Keiko Higuchi

Economic Burden of COPD in the Presence of Comorbidities

BACKGROUND: The morbidity and mortality associated with COPD exacts a considerable economic burden. Comorbidities in COPD are associated with poor health outcomes and increased costs. Our objective was to assess the impact of comorbidities on COPD-associated costs in a large administrative claims dataset. METHODS: This was a retrospective observational study of data from the Truven Health MarketScan Commercial Claims and Encounters and the MarketScan Medicare Supplemental Databases from January 1, 2009, to September 30, 2012. Resource consumption was measured from the index date (date of first occurrence of non-rule-out COPD diagnosis) to 360 days after the index date. Resource use (all-cause and disease-specific [ie, COPD- or asthma-related] ED visits, hospitalizations, office visits, other outpatient visits, and total length of hospital stay) and health-care costs (all-cause and disease-specific costs for ED visits, hospitalizations, office visits, and other outpatient visits and medical, prescription, and total health-care costs) were assessed. Generalized linear models were used to evaluate the impact of comorbidities on total health-care costs, adjusting for age, sex, geographic location, baseline health-care use, employment status, and index COPD medication. RESULTS: Among 183,681 patients with COPD, the most common comorbidities were cardiovascular disease (34.8%), diabetes (22.8%), asthma (14.7%), and anemia (14.2%). Most patients (52.8%) had one or two comorbidities of interest. The average all-cause total health-care costs from the index date to 360 days after the index date were highest for patients with chronic kidney disease (

Clinical and economic outcomes in a real-world population of patients with elevated triglyceride levels.

41,288) and anemia (

Abstract 2269: Comparative effectiveness of everolimus + endocrine therapy vs endocrine monotherapy among postmenopausal women with HR+/HER2- advanced breast cancer: a multicountry retrospective chart review

38,870). The impact on total health-care costs was greatest for anemia (

Economic Burden of Chronic Obstructive Pulmonary Disease by Presence of Comorbidities

10,762 more, on average, than a patient with COPD without anemia). CONCLUSIONS: Our analysis demonstrated that high resource use and costs were associated with COPD and multiple comorbidities.

Real-World Treatment Patterns Of Everolimus + Exemestane In Patients With Hormone-Receptor-Positive, Human Epidermal Growth Factor Receptor-Negative Advanced Breast Cancer By Line Of Therapy: A Global Chart Review

OBJECTIVE This study investigated real-world treatment patterns, healthcare utilization, and costs of hypertriglyceridemia in a large commercially insured United States population. METHODS This observational claims study was conducted among adult patients with TG > 500 mg/dL between 01/01/2007 and 04/30/2013. Patients were stratified into mutually exclusive cohorts based on their first available TG measurement (index date): TG ≥ 1500 (Cohort A); 750 ≤ TG < 1500 (Cohort B), and 500 < TG < 750 (Cohort C). Study inclusion required ≥ 12 months of eligibility pre- (baseline) and post-index date (follow-up). Patient characteristics and outcomes were assessed descriptively. Costs associated with acute pancreatitis episodes were estimated using a Generalized Linear Model regression. RESULTS We identified a total of 1964 patients in Cohort A, 7432 in Cohort B, and 17,500 in Cohort C. Patients were young (mean age 46-48) and mostly male (75%-80%). Treatment switching and augmentation occurred rarely, and almost 50% of patients discontinued their initial treatment. At baseline, healthcare utilization and costs were highest in Cohort A (mean all-cause medical and pharmacy costs,

Economic Burden of Advanced Breast Cancer

8850). At follow-up, the number of patients with dyslipidemia-related office and pharmacy claims and related costs almost doubled across the cohorts. Mean all-cause costs/patient in Cohort A at follow-up were

Health Care Resource Utilization And Costs In A Sample Of Real-World Patients With Severe Hypertriglyceridemia

12,642, of which

Diagnosis and treatment patterns of real-world patients with severe hypertriglyceridemia

3730 were dyslipidemia-related. Acute pancreatitis episodes were associated with >300% increase in total all-cause costs in Cohort A. CONCLUSIONS These results suggest that severe hypertriglyceridemia is undertreated and healthcare utilization and costs scale with magnitude of TG elevation. Patients with more severe hypertriglyceridemia received greater medical and pharmacy services. Managing severe hypertriglyceridemia more aggressively and preventing acute pancreatitis may generate cost savings.

Incidence and characteristics of acute pancreatitis in a real-world sample of patients with severe hypertriglyceridemia

Background: This study aims to compare patient characteristics and outcomes of everolimus (EVE) + endocrine therapy (ET) vs ET monotherapy among postmenopausal women with hormone receptor-positive (HR+) human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer (aBC) across multiple countries. Methods: This retrospective chart review included postmenopausal patients with HR+/HER2- aBC who were previously treated with a nonsteroidal aromatase inhibitor (NSAI) and later received EVE + ET, ET monotherapy, or chemotherapy (the index treatment) from 17 sites in 6 countries (Canada, the Netherlands, France, Italy, Russia, and Argentina). This is a subset analysis comparing patients who received EVE + ET vs ET monotherapy. Stratified sampling by index treatment and line of therapy was used to ensure the sample groups included different treatments and lines of therapy. Patient characteristics were compared using Wilcoxon rank-sum tests for continuous variables and Fisher exact tests for categorical variables. Progression-free survival (PFS) was estimated using Kaplan-Meier analysis and was compared between the 2 groups using Cox proportional hazards models adjusting for age, country, line of therapy, metastatic sites, symptoms, comorbidities, prior chemotherapy, recurrent vs de novo cancer, and time from the last adjuvant ET to aBC diagnosis. Results: A total of 119 patients in the EVE + ET group (77 in 1st/2nd, and 42 in 3rd/4th lines) and 102 patients in the ET monotherapy group (76 in 1st /2nd, and 26 in 3rd/4th lines) were included in the study. All but 2 patients in the EVE + ET group received EVE + exemestane; ET monotherapy included fulvestrant (46.1%), exemestane (21.6%), NSAIs (16.7%), and tamoxifen (14.7%). Patients in the EVE + ET group were numerically younger (median 63.0 vs 66.0 years; P = .10); appeared to have fewer comorbidities, particularly hypertension (11.8% vs 35.3%; P number of metastatic sites (median 2.0 vs 1.0; P = .14); had a lower proportion of bone/joint symptoms (30.3% vs 42.2%; P = .07); and had a shorter time from initiation of the last adjuvant ET to aBC diagnosis (median 43.1 vs 55.6 months; P = .05). In the unadjusted analysis, patients in the EVE + ET group had similar PFS as those in the ET monotherapy group (median 9.1 vs 9.2 months; unadjusted HR = 0.98; P = .90), but after adjustment for baseline characteristics, the hazard of progression or death of any cause was lower (adjusted HR = 0.67; P = .05). Conclusions: Patients who received EVE + ET tended to be younger with fewer comorbidities yet have disease with faster progression and a higher burden of metastases. After adjusting for these characteristics, EVE + ET was associated with longer PFS compared with ET monotherapy. Citation Format: Fernando Petracci, Jose Zarba, Andrea Michelotti, Lorenzo Livi, Cristian Villanueva, Roberto Bordonaro, Viktor Sherstnev, Ruben Kowalyszyn, Nina Marinsek, Zhou Zhou, Alexander Macalalad, Valerie Koo, Erich Trieschman, Jipan Xie, James Signorovitch, Barbara Ratto, Keiko Higuchi, Mahasti Saghatchian. Comparative effectiveness of everolimus + endocrine therapy vs endocrine monotherapy among postmenopausal women with HR+/HER2- advanced breast cancer: a multicountry retrospective chart review. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2269.