Noam Y. Kirson

Medical cost savings associated with an extended-release opioid with abuse-deterrent technology in the US

Abstract Objectives: In the US, prescription opioids with technology designed to deter abuse have been introduced to deter drug abuse without hindering appropriate access for pain patients. The objective of this study was to estimate changes in medical costs following the introduction of a new formulation of extended-release (ER) oxycodone HCl (oxycodone) with abuse-deterrent technology in the US. Methods: Health insurance claims data were used to estimate changes in rates of diagnosed opioid abuse among continuous users of extended-release opioids (EROs) following the introduction of reformulated ER oxycodone in August 2010. This study also calculated the excess medical costs of diagnosed opioid abuse using a propensity score matching approach. These findings were integrated with published government reports and literature to extrapolate the findings to the national level. All costs were inflated to 2011 US dollars. Results: The introduction of reformulated ER oxycodone was associated with relative reductions in rates of diagnosed opioid abuse of 22.7% (p < 0.001) and 18.0% (p = 0.034) among commercially-insured and Medicaid patients, respectively. There was no significant change among Medicare-eligible patients. The excess annual per-patient medical costs associated with diagnosed opioid abuse were

Prevalence of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension in the United States

9456 (p < 0.001),

Excess costs associated with patients with pulmonary arterial hypertension in a US privately insured population

10,046 (p < 0.001), and

Sources of prescription opioids among diagnosed opioid abusers

11,501 (p < 0.001) for commercially-insured, Medicare-eligible, and Medicaid patients, respectively. Overall, reformulated ER oxycodone was associated with annual medical cost savings of ∼

Implications of early treatment among Medicaid patients with Alzheimer's disease

430 million in the US. Limitations: Because of the observational research design of this study, caution is warranted in any causal interpretation of the findings. Portions of the study relied on prior literature, government reports, and assumptions to extrapolate the national medical cost savings. Conclusions: This study provides evidence that reformulated ER oxycodone has been associated with reductions in abuse rates and substantial medical cost savings. Payers and policy-makers should consider these benefits as they devise and implement new guidelines and policies in this therapeutic area.

Estimating the health care burden of prescription opioid abuse in five European countries.

Abstract Background: The prevalence of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) in the US is largely unknown. Prior research has estimated PAH prevalence in Europe at ∼15–52 per million. Methods: Using a privately insured claims database (1999–2007) for the under age 65 population and a Medicare claims database for the 65+ population, and following the current clinical classification of PH, CTEPH patients were identified as having: ≥2 claims for pulmonary hypertension (PH) [ICD-9-CM: 416.0, 416.8]; ≥1 claim for pulmonary embolism (PE) ≤12 months prior or 1 month after the initial PH claim (index date). PAH patients were identified: ≥2 claims for primary PH [416.0]; no left heart disease, lung diseases, CTEPH, or miscellaneous PH diagnoses ≤12 months prior or 1 month after the index date. Both cohorts were required to have ≥1 claim for right heart catheterization ≤6 months prior to any PH claim, or ≥1 claim for echocardiogram ≤6 months prior to a specialist-diagnosed PH claim. Age- and gender-standardized prevalence rates per million individuals (PMI) were calculated using appropriate population weights. Results: Prevalence rates (95% CI) of CTEPH were estimated at 63 (34–91) PMI among the privately insured (<65), and 1007 (904–1111) PMI among the Medicare population (≥65). The corresponding estimates for PAH were 109 (71–146) PMI among the <65 population, and 451 (384–519) PMI for Medicare. Limitations: Identification of PAH and CTEPH patients in administrative claims data is challenging, due to lack of specific ICD-9-CM codes for the conditions and risk of misdiagnosis. Conclusions: Prevalence rates of CTEPH and PAH increase with age, and are higher among women. The increased risk of PE may explain the sharp age gradient for CTEPH prevalence. The estimated US prevalence of PAH is higher than existing estimates.

The Economic Burden of Diagnosed Opioid Abuse Among Commercially Insured Individuals

BackgroundPulmonary arterial hypertension (PAH) is a rare but fatal disease. Little is known about the economic burden associated with PAH patients in the US.ObjectivesThe objective of this study was to estimate excess direct costs associated with privately insured PAH patients in the US.MethodsFrom a privately insured claims database (>8 million beneficiaries, 2002–7), 471 patients with PAH were identified using the criteria: two or more claims for primary pulmonary hypertension (PH), International Classification of Diseases, ninth edition, clinical modification (ICD-9-CM) code 416.0; no left heart disease, lung diseases, chronic thromboembolic PH or miscellaneous PH diagnoses within 12 months prior or 1 month after the initial PH claim (index date); one or more claim for right heart catheterization (RHC) within 6 months prior to any PH claim or one or more claim for echocardiogram within 6 months prior to a specialist-diagnosed PH claim; aged 18–64 years. Patients with PAH were matched demographically to controls without PH. Patients were followed as long as continuously eligible; mean follow-up of PAH patients was 24.8 months. Chi-squared tests were used to compare baseline co-morbidities. Wilcoxon rank-sum tests were used to compare direct (medical and pharmaceutical) patient-month costs to insurers.ResultsThe average age for PAH patients was 52.2 years, and 55.8% were women. Compared with controls, PAH patients had significantly higher baseline rates of co-morbidities (e.g. essential hypertension, diabetes mellitus and congestive heart failure) and a higher mean Charlson Co-morbidity Index score. Mean direct patient-month costs (year 2007 values) were

Excess costs associated with patients with chronic thromboembolic pulmonary hypertension in a US privately insured population

US2023 for PAH patients and

Use of prescription opioids with abuse-deterrent technology to address opioid abuse

US498 for controls (p< 0.0001), yielding excess costs of

Basal insulin persistence, associated factors, and outcomes after treatment initiation among people with type 2 diabetes mellitus in the US

US1525. Sensitivity analysis restricting the sample to patients diagnosed following RHC yielded a 64% increase in excess costs relative to the original sample. Regarding cost drivers, inpatient services accounted for 45%, outpatient and other services for 38% and prescription drugs for 15% of total direct healthcare costs per patient-month in PAH patients. Circulatory/respiratory system-related patient-month costs were