Piyameth Dilokthornsakul

Multiple sclerosis prevalence in the United States commercially insured population

Objective: To estimate the US commercially insured multiple sclerosis (MS) annual prevalence from 2008 to 2012. Methods: The study was a retrospective analysis using PharMetrics Plus, a nationwide claims database for over 42 million covered US representative lives. Annual point prevalence required insurance eligibility during an entire year. Our primary annual MS identification algorithm required 2 inpatient claims coded ICD-9 340 or 3 outpatient claims coded ICD-9 340 or 1 MS-indicated disease-modifying therapy claim. Age-adjusted annual prevalence estimates were extrapolated to the US population using US Census data. Results: The 2012 MS prevalence was 149.2 per 100,000 individuals (95% confidence interval 147.6–150.9). Prevalence was consistent over 2008–2012. Female participants were 3.13 times more likely to have MS. The highest prevalence was in participants aged 45–49 years (303.5 per 100,000 individuals [295.6–311.5]). The East Census region recorded the highest prevalence (192.1 [188.2–196.0]); the West Census region recorded the lowest prevalence (110.7 [105.5–116.0]). The US annual 2012 MS extrapolated population was 403,630 (387,445–419,833). Conclusions: MS prevalence rates from a representative commercially insured database were higher than or consistent with prior US estimates. For further accuracy improvement of US prevalence estimates, results should be confirmed after validation of MS identification algorithms, and should be expanded to other US populations, including the government-insured and the uninsured.

Prevention and Control of Multidrug-Resistant Gram-Negative Bacteria in Adult Intensive Care Units: A Systematic Review and Network Meta-analysis

Background This study evaluated the relative efficacy of strategies for the prevention of multidrug-resistant gram-negative bacteria (MDR-GNB) in adult intensive care units (ICUs). Methods A systematic review and network meta-analysis was performed; searches of the Cochrane Library, PubMed, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) included all randomized controlled trials and observational studies conducted in adult patients hospitalized in ICUs and evaluating standard care (STD), antimicrobial stewardship program (ASP), environmental cleaning (ENV), decolonization methods (DCL), or source control (SCT), simultaneously. The primary outcomes were MDR-GNB acquisition, colonization, and infection; secondary outcome was ICU mortality. Results Of 3805 publications retrieved, 42 met inclusion criteria (5 randomized controlled trials and 37 observational studies), involving 62068 patients (median age, 58.8 years; median APACHE [Acute Physiology and Chronic Health Evaluation] II score, 18.9). The majority of studies reported extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae and MDR Acinetobacter baumannii. Compared with STD, a 4-component strategy composed of STD, ASP, ENV, and SCT was the most effective intervention (rate ratio [RR], 0.05 [95% confidence interval {CI}, .01-.38]). When ENV was added to STD+ASP or SCT was added to STD+ENV, there was a significant reduction in the acquisition of MDR A. baumannii (RR, 0.28 [95% CI, .18-.43] and 0.48 [95% CI, .35-.66], respectively). Strategies with ASP as a core component showed a statistically significant reduction the acquisition of ESBL-producing Enterobacteriaceae (RR, 0.28 [95% CI, .11-.69] for STD+ASP+ENV and 0.23 [95% CI, .07-.80] for STD+ASP+DCL). Conclusions A 4-component strategy was the most effective intervention to prevent MDR-GNB acquisition. As some strategies were differential for certain bacteria, our study highlighted the need for further evaluation of the most effective prevention strategies.

Forecasting US ivacaftor outcomes and cost in cystic fibrosis patients with the G551D mutation

Ivacaftor, a breakthrough treatment for cystic fibrosis (CF) patients with the G551D genetic mutation, lacks long-term clinical and cost projections. This study forecasted outcomes and cost by comparing ivacaftor plus usual care versus usual care alone. A lifetime Markov model was conducted from a US payer perspective. The model consisted of five health states: 1) forced expiratory volume in 1 s (FEV1) % pred ≥70%, 2) 40%≤ FEV1 % pred <70%, 3) FEV1 % pred <40%, 4) lung transplantation and 5) death. All inputs were extracted from published literature. Budget impact was also estimated. We estimated ivacaftors improvement in outcomes compared with a non-CF referent population. Ivacaftor was associated with 18.25 (95% credible interval (CrI) 13.71–22.20) additional life-years and 15.03 (95% CrI 11.13–18.73) additional quality-adjusted life-years (QALYs). Ivacaftor was associated with improvements in survival and QALYs equivalent to 68% and 56%, respectively, for the survival and QALY gaps between CF usual care and their non-CF peers. The incremental lifetime cost was

Databases in the Asia-pacific region: The potential for a distributed network approach

3 374 584. The budget impact was

Estimation of Financial Burden Due to Oversupply of Medications for Chronic Diseases

0.087 per member per month. Ivacaftor increased life-years and QALYs in CF patients with the G551D mutation, and moved morbidity and mortality closer to that of their non-CF peers. Ivacaftor costs much more than usual care, but comes at a relatively limited budget impact. Ivacaftor improves health outcomes in G551D mutation CF patients at a high cost but with limited budget impact http://ow.ly/ZlmUf

Quality of Reporting of Randomised Controlled Trials of Herbal Interventions in ASEAN Plus Six Countries: A Systematic Review

Background: This study describes the availability and characteristics of databases in Asian-Pacific countries and assesses the feasibility of a distributed network approach in the region. Methods: A web-based survey was conducted among investigators using healthcare databases in the Asia-Pacific countries. Potential survey participants were identified through the Asian Pharmacoepidemiology Network. Results: Investigators from a total of 11 databases participated in the survey. Database sources included four nationwide claims databases from Japan, South Korea, and Taiwan; two nationwide electronic health records from Hong Kong and Singapore; a regional electronic health record from western China; two electronic health records from Thailand; and cancer and stroke registries from Taiwan. Conclusions: We identified 11 databases with capabilities for distributed network approaches. Many country-specific coding systems and terminologies have been already converted to international coding systems. The harmonization of health expenditure data is a major obstacle for future investigations attempting to evaluate issues related to medical costs.

Clinical Effects of Krachaidum (Kaempferia parviflora): A Systematic Review

Given the potential of financial burden due to oversupply of medications for chronic diseases, this study aims to determine the prevalence of oversupply and to estimate the magnitude of financial loss in Thailand. Electronic patient database in a university-affiliated hospital in Thailand was used. Based on the utilization of top 5 high drug expenditure in 2005, the prevalence and the financial loss of oversupply (medication possession ratio [MPR] >1.00) were estimated. In total, 1893 patients were included in this study. The average age was 65.2 years and the majority were female (56%). The prevalence of oversupply ranged from 23.2% to 62.8%, whereas the annual financial loss ranged from US

Brief Report: Databases in the Asia-Pacific Region: The Potential for a Distributed Network Approach.

4108 to US

An overview of the evidences of herbals for smoking cessation.

10 517. The total amount of loss was US

Effects of Centella asiatica (L.) Urb. on cognitive function and mood related outcomes: A Systematic Review and Meta-analysis

32 903 or 3.77% of total medication costs. In summary, because of the high prevalence and associated high financial loss, oversupply of medication is a significant financial burden on hospitals and society.