Kathleen Foley

Relationship Between Potential Opioid-Related Adverse Effects and Hospital Length of Stay in Patients Receiving Opioids After Orthopedic Surgery

To determine whether there is an association between opioid‐related adverse effects and postoperative hospital length of stay (p‐LOS).

Direct healthcare costs of hip, vertebral, and non-hip, non-vertebral fractures☆

Limited data exist regarding the cost of non-hip, non-vertebral (NHNV) fractures. Although NHNV fractures may be less expensive than hip and vertebral fractures, they have a higher incidence rate. The objective of this study was to quantify first-year healthcare costs of hip, vertebral, and NHNV fractures. This was a claims-based retrospective analysis using a case-control design among patients with commercial insurance and Medicare employer-based supplemental coverage. Patients were > or =50 years old with a closed hip, vertebral, or NHNV fracture between 7/1/2001 and 12/31/2004, and continuous enrollment 6 months prior to and 12 months after the index fracture. Adjusted mean first-year healthcare costs associated with these fractures were determined. Six cohorts were identified. Patients 50-64 years: NHNV (n=27,424), vertebral (n=3386) and hip (n=2423); patients > or =65 years: NHNV (n=40,960), vertebral (n=11,751) and hip (n=21,504). The ratio of NHNV to hip fractures was 11:1 in the 50-64 cohort and 2:1 in the > or =65 cohort. Adjusted mean first-year costs associated with hip, vertebral, and NHNV fractures were

Physician Beliefs and Practices for Adjuvant and Salvage Radiation Therapy After Prostatectomy

26,545,

Association of insomnia severity and comorbid medical and psychiatric disorders in a health plan-based sample: Insomnia severity and comorbidities

14,977, and

Clinical and economic impact of infusion reactions in patients with colorectal cancer treated with cetuximab

9183 for the 50-64 age cohort, and

Associations of nonrestorative sleep with insomnia, depression, and daytime function.

15,196,

Subtypes of sleep disturbance: associations among symptoms, comorbidities, treatment, and medical costs.

6701, and

Comparative effectiveness research for prostate cancer radiation therapy: current status and future directions

6106 for patients > or =65 years. After taking prevalence rate into account, the proportion of the total fracture costs accounted for by NHNV, hip, and vertebral fractures were 66%, 21% and 13% for the 50-64 age cohort, and 36%, 52% and 12% for the > or =65 age cohort. Limitations included the exclusion of the uninsured and those covered by Medicaid or military-based insurance programs. The results of this study demonstrate that osteoporotic fractures are associated with significant costs. Although NHNV fractures have a lower per-patient cost than hip or vertebral fractures, their total first-year cost is greater for those 50-64 because of their higher prevalence.

Costs of early adjuvant radiation therapy after radical prostatectomy: a decision analysis

PURPOSEnDespite results of randomized trials that support adjuvant radiation therapy (RT) after radical prostatectomy (RP) for prostate cancer with adverse pathologic features (APF), many clinicians favor selective use of salvage RT. This survey was conducted to evaluate the beliefs and practices of radiation oncologists (RO) and urologists (U) regarding RT after RP.nnnMETHODS AND MATERIALSnWe designed a Web-based survey of post-RP RT beliefs and policies. Survey invitations were e-mailed to a list of 926 RO and 591 U. APF were defined as extracapsular extension, seminal vesicle invasion, or positive surgical margin. Differences between U and RO in adjuvant RT recommendations were evaluated by comparative statistics. Multivariate analyses were performed to evaluate factors predictive of adjuvant RT recommendation.nnnRESULTSnAnalyzable surveys were completed by 218 RO and 92 U (overallresponse rate, 20%). Adjuvant RT was recommended based on APF by 68% of respondents (78% RO, 44% U, p <0.001). U were less likely than RO to agree that adjuvant RT improves survival and/or biochemical control (p < 0.0001). PSA thresholds for salvage RT were higher among U than RO (p < 0.001). Predicted rates of erectile dysfunction due to RT were higher among U than RO (p <0.001). On multivariate analysis, respondent specialty was the only predictor of adjuvant RT recommendations.nnnCONCLUSIONSnU are less likely than RO to recommend adjuvant RT. Future research efforts should focus on defining the toxicities of post-RP RT and on identifying the subgroups of patients who will benefit from adjuvant vs. selective salvage RT.

Healthcare resource utilization and expenditures of women diagnosed with hypoactive sexual desire disorder

BACKGROUNDnInsomnia is commonly associated with one or more comorbid illnesses. Data on the relationship between insomnia severity and comorbid disorders are still limited, especially with regard to the use of well-validated measures of insomnia severity.nnnMETHODSnA total of 2086 health plan enrollees, over-sampling for those with insomnia based on health claims, completed a telephone survey between April and June of 2006. Participants were categorized using four insomnia severity categories and compared on their administrative health claims psychiatric and medical comorbidities.nnnRESULTSnControlling for age and gender, the odds ratio for having at least one psychiatric diagnosis was 5.04 (CI=3.24-7.84) for severe insomnia, 2.63 (CI=1.97-3.51) for moderate insomnia, and 1.7 (CI=1.30-2.23) for subthreshold insomnia compared with those with no insomnia. Similarly, the odds ratio for having treatment for at least one chronic disease was 2.83 (CI=1.84-4.35) for severe insomnia, 2.34 (CI=1.83-2.99) for moderate insomnia, and 1.55 (CI=1.25-1.92) for subthreshold insomnia compared with the no insomnia group.nnnCONCLUSIONSnIncreasing insomnia severity is associated with increased chronic medical and psychiatric illnesses. Further research is needed to better understand associations between insomnia severity and individual psychiatric and chronic medical comorbidities.