Mitch DeKoven

“Real‐World” comparison of prasugrel with ticagrelor in patients with acute coronary syndrome treated with percutaneous coronary intervention in the United States

The 30‐day clinical outcomes with prasugrel or ticagrelor were compared using a US payer database in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).

Improved real‐world glycaemic outcomes with liraglutide versus other incretin‐based therapies in type 2 diabetes

Liraglutide (LIRA) once‐daily has provided greater A1C reductions than either exenatide (EXEN) twice‐daily or sitagliptin (SITA) once‐daily in head‐to‐head trials. The objective of this analysis is to compare the real‐world clinical effectiveness of these agents in the USA.

Health‐related quality of life in haemophilia patients with inhibitors and their caregivers

Data on the health‐related quality of life (HRQoL) of congenital haemophilia patients with inhibitors (CHwI) and their caregivers are limited. To understand the association between patient demo‐graphics/clinical characteristics with HRQoL among CHwI patients and caregivers, a survey was developed to assess HRQoL with haemophilia‐specific QoL questionnaires (HAEMO‐QoL/HAEM‐A‐QoL). In the cross‐sectional study, paper‐pencil questionnaires were mailed to 261 US CHwI patients/caregivers in July 2010. Descriptive analyses were performed to characterize HRQoL by age and to identify drivers of impairment, from both patient/caregiver perspectives. HRQoL scores were transformed on a scale of 0–100, with higher scores indicating higher impairment in HRQoL. Ninety‐seven respondents completed the HRQoL assessment. HRQoL impairment was higher in adult patients. In children ages 8–16 years, mean HAEMO‐QoL total score was 33.8 (SD = 15.5), and 35.0 (SD = 16.1) in children ages 4–7 years; for adult patients the mean HAEM‐A‐QoL total score was 42.2 (SD = 14.8). Adults reported highest impairment in the ‘sports/leisure’ subscale (Mean = 62.5, SD = 18.7), whereas patients 8–16 years reported highest impairment in the ‘physical health’ subscale (Mean = 50.8, SD = 30.5).Caregivers of patients ages 4–7 years reported greatest impairment within the ‘family’ subscale (Mean = 55.6, SD = 19.4). Caregivers were ‘‘considerably/very much’’ bothered by their childs inhibitors and reported higher QoL impairment for their child than parents who were not bothered. Within ChwI patients, HRQoL impairments increased with age and existed across a range of physical/psychosocial domains. In addition, caregiver burden also affected the perceived HRQoL of paediatric CHwI patients. Additional research is considered necessary to further understand the support caregivers need while caring for children with CHwI.

Understanding the experience of caring for children with haemophilia: cross-sectional study of caregivers in the United States.

Congenital haemophilia is an inherited bleeding disorder typically diagnosed at birth or shortly thereafter. Haemophilia imposes a significant burden on patients and their caregivers. The aim of the study was to quantify the overall burden of haemophilia on caregivers in the USA using a novel disease‐specific questionnaire and the previously validated CarerQol. Targeted literature review and a previous survey conducted by the authors was used to develop an online questionnaire with six burden domains of interest to caregivers (emotional stress, financial, sacrifice, medical management, childs pain and transportation) and several visual analogue scales (VAS). Content validity of the questionnaire was confirmed by three haemophilia caregivers. The study sample consisted of caregivers of children with haemophilia identified via a previously developed opt‐in research database. Descriptive statistics were employed for demographic and clinical characteristics; a generalized linear model (GLM) was used to identify factors influencing caregiver burden. A total of 310 caregivers completed the survey (45.5% response rate). Most of the participating caregivers were mothers of a child with haemophilia (88%), between 35 and 44 years of age (48%), and with a college education or a postgraduate degree (63%). ‘Childs pain’ was identified as the most burdensome domain to caregivers (median score = 3.50 out of 5), followed by ‘emotional stress’ (2.67), ‘financial’ (2.40), ‘transportation’ (2.33), ‘sacrifice’ (2.17) and ‘medical management’ (2.00) domains. Although higher income exhibited a protective effect, episodes of bleeds, current presence of an inhibitor and lower caregiver productivity in the past month negatively affected caregiver burden per GLM results. Training and educational programs should potentially be developed to address caregiver burden.

Treatment pattern by hormone receptors and HER2 status in patients with metastatic breast cancer in the UK, Germany, France, Spain and Italy (EU-5): results from a physician survey

BACKGROUND The differences in country-specific treatment patterns across Europe for metastatic breast cancer (mBC) patients have not been extensively studied. This study compared the treatment choices in aggregate, as well as by biomarker status, between various lines of therapy in clinical practice in the EU-5 countries among newly diagnosed mBC patients. MATERIALS & METHODS The IMS LifeLink™ Oncology Analyzer database, based on surveys of practicing oncologists, was used to identify mBC patients aged ≥21 years. In this database, sample-level data are projected to national-level estimates for each country using a sample projection technique. RESULTS The prevalence of hormone receptors (71-74%) is quite similar across different countries, while HER2 overexpression varies from 22 (France) to 34% (Italy); chemotherapy combined with HER2-targeted medicine was the mainstay of treatment for HER2(+) patients. The use of HER2-targeted medicine and bevacizumab greatly varied: while they were most frequently used in France, they were least frequently used in the UK. Fewer treatment options existed for triple-negative patients and patients with HER2(+) disease following trastuzumab treatment. Chemotherapy was the treatment choice for triple-negative patients, as these patients do not respond to hormonal therapy and HER2-targeted medicine. CONCLUSION This study found that, while a trastuzumab-based regimen is the preferred option for treating HER2(+) mBC patients in the EU-5, variations in this personalized medicine approach exist between different EU-5 countries. However, fewer treatment options exist for triple-negative and HER2(+) patients after trastuzumab treatment, highlighting the unmet need for these patient subgroups.

Low-intensity pulsed ultrasound (LIPUS) can decrease the economic burden of fracture non-union

Abstract Objectives: Few studies have evaluated the economic burden of surgical and conservative treatment of fracture non-union. An analysis was undertaken of aggregated payer data to determine economic costs of non-unions treated with surgery only vs non-unions treated conservatively with low-intensity pulsed ultrasound (LIPUS) only. Methods: This study used administrative claims from a health plan database including nearly 80 million people. Patients with a claim for non-union surgery or LIPUS for non-union were identified, from April 2007 until April 2010. A retrospective cohort was formed by pairwise demographic matching among patients who received ‘Surgery Only’ or ‘LIPUS Only’. Date of the first non-union intervention (surgery or LIPUS) was defined as the index date. All medical costs were assessed over 12 months following the index date for the ‘Surgery Only’ and ‘LIPUS Only’ cohorts. Results: A total of 1158 matched patients were identified. ‘Surgery Only’ patients used significantly more healthcare services. In the year following intervention, ‘Surgery Only’ patients had total medical costs

Comparison of healthcare resource utilization and costs in patients hospitalized for acute coronary syndrome managed with percutaneous coronary intervention and receiving prasugrel or ticagrelor

6289 higher than ‘LIPUS Only’ patients (Mean = 

The direct medical costs of Huntington’s disease by stage. A retrospective commercial and Medicaid claims data analysis

11,276 vs

Patient/caregiver perceived benefits and barriers to elective orthopedic surgery (EOS) in patients with congenital hemophilia with inhibitors

4986; p < 0.0001). Outpatient costs accounted for >68% of overall costs in both cohorts, and outpatient costs were significantly higher among the ‘Surgery Only’ cohort (Mean = 

Economic Burden of HIV Antiretroviral Therapy Adverse Events in the United States

7682 vs