Kevin E. Cahill

Frequency, Risk, and Cost of Gout-related Episodes Among the Elderly: Does Serum Uric Acid Level Matter?

Objective. We examined the association between serum uric acid (SUA) level and the frequency, risk, and cost of gout flares among the elderly. Methods. Data were extracted from the Integrated Healthcare Information Services claims database (1999–2005). Patients were included if they had gout, were aged 65 years and older and had both medical and pharmacy benefits, and electronic laboratory data. Patients with gout and gouty episodes were identified using algorithms based on ICD-9-CM codes and medications. Logistic regression and negative binomial regressions were used to study the relationship between SUA concentration and the annual frequency and one-year risk of gout episodes. Generalized linear models were used to examine the direct healthcare costs associated with gout episodes in the 30 days following each episode. Results. Elderly patients with gout (n = 2237) with high (6–8.99 mg/dl) and very high (> 9 mg/dl) SUA concentrations were more likely to develop a flare within 12 months compared to patients with normal (< 6 mg/dl) SUA levels (OR 2.1, 95% CI 1.7–2.6; OR 3.4, 95% CI 2.6–4.4, respectively). In multivariate regressions, the average annual number of flares increased by 11.9% (p < 0.001) with each unit-increase in SUA level above 6 mg/dl (p < 0.001). Among patients with very high SUA levels, average adjusted total healthcare and gout-related costs per episode were

Clinical outcomes and medical care costs among medicare beneficiaries receiving therapy for peripheral arterial disease.

2,555 and

Bridge Jobs A Comparison Across Cohorts

356 higher, respectively, than those of patients with normal SUA levels (both p < 0.001). Conclusion. Higher SUA levels are associated with increased frequency and risk of gout episode, and with higher total and gout-related direct healthcare costs per episode.

Direct and indirect costs among employees with diabetic retinopathy in the United States

BACKGROUNDnPeripheral arterial disease (PAD) is a common disorder with multiple options for treatment, ranging from medical interventions, surgical revascularization, and endovascular therapy. Despite the explosive advances in endovascular therapy, cost-effective methods of care have not been well defined. We analyze therapeutic strategies, outcomes, and medical cost of treatment among Medicare patients with PAD.nnnMETHODS AND RESULTSnPatients who underwent therapy for PAD were identified from a 5% random sample of Medicare beneficiaries from Medicare Standard Analytic Files for the period 1999-2005. Clinical outcomes (death, amputation, new clinical symptoms related to PAD) and direct medical costs were examined by chosen revascularization options (endovascular, surgical, and combinations). One-year PAD prevalence increased steadily from 8.2% in 1999 to 9.5% in 2005. The risk-adjusted time to first post-treatment clinical outcome was lowest in those treated with percutaneous transluminal angioplasty (PTA) or atherectomy and stents (HR, 0.829; 95% CI, 0.793-0.865; p < 0.001) and stents only (HR, 0.904; 95% CI, 0.848-0.963; p = 0.002) compared with PTA alone. The lowest per patient risk-adjusted costs during the quarter of the first observed treatment were associated with PTA and stents (

The economic implications of generic substitution of antiepileptic drugs: a review of recent evidence

15,197), and stents only (

Microeconometric Analysis of the Retirement Decision

15,867). Risk-adjusted costs for surgical procedures (bypass and endarterectomy) were

Disease-Related and All-Cause Health Care Costs of Elderly Patients With Gout

27,021 during the same period. Diabetes was present in 61.7% of the PAD population and was associated with higher risks of clinical events and higher medical costs compared with PAD patients without diabetes.nnnCONCLUSIONnThe clinical and economic burden of PAD in the Medicare population is substantial, and the interventions used to treat PAD are associated with differences in clinical and economic outcomes. Prospective cost-effectiveness analyses should be included in future PAD therapy trials to inform payers and providers of the relative value of available treatment options.

Self-Employment Transitions among Older American Workers with Career Jobs

Are todays retirees following in the footsteps of their older peers with respect to gradual retirement? Recent evidence from the Health and Retirement Study (HRS) suggests that most older Americans with full-time career jobs late in life moved to other jobs prior to complete labor force withdrawal. The authors explored the retirement patterns of two cohorts of individuals from the HRS. One group (the war babies) was born between 1942 and 1947 and therefore aged 59 to 64 years at the time of their fifth biennial HRS interviews in 2006. The others (the original HRS respondents) were aged 59 to 64 in 2000 and therefore 6 years older. The war babies have followed the gradual-retirement trends of their predecessors. Traditional one-step retirement appears to be fading as the effects of changes in the retirement environment continue to unfold.

Microeconometric Analysis of the Retirement Decision: United States

ABSTRACT Objective: To examine, from the employer perspective, the direct (healthcare) and indirect (workloss) costs of employees with diabetic retinopathy (DR) compared to control non-DR employees with diabetes, and within DR subgroups. Methods: Compared annual costs using claims data from 17 large companies (1999–2004). ‘DR employees’ (nu2009=u20092098) hadu2009≥u20091 DR (International Classification of Disease, 9th Revision [ICD‑9]) diagnosis; DR subgroups included employees with diabetic macular edema (DME), proliferative DR (PDR), and employees receiving photocoagulation or vitrectomy procedures. Descriptive and multivariate tests were performed. Results: DR employee annual direct costs were

The role of re-entry in the retirement process

18u2009218 (indirectu2009=u2009