Laura M. Katz

Medication compliance and disease exacerbation in patients with asthma: a retrospective study of managed care data

BACKGROUND Compliance with asthma medications probably results in improved outcomes, but few studies have examined this relationship. OBJECTIVE To examine the association between medication compliance and exacerbation in asthmatic patients. METHODS Retrospective analysis of a managed care database. The 97,743 participants (aged 6-99 years; mean age, 32.8 years) had asthma and prescriptions for controller medications. Compliance with the index medication (the first controller medication prescribed) was measured using 2 methods: medication possession ratio (MPR), calculated for 365 days after the index date, and number of prescriptions for each index medication. Exacerbation was defined as 1 or more emergency department visits or hospitalizations within 1 year of the index date. Multivariate models were used to determine the odds of exacerbation based on relative compliance for each definition of compliance. RESULTS Based on the median MPR, more-compliant patients were less likely to experience exacerbation than less-compliant patients (odds ratio, 0.94; 95% confidence interval, 0.91-0.97; P < .001). Using the 75th percentile MPR, risk of exacerbation was even smaller (odds ratio, 0.89; 95% confidence interval, 0.86-0.92; P < .001). All the cutoff points for compliance (> or = 2 through > or = 6 prescriptions) demonstrated significantly less exacerbations in more-compliant vs less-compliant patients after adjusting for covariates. As the criteria for compliance became more stringent, more-compliant patients became increasingly less likely to have an exacerbation vs less-compliant patients. CONCLUSION More-compliant asthmatic patients were significantly less likely to experience exacerbation than less-compliant asthmatic patients. These findings demonstrate the importance of improving medication compliance among asthmatic patients to impact outcomes.

Glaucoma in the United States and europe: predicting costs and surgical rates based upon stage of disease.

PurposePrimary open-angle glaucoma is a significant health-economic burden in both the United States and Europe that is likely to increase. This study compared treatment patterns and cost among patients with primary open-angle glaucoma in these locations. MethodsRetrospective medical chart reviews were conducted in the United States (1990 to 2002) and Europe (1995 to 2003). A total sample of 151 US charts and 194 European charts was studied, and patients were assigned a baseline intraocular pressure (IOP) and baseline stage, using a 6-stage visual functional glaucoma staging algorithm. Resource utilization and direct costs were assessed by stage of disease using publicly available United States and European costs. Cox Proportional Hazards modeling were used to examine covariates predicting glaucoma surgery. Total cost was predicted, adjusting for covariates using Generalized Linear Models, with baseline stage as the independent variable. ResultsGlaucoma surgery requirement was highly associated with baseline disease stage and IOP increase before surgery in the United States and somewhat associated with these factors in Europe. Within both locations, baseline IOP was highly associated with glaucoma surgery requirement. Controlling for covariates, patients at higher baseline stages incurred greater costs in the United States (P=0.0017) and Europe (P=0.0715). Surgery and medication were also highly predictive of increased cost (P<0.0001). Cost of care differed greatly between the European countries, with costs lowest in Italy. ConclusionsIncreases in annual cost were related to higher baseline IOP, higher baseline stage, medication, and surgery. Thus, significant potential savings and reductions in annual healthcare burden are possible if patients are diagnosed and treated at earlier stages of glaucoma.

Costs and utilization of end-stage glaucoma patients receiving visual rehabilitation care: a US multisite retrospective study.

PurposeGlaucoma is a prevalent ophthalmologic disease and leading cause of blindness. A retrospective analysis was conducted to evaluate resources and costs for end-stage glaucoma patients receiving visual rehabilitation care (VRC). Materials and MethodsA chart review was conducted in 3 United States VRC centers. Charts of patients with primary open-angle glaucoma as the primary cause of vision loss (1998 to 2003) were selected, yielding 81 records. Data were collected from patient-level billing and reimbursement records (ophthalmologist/optometrist visits, glaucoma medications, procedures, and specialized low-vision and glaucoma-related services). Visual rehabilitation services included utilization of low-vision devices, assessment of daily functioning, orientation and mobility training, and patient counseling. ResultsMean age at baseline was 72.7 years [standard deviation (SD)=17.2, range: 29 to 95]. Of those with known sex (n=77), 55.8% were women. Medicare was the payer type for most patients (59.3%), whereas 20% had Medicaid. Mean number of visits was 7.1 (SD=6.1) in year 1 and 3.7 (SD=4.2) in year 2, for an annual mean of 5.4 (SD=5.0) visits overall. Total mean cost per patient in year 1 was greater than year 2 [

Use of nebulized inhaled corticosteroids among older adult patients: an assessment of outcomes

2170 (SD=

P182: Amphotericin B Nasal Spray in Chronic Sinusitis Chart Review

2252) vs.

Gender Differences in Psychiatric Disorders at Juvenile Probation Intake

1202 (SD=

Utility Assessment to Measure the Impact of Dry Eye Disease

1080), respectively]; of the total 2-year costs, 15% were VRC, 37% ophthalmology care, and 48% pharmacy. Analysis of nonpharmacy costs revealed that VRC accounted for 28% and ophthalmology for 72%. ConclusionsEnd-stage glaucoma is associated with appreciable resource utilization and costs, because of both vision rehabilitation and ophthalmology care. Advanced primary open-angle glaucoma has a substantial cost-of-illness, warranting improved management in early stages of disease.

Cost of Patients with Primary Open-angle Glaucoma: A Retrospective Study of Commercial Insurance Claims Data

BACKGROUND Inhaled corticosteroids (ICSs) are used by patients of all ages, but older patients may have difficulty with conventional inhalation devices and therefore may benefit from the easy-to-use delivery mechanism of the nebulizer. OBJECTIVE To compare the outcomes, resource use, and health care costs of patients prescribed nebulized ICSs before and after treatment. METHODS All patients 50 years and older prescribed nebulized ICSs were identified from a nationally representative managed care claims database (1999-2003). Patients with 1 year of continuous enrollment were analyzed using a retrospective cohort design; outcomes, resource use, and costs were measured and compared 6 months before and 6 months after the initial nebulized ICS prescription. RESULTS A total of 2,178 patients were identified for participation in the study, of whom 668 were analyzed. Patients were prescribed nebulized ICSs primarily for asthma (57.4%) and chronic obstructive pulmonary disease (52.1%). Nebulized ICSs were prescribed mostly by primary care physicians and pulmonologists. More than 40% of patients used nebulized ICSs persistently (at least 1 refill); persistent users averaged 123.4 days of use during 6 months of follow-up. There was a significant decrease in systemic corticosteroid use among persistent users (48.0% vs 38.8%; odds ratio, 0.7; 95% confidence interval, 0.5-1.0; P = .03). There was an emergency department visit in 20.2% and 15.0% of persistent users before and after the index date, respectively (odds ratio, 0.7; 95% confidence interval, 0.45-1.09; P = .12); 20.5% and 17.5% were hospitalized before and after the index date, respectively (odds ratio, 0.8; 95% confidence interval, 0.54-1.27; P = .38). No significant difference occurred in total health care costs during follow-up compared with baseline. CONCLUSIONS In this retrospective cohort study, older patients who used nebulized ICSs persistently demonstrated fewer emergency department visits and systemic corticosteroid use than before nebulized ICS use. These improved outcomes were not associated with an increase in health care costs.

Diagnosis and treatment of chronic rhinosinusitis: focus on intranasal Amphotericin B

nosis of paranasal sinus cysts (PSC), using a newly developed 3D-CT. 2) Determine the surgical strategy of PSC by referring the images showed in the notebook monitor. METHODS: Between October 2004 and April 2005, 8 patients with PSC were operated on, with aid of a newly developed three-dimensional CT scan (3D Accuitomo®, Morita, Inc, Kyoto). The PSC consisted of 7 maxillary sinus and 1 frontal sinus cysts. Before surgery, the 3D-CT examination was done; 512 frames of X-ray pictures were taken, and transmitted to a personal computer (PC) as mass-volume digital data. The 3D-CT was able to show a high-resolution axial, coronal, and saggital slice view equally in the monitor of the same PC. Catching and dragging a cursor on the monitor moved the selected images sequentially. A notebook in which the software and the mass-volume data were installed could be used in the operating room during surgery. RESULTS: It would have been easy to choose surgical approaches such as an endoscopic endonasal or a transantral method in all patients, using a notebook showing the sequential CT images. Endoscopic endonasal surgery was performed on 7 out of the 8 patients. No recurrent case was seen after surgery. CONCLUSIONS: The 3D-CT showed the best-targeted lesion equally with axial, coronal, saggital plane in the monitor of a notebook brought to the operating room. The 3D-CT was very useful for preoperative surgical diagnosis of PSC, and contributed to minimally invasive surgery.