suggesting a convergence of gender ideologies. Originality/value - – The investigation reveals interesting patterns that not only contribute to the current state of literature, but also motivate future research. Fairlie and Oaxaca-Blinder decomposition techniques are also used to further explore attainment gaps among the religious groups.

Labor Market Attainment of Canadian Jews During the First Two Decades of the 20th Century

Using the Survey of Labour and Income Dynamics (SLID) I examine how immigrants’ foreign human capital is rewarded in the labour market. I exploit the enhanced details on education attainment, provided in the SLID, to decompose human capital variables into foreign and Canadian measures that are more precise than those used in related Census-based studies. I find that measurement error associated with using imprecise measures exaggerate the portability of foreign schooling and the degree of immigrant wage assimilation. However, the virtually zero returns to foreign work experience, commonly found in the literature, cannot be attributed to measurement error and is mainly responsible for estimated wage gaps in the standard human-capital-adjusted earnings function.