Mary Lynn Davis-Ajami

Pharmacoeconomic Considerations in Treating Actinic Keratosis

AbstractActinic keratosis is among the most commonly treated skin conditions in the outpatient setting. Its prevalence spans the globe, with greater distribution in fair skinned individuals and the immunocompromised. With high prevalence, increasing incidence and the risk of transformation to a cancerous lesion, prevention and timely treatment present opportunities to rein in costs.The purpose of this article is to review published economic studies relating to the treatment of actinic keratosis, to summarize results discussing the cost drivers of current treatment modalities and to identify parameters most likely to influence the cost effectiveness of treatment.We systematically conducted a published literature search for pharmacoeconomic research of actinic keratosis using title, abstract or full-text searches with the following search terms ([actinic OR solar] AND [keratosis OR keratoses]) AND (economic OR cost OR pharmacoeconomics OR decision). We included published articles referencing actinic keratosis in a standalone study or in a broader study referencing non-melanoma skin cancer and articles evaluating cost-of-illness, cost-of-treatment, cost minimization, cost effectiveness, cost utility, cost-benefit analysis and cost consequence.Our review of the literature found nine studies devoted to pharmacoeconomic considerations of actinic keratosis treatments, with one article investigating both cost-of-illness and cost-of-treatment, two measuring cost-of-illness, two evaluating cost-of-treatment, one focusing on cost minimization, and three focusing on cost effectiveness. The literature compared a broad range of actinic keratosis treatments including topical medications, cryotherapy, photodynamic therapy, excision and a combination of treatment modalities. The direct cost of actinic keratosis management in the US was estimated at

Epoetin zeta in the management of anemia associated with chronic kidney disease, differential pharmacology and clinical utility.

US1.2 billion per year, with indirect costs totalling

Impact of Depression on Health and Medical Care Utilization and Expenses in US Adults With Migraine: A Retrospective Cross Sectional Study

US295 million (year 2004 values). The primary drivers of cost were physician office visits and associated procedures.Pharmacoeconomic research defining standards, outcomes and areas of efficiencies in the treatment of actinic keratosis is in its infancy. To move towards more comprehensive analysis, research needs to focus on updating epidemiological data, evolving evidence-based standards, delineating cost drivers in immunocompetent and immunocompromised populations, and on health outcomes.

Venue of receiving diabetes self-management education and training and its impact on oral diabetic medication adherence

Epoetin zeta was granted marketing authorization in October 2007 by the European Medicines Agency as a recombinant human erythropoietin erythropoiesis-stimulating agent to treat symptomatic anemia of renal origin in adult and pediatric patients on hemodialysis and adults on peritoneal dialysis, as well as for symptomatic renal anemia in adult patients with renal insufficiency not yet on dialysis. Currently, epoetin zeta can be administered either subcutaneously or intravenously to correct for hemoglobin concentrations ≤10 g/dL (6.2 mmol/L) or with dose adjustment to maintain hemoglobin levels at desired levels not in excess of 12 g/dL (7.5 mmol/L). This review article focuses on epoetin zeta indications in chronic kidney disease, its use in managing anemia of renal origin, and discusses its pharmacology and clinical utility.

Antidepressant Treatment Persistence in Low-Income, Insured Pregnant Women

The association between migraine and depression has been extensively examined and a bidirectional hypothesis of the comorbidity between the 2 diseases has been reported. However, the economic impact of comorbid depression on migraine has not been fully explored.

Nephrotoxic Medication Exposure in U.S. Adults with Predialysis Chronic Kidney Disease: Health Services Utilization and Cost Outcomes.

AIMS To determine predictors associated with the diabetes self-management education and training (DSME) venue and its impact on oral antidiabetic (OAD) medication adherence. METHODS The Medical Expenditure Panel Survey household component (MEPS-HC) data (2010-2012) identified adults with diabetes prescribed OAD medication(s) who completed a supplemental Diabetes Care Survey (DCS). Based on the DCS responses to questions about the number and type of DSME venue(s), two groups were created: (1) multiple venues (a physician or health professional plus internet and/or group classes) vs (2) single venue (physician or health professional only). The medication possession ratio (MPR) measured medication adherence, with 0.80 the cut-point defining adherent. Logistic regression examined factors associated with the DSME venue and its effect on OAD medication adherence. RESULTS Of the 2119 respondents, 41.6% received DSME from multiple venues. Age (<65years), education-level (college or higher), high-income, and diet modification were significantly more likely associated with receiving DSME from multiple venues. In single vs multiple venues, medication adherence was suboptimal (mean MPR 0.66 vs 0.64, p=0.245), and venue showed no influence on adherence (OR: 0.92, 95% CI, 0.73-1.16). CONCLUSION Sociodemographic characteristics influence where adults with diabetes receive DSME. Adding different DSME venues may not address suboptimal OAD medication adherence.