Margarita Dolgitser

Anemia in chronic obstructive pulmonary disease: epidemiology and economic implications

ABSTRACT Background: Anemia in chronic illness is associated with increased healthcare resource utilization (HRU) and costs. In COPD, it occurs frequently and influences both clinical and economic outcomes. Because no data studies have been performed either in a single center or a subpopulation of COPD patients, anemias influence on the outcomes is not fully understood. Research design and methods: We conducted a retrospective cohort study in a large healthcare database to quantify prevalence, HRU and costs of anemia in COPD. From 1997 to 2005, patients ≥ 45 years of age with an ICD-9 diagnosis code for COPD and > 3.5 years of follow-up were included. Anemia was defined by the WHO criteria. Other disease states for which anemia is a known complication were excluded. We calculated the prevalence of anemia and compared annual HRU and costs between COPD patients with and without anemia. Multiple regression analysis adjusted for the effects of age, gender, race, length of enrollment, diagnosing physician specialty, co-morbidity burden, anemia and COPD severity. Results: Of the 2404 patients with COPD, 33% (n = 788) had a diagnosis of anemia. Anemic patients were older, more likely to be male and non-Caucasian, and had a greater co-morbidity burden than non-anemic individuals. Annual costs for COPD patients with anemia were more than twice those for patients without anemia (

Pharmacotherapy Compliance in Patients with Ocular Hypertension or Primary Open-Angle Glaucoma

17 240 vs. 6492, p < 0.001, unadjusted). HRU was also significantly greater among anemic than non-anemic COPD patients ( p < 0.0001). In a multiple regression analysis, anemia accounted for

Healthcare charges in patients with glaucoma who undergo laser trabeculoplasty.

7929 per patient (95% CI:

Healthcare charges in patients who transition from ocular hypertension to primary open-angle glaucoma based on ophthalmic coding data.

5572–10 599) of the total costs of care. Limitations: This is a retrospective cohort study and thus subject to multiple forms of bias. Although spirometric evidence of COPD was available only for a subgroup of patients, our case identification methods have been previously validated and found to be accurate in recognizing COPD. Conclusions: Anemia is a common co-morbidity in COPD. It is significantly associated with an increase in HRU and costs of care for COPD, independent of demographic and clinical patient characteristics.

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

PURPOSE The aim of this study was to compare rates of pharmacotherapy coverage in patients with ocular hypertension (OH) and patients with primary open-angle glaucoma (POAG). METHODS Retrospective cohort study analysis of a nationally representative, multimanaged health plan database (PharMetrics; 1998-2005) which included 4818 medicated OH patients and 52,985 medicated POAG patients with at least 1 year of continuous enrollment and at least one prescription for IOP-lowering medication during the first year of follow-up. Patients selected for the current study were nested within the cohort of OH patients (n = 36,767) and POAG patients (n =72,412) previously reported. Of the previously reported OH cohort, only 13.1% of patients filled at least one prescription, as compared to 73.2% of the previously reported POAG cohort. Medication coverage was defined as the percent of days during which a patient was in possession of IOP-lowering therapy over the first year of follow-up (medication coverage = number of covered days/365). Compliant patients were defined as those with >or= 75th percentile medication coverage. RESULTS POAG patients had slightly longer mean length of enrollment in the database (2.5 years, SD = 1.2) than did OH patients (2.4 years, SD = 1.1; P < 0.0001). The mean medication coverage was 50% for the POAG cohort (SD = 0.26) and 40% for the OH cohort (SD = 0.25; P < 0.0001). In multivariate models controlling for key covariates of interest, POAG patients were 1.9 (95% CI: 1.7 to 2.0) times more likely to be compliant with their pharmacotherapy than OH patients. CONCLUSION In general, pharmacotherapy coverage was poor. Patients with POAG, a more severe condition, were significantly more covered with pharmacotherapies than patients with OH. It is important to implement strategies to help improve patient coverage prior to occurrence of more severe disease.

Direct costs of blindness experienced by patients enrolled in managed care.

IntroductionThe objective of this study was to assess the impact of laser trabeculoplasty (LTP) on healthcare charges in patients with primary open-angle glaucoma (POAG).MethodsUsing a managed care database (PharMetrics; Watertown, MA, USA), we formed a case-control group nested within a POAG cohort (n=72,412) formed using International Classification of Disease, Ninth Edition (ICD-9) coding data. Cases (n=1145) had LTP (Current Procedural Terminology code: 65855) with ≥1 year of continuous enrollment both prior to, and following LTP index date in PharMetrics from 1998–2005. Using the date of LTP as the index date, controls (n=2290) without LTP were matched to cases on gender, age, and index year in a 2:1 ratio. Cases and controls had ≥6 months of continuous enrollment in PharMetrics prior to receiving a diagnosis of POAG (ICD-9 code: 365.11). One-year total and ophthalmology healthcare charges were calculated in the year pre- and post-index date (excluding charges for LTP at the index date). Conditional logistic regression models and multiple linear regression models determined the impact of LTP on healthcare charges, while controlling for glaucoma duration and other key covariates.ResultsWhile the mean age of cases (60.1±13.1 years) and controls (60.3±13.6 years) was similar (P=0.5589), cases had more comorbid systemic conditions (P<0.05) and underwent more cataract surgery in the year after index date (4.4% vs. 2.1%; P=0.002). In the year after index date, ophthalmology-related charges increased by

Health care charges for patients with ocular hypertension or primary open-angle glaucoma.

1364 for cases vs.

Racial Differences in Medication Switching and Concomitant Prescriptions in the Treatment of Bipolar Disorder

30 for controls (P=0.0003). Total healthcare charges increased by

The Impact of Glaucoma Coding in a Large Claims Database

5084 for cases and

Association Between Intraocular Pressure-Lowering Medication and Ocular Ischemic Events: A Case-Control Analysis

1594 for controls in the year after index date (P=0.0085). Cases and controls experienced similar increases in ophthalmology-related pharmacy charges from the year pre- to the year post-index date (