Maureen C. O’Keeffe Rosetti

Case-Control Study of Medical Comorbidities in Women With Interstitial Cystitis

PURPOSE We used physician assigned diagnoses in an electronic medical record to assess comorbidities associated with interstitial cystitis. MATERIALS AND METHODS A computer search of the administrative database at Kaiser Permanente Northwest, Portland, Oregon was performed for May 1, 1998 to April 30, 2003. All women with a medical record diagnosis of interstitial cystitis (ICD-9 code 595.1) were identified. These cases were then matched with 3 controls each based on age and duration in the health plan. The medical diagnoses (using ICD-9 codes restricted to 3 digits) assigned to these 2 groups were compared using the OR. RESULTS A total of 239 cases and 717 matched controls were analyzed. There were 23 diagnoses that were significantly more common in cases than in controls (p < or = 0.005). Seven of these 23 diagnoses were other urological or gynecological codes used to describe pelvic symptoms. Additional specific conditions associated with interstitial cystitis were gastritis (OR 12.2), child abuse (OR 9.3), fibromyalgia (OR 3.0), anxiety disorder (OR 2.8), headache (OR 2.5), esophageal reflux (OR 2.2), unspecified back disorder (OR 2.2) and depression (OR 2.0). CONCLUSIONS A diagnosis of interstitial cystitis was associated with multiple other unexplained physical symptoms and certain psychiatric conditions. Studies to explore the possible biological explanations for these associations are needed. Interstitial cystitis was also associated with a history of child abuse, although 96% of patients with IC did not have this diagnosis.

Prevalence and severity of undiagnosed urinary incontinence in women.

BACKGROUND Urinary incontinence is a highly prevalent condition in aging women that results in significant morbidity. Less than half of women who suffer from urinary incontinence seek treatment, resulting in a significant proportion of clinically relevant urinary incontinence remaining undiagnosed. Therefore, the purpose of this study was to quantify the prevalence of urinary incontinence in undiagnosed women in a managed care population. METHODS There were 136,457 women aged 25-80 years enrolled in Kaiser Permanente Northwest who were free of genitourinary diagnoses, including urinary incontinence, who were included in this study. Of the 2118 women who were mailed questionnaires ascertaining information on demographic and urinary incontinence characteristics, 875 completed the survey. A chart review of the 234 women who reported moderate to severe urinary incontinence was performed. RESULTS The prevalence of undiagnosed urinary incontinence was 53% in the preceding year, and 39% in the preceding week. The prevalence of undiagnosed stress, mixed, and urge incontinence was found to be 18.7%, 12.0%, and 6.8%, respectively. Quality of life was found to significantly decrease with increasing urinary incontinence severity. Of the 234 chart-reviewed women, 5% were found to have physician-documented urinary incontinence. CONCLUSIONS These results suggest that a significant proportion of women in this managed care population are suffering from urinary incontinence that remains undiagnosed. Efforts should be made to encourage women and physicians to initiate conversations about urinary incontinence symptoms in order to decrease the unnecessary burden of this disease.

Costs of Interstitial Cystitis in a Managed Care Population

OBJECTIVES To assess the direct medical costs, medication, and procedure use associated with interstitial cystitis (IC) in women in the Kaiser Permanente Northwest (KPNW) managed care population. METHODS The KPNW electronic medical record was used to identify women diagnosed with IC (n = 239). Each of these patients was matched with three controls according to age and duration in the health plan. Health plan cost accounting data were used to determine the inpatient, outpatient, and pharmacy costs for 1998 to 2003. An analysis of the prescription medication use and cystoscopic and urodynamic procedures commonly associated with IC was also performed. To evaluate for co-morbidities, an automated risk-adjustment model linked to 28 chronic medical conditions was applied to the administrative data sets from both groups. RESULTS The mean duration from the date of IC diagnosis to the end of the study period was 36.6 months (range 1.4 to 60). The mean yearly costs were 2.4-fold greater for the patients than for the controls (

Positron Emission Tomography and Stage Migration in Head and Neck Cancer

7100 versus

C-C2-03: Incidence-based Costs of Multiple HAART Switches Among HIV-infected Patients in an HMO.

2994), and the median yearly costs were 3.8-fold greater (

Risk adjustment using automated ambulatory pharmacy data the RxRisk model

5000 versus

PREVALENCE AND INCIDENCE OF INTERSTITIAL CYSTITIS IN A MANAGED CARE POPULATION

1304). These cost differences were predominantly due to outpatient and pharmacy expenses. Medication and procedure use were significantly greater for the patients than for the controls. These findings were consistent across risk-adjustment model categories, which suggest that the observed cost differences are IC specific. CONCLUSIONS The direct per-person costs of IC are high, with average yearly costs approximately

Prevalence of interstitial cystitis symptoms in a managed care population.

4000 greater than for the age-matched controls. This cost differential is an underestimate, because the costs preceding the diagnosis, the use of alternative therapies, indirect costs, and the costs of those with IC that is not diagnosed were not included.

Overlap of voiding symptoms, storage symptoms and pain in men and women.

IMPORTANCE Since 2001, there has been a rapid adoption of positron emission tomography (PET) for diagnosis and American Joint Committee on Cancer (AJCC) staging of head and neck cancer (HNC) without data describing improved clinical outcomes. OBJECTIVE To determine the association between increased use of PET and stage and/or survival for patients with HNC in the managed care environment. DESIGN, SETTING, AND PARTICIPANTS Adult patients diagnosed as having HNC (n = 958) from 2000 to 2008 at 4 integrated health systems were identified via tumor registries linked to administrative data. The AJCC stage distribution, patient and treatment characteristics, and survival between pre-PET era (2000-2004) vs PET era (2005-2008) and use of PET vs no use of PET during the PET era were compared. The AJCC stages were categorized to represent localized (stage I or II), locally advanced (stage III, IVA, or IVB), and metastatic (stage IVC) disease. INTERVENTIONS Treatments were determined by billing codes for surgery, radiation treatment, and chemotherapy. MAIN OUTCOMES AND MEASURES The primary outcome for this study was the use of PET. Secondary outcomes included treatment received and 2-year survival. A logit model estimated the effects of PET on diagnosis of locally advanced disease. Kaplan-Meier estimates described overall survival differences between PET and non-PET. Cox regression evaluated the association of PET on survival in patients with locally advanced disease. RESULTS An association between PET and locally advanced disease was found (odds ratio, 2.86 [95% CI, 1.90-4.29) (P < .001). Two-year overall survival for patients with locally advanced disease with and without PET was 52% and 32%, respectively (P = .004), but there was no difference for all stages (P = .69). On Cox proportional hazard regression, PET had no association with survival in patients with locally advanced disease (hazard ratio, 1.208 [95% CI, 0.778-1.877]) (P = .40). CONCLUSIONS AND RELEVANCE The increasing use of PET among patients with HNC is associated with a greater number of patients with higher-stage disease and a dilution of the population with higher-stage disease with patients who have a better prognosis. Thus, the improved survival in patients with locally advanced disease likely reflects selection bias and stage migration. Further research on PET use among patients with HNC is necessary to determine if it results in improved treatment for individual patients.

INCIDENCE AND CLINICAL CHARACTERISTICS OF NATIONAL INSTITUTES OF HEALTH TYPE III PROSTATITIS IN THE COMMUNITY

Background: Highly active antiretroviral therapy (HAART) or combination antiretroviral (ARV) therapy is associated with reduced morbidity and mortality. Yet, many HIV-infected patients endure incomplete HIV suppression from HAART or combination ARV therapy, increasing cost and limiting effectiveness. Little is known about the direct healthcare costs of HIV+ patients requiring multiple HAART regimen switches because of incomplete HIV suppression. In an HMO-based population of HIV+ patients, we examined resource and cost implications of multiple relative to single (or no) HAART switches starting from first HAART regimen. Methods: Retrospective analysis of HIV+ patients of the Northern California and Northwest regions of Kaiser Permanente during 2004. Continuous active 12-month membership and minimum 12 months of continuous HAART. Cases on third or later HAART regimen; controls on 1st or 2nd regimen. Regimen switch is combination change of two or more additions of ARV drugs to an existing HAART regimen. Cost categories drugs, outpatient, inpatient, lab, and radiology. Patients followed from first HAART regimen to death, disenrollment, or end of study up to 60 months. Results: 287 cases (19% female); 1,645 controls (12% female) followed from 1st regimen. Mean total per-patient follow-up costs were