Jennifer H. Lofland

Adjusting for comorbidities in cost of illness studies

Abstract Motivation: Differences in cost of illness (COI) methodological approaches have led to disparate results. This analysis examines two sources of this variation: specification of comorbidities in the estimated cost models and assumed prevalence rates used for generating aggregate costs. The study provides guidance in determining which comorbidities are important to include and how to handle uncertainty in optimal model specification and prevalence rate assumptions. Methods: Comorbidities are categorized into four types. Type I comorbidities are those that increase the risk of the disease of interest; Type II comorbidities have no causal link to the disease of interest but are, nonetheless, highly correlated with that disease; Type III comorbidities are illnesses that the disease of interest may cause, and Type IV are comorbidities that have no causal link to the disease of interest and are only weakly correlated with that disease. Two-part models are used to estimate the direct costs of rheumatoid arthritis and diabetes mellitus using 2000–2007 Medical Expenditure Panel Survey data. Results: COI estimates are sensitive to the specification of comorbidities. The odds of incurring any expenses varies by 71% for diabetes mellitus and by 27% for rheumatoid arthritis, while conditional expenditures (e.g., expenditures among subjects incurring at least some expenditures) vary by 62% and 45%, respectively. Uncertainty in prevalence rates cause costs to vary. A sensitivity analysis estimated the COI for diabetes ranges from

Variations in care: a retrospective database analysis of healthcare utilization patterns for patients with inflammatory bowel disease

131.7–

Cost-per-remission analysis of infliximab compared to adalimumab among adults with moderate-to-severe ulcerative colitis

172.0 billion, while rheumatoid arthritis varies from

Patient experience with intravenous biologic therapies for ankylosing spondylitis, Crohn’s disease, psoriatic arthritis, psoriasis, rheumatoid arthritis, and ulcerative colitis

12.8–

Prescribing Patterns of Intravenous Golimumab for Rheumatoid Arthritis

26.2 billion. Conclusions: The decision to include Type II and Type III comorbidities is crucial in COI studies. Alternative models should be included with and without the Type III comorbidities to gauge the range of cost effects of the disease. In generating costs, alternative values for prevalence rates should be used and a sensitivity analysis should be performed.

Dermatologist–Patient In-Office Discussions of Psoriasis: Focus on Quality of Life

Abstract Background: Biologic therapy has been shown to be effective in achieving and maintaining remission in the treatment of inflammatory bowel disease (IBD). However, their impact on healthcare resource utilization is not well understood. This study explored the impact of biologic use on IBD-related hospital admissions and emergency room visits and healthcare expenditures. Methods: This study used a retrospective cohort design to analyze data from the MarketScan Commercial and Medicare databases (Truven Health Analytics Inc.) for the years 2006–2010. Patients were identified using ICD-9 diagnosis codes for IBD and age 18 or older at time of initial diagnosis. Linear models were used to predict the probability of an IBD-related hospitalization or ER visit and healthcare expenditures with binary variables indicating use of biologics in the current year and in the previous 2 years, as well as patient- and area-level control variables. Results: Patients using biologics in the current year were 14.1–17.6% more likely to be hospitalized for IBD. However, biologic use in the previous year was associated with a 3.8–5.6% reduction in hospitalizations, and biologic use 2 years prior was associated with a 1–2.8% reduction in hospitalizations in the current year. Similar results are found for ER visits. All indicators for biologic use were associated with increased expenditures. Conclusions: There was a negative association between lagged use of biologics and the proportion of patients with IBD-related hospitalizations and ER visits. This finding may suggest that increased use of biologics over time is associated with a decrease in IBD-related healthcare utilization.

Direct Health Care Insurer and Out-of-Pocket Expenditures of Inflammatory Bowel Disease: Evidence from a US National Survey

Abstract Objective: To compare cost per remission (CPR) of infliximab (IFX) versus adalimumab (ADA) for the treatment of moderately-to-severely active UC. Methods: This is CPR model comparing IFX and ADA in the treatment of UC using clinical trial data. Clinical outcome measures include clinical remission and sustained clinical remission (SCR). Economic endpoints were modeled as medication costs. CPR ratios and number needed to treat (NNT) costs were computed at 8, 52, and 54 weeks. Results: CPR for bio-naïve patients for IFX and ADA at weeks 8, 52, and 54 was

The direct healthcare insurer and out-of-pocket expenditures of psoriasis: evidence from a United States national survey

42,086 vs.

Novel Statistical Approach to Determine Inflammatory Bowel Disease: Patients’ Perspectives on Shared Decision Making

79,558:

Gastroenterologists' Views of Shared Decision Making for Patients with Inflammatory Bowel Disease.

147,379 vs.