Rohan Parikh

United States-based practice patterns and resource utilization in advanced neuroendocrine tumor treatment

AIM To assess advanced neuroendocrine tumor (NET) treatment patterns and resource utilization by tumor progression stage and tumor site in the United States. METHODS United States Physicians meeting eligibility criteria were provided with online data extraction forms to collect patient chart data on recent NET patients. Resource utilization and treatment pattern data were collected over a baseline period (after diagnosis and before tumor progression), as well as initial and secondary progression periods, with progression defined according to measureable radiographic evidence of tumor progression. Resource categories used in the analysis include: Treatments (e.g., surgery, chemotherapy, radiotherapy, targeted therapies), hospitalizations and physician visits, diagnostic tests (biomarkers, imaging, laboratory tests). Comparisons between categories of resource utilization and tumor progression status were examined using univariate (by tumor site) and multivariate analyses (across all tumor sites). RESULTS Fifty-five physicians were included in the study and completed online data extraction forms using the charts of 110 patients. The physician sample showed a relatively even distribution for those affiliated with academic versus community hospitals (46% vs 55%). Forty (36.3%) patients were reported to have pancreatic NET (pNET), while 70 (63.6%) patients had gastrointestinal tract (GI)/Lung as the primary NET site. Univariate analysis showed the proportion of patients hospitalized increased from 32.7% during baseline to 42.1% in the progression stages. While surgeries were performed at similar proportions overall at baseline and progression, pNET patients, were more likely than GI/Lung NET patients to have undergone surgery during the baseline (33.3% vs 25.0%) and any progression periods (26.7% vs 23.4%). While peptide-receptor radionuclide and targeted therapy utilization was low across NET types and tumor stages, GI/Lung types exhibited greater utilization of these technologies compared to pNET. Chemotherapy utilization was also greater among GI/Lung types. Multivariate analysis results demonstrated that patients in first progression period were over 3 times more likely to receive chemotherapy when compared to baseline (odds ratio: 3.31; 95%CI: 1.46-7.48, P = 0.0041). Further, progression was associated with a greater likelihood of having a study physician visit [relative risk (RR): 1.54; 95%CI: 1.10-2.17, P = 0.0117], and an increased frequency of other physician visits (RR: 1.84; 95%CI: 1.10-3.10, P = 0.0211). CONCLUSION Resource utilization in advanced NET in the United States is significant overall and data suggests progression has an impact on resource utilization regardless of NET tumor site.

International practice patterns and resource utilization in the treatment of neuroendocrine tumors.

Objectives This study compared resource use and practice patterns in patients with advanced neuroendocrine tumors (NETs) on disease progression, across countries, and by tumor type. Methods Physicians in the United States, United Kingdom, Germany, France, Brazil, and Italy completed data extraction forms to extract chart data of patients with NET relating to health care resource utilization and treatment practice. Data were assessed in a cross-sectional manner, by country, and by NET subtype. Univariate and multivariate analyses were performed to compare categories of resource use by disease progression status. Results A total of 197 physicians provided data on 394 patients. Overall resource utilization was high across tumor types, countries, and progression. Nearly half of all patients received chemotherapy (49%); moreover, high rates of hospitalization (65%), surgery (47%), and use of somatostatin analog (77%) were observed, with lower rates of peptide receptor radionuclide therapy (10%) and targeted therapies (6%). These patterns were consistent across gastrointestinal tract/lung NET and pancreatic NET. However, a certain variation in resource utilization was observed across countries. Disease progression was associated with increasing utilization of chemotherapy, hospitalization, and targeted therapy. Conclusions Advanced NET is associated with significant resource use across subtypes and countries, and resource utilization is likely to increase on disease progression. There remains an unmet need for therapeutic options after disease progression.

Differences in obesity management among physicians.

Despite the strong recommendations of guidelines, intensive obesity management is not offered to all obese patients. This study aimed to examine differences in obesity management between primary care physicians (PCPs) and non-PCPs. A cross-sectional study was performed using the 2006-2007 National Ambulatory Medical Care Survey. Adults (age ≥20 years) with obesity (body mass index (BMI)≥30 kg/m(2) or obesity diagnosis using International Classification of Diseases, Ninth Revision, Clinical Modification code 278) were included in the study cohort. A multivariate logistic regression model was constructed to examine differences between PCPs and non-PCPs (primary independent variable) for obesity management (dependent variable) while controlling for predisposing, enabling, and need characteristics per Andersons behavioral model. In all, 32.66% of 214 million visits by obese patients in 2006-2007 resulted in obesity management. PCPs were 2.38 times more likely to provide obesity management compared to non-PCPs (odds ratio [OR]=2.37; 95% confidence interval [CI]: 1.69, 3.36). Patients who had preventive visits (OR=2.23; 95% CI: 1.50, 3.32) and chronic visits (OR=1.93; 95% CI: 1.46, 2.55) were more likely to receive obesity management than patients who had acute visits. More time spent with physician, more comorbid conditions, and BMI ≥ 40 significantly increased the likelihood of receiving obesity management, while older age and smoking reduced the likelihood of receiving obesity management. Only one third of ambulatory care visits in 2006-2007 resulted in obesity management. A difference in obesity management was noted between PCPs and non-PCPs. Future research should aim to identify the reasons for these observed differences, ensure equitable access, and address the undertreatment of obesity.

The burden of preserved ejection fraction heart failure in a real-world Swedish patient population

Abstract Objectives: To evaluate resource use and associated costs in patients with a diagnosis of heart failure with preserved ejection fraction (HF-PEF) in Sweden. Methods: This retrospective study identified real-world patients with an ICD-10 diagnosis code for heart failure (I50) for the period between July 1, 2005 and December 31, 2006 from electronic medical records of primary care centers in Uppsala County Council, and in the Swedish patient registry data. Patients were categorized as having HF-PEF (left ventricle ejection fraction [LVEF] > 50%) during the index period. The study assessed medication utilization, outpatient visits, hospitalizations, and associated healthcare costs, as well as the incidence rates and time to all-cause and heart failure mortality following the index period. Results: The study included 137 HF-PEF patients with a mean age of 77.1 (SD = 9.1) years. Over 50% of HF-PEF patients were female and hypertensive. Nearly all patients received ≥1 medication post-index. Patients had an average of 1.5 heart failure related hospitalizations per follow-up year. The average annual per patient cost for the management of a HF-PEF patient was found in Sweden to be Swedish Krona (SEK) 108,246 (EURO [EUR] 11,344). Hospitalizations contributed to more than 80% of the total cost. All-cause mortality over the 18-month study period was 25.5%, and more than 50% of these deaths occurred within 1 year of index. Limitations: Due to the limitations of registry data, it is not possible to confirm the HF diagnosis, and therefore the accuracy of registry records must be assumed. Other factors such as short follow-up time, the study-mandated LVEF assessment, and a lack of drug duration data may also have an impact on the study results. Conclusions: All-cause mortality was high in the HF-PEF population, with more than half of patients dying within 1 year of study follow-up. Study results also indicate that 60% of HF-PEF patients have ≥1 hospitalization during follow-up. Hospitalizations, especially heart failure related admissions, represent a substantial proportion of the total healthcare burden of patients with HF-PEF in Sweden.

Resource utilization among neuroendocrine tumor patients in the United States.

251 Background: Neuroendocrine Tumors (NET) constitute over 100,000 prevalent cases in the United States (US), with predicted increase of incidence in the future. Advanced NET is associated with significant morbidity and mortality. Resource use was assessed for managing advanced NET. METHODS As part of a global study, an online survey was administered to US physicians to quantify resource use among advanced pancreatic (pNET) and lung/gastrointestinal (GI) NET patients. The study collected resource use data (treatments, visits with survey and other physicians, surgery and hospitalizations) for baseline (diagnosis to 1st disease progression [DP]), 1st and 2nd DP periods. DP was defined as measurable/radiographic evidence of tumor progression. As patients with 2nd DP were likely to be less, resources were estimated in a hypothetical scenario. RESULTS 55 US physicians provided data on 110 NET patients (36.4% pNET, 63.6% Lung/GI NET). Average follow up in baseline was 14.0 and 13.3 months for pNET and Lung/GI NET, respectively; in 1st DP period, it was 5.7 and 7.9 months, respectively. For 2nd DP, it was assumed to be 12 months. Table 1 shows resource use for baseline and 1st DP. Increased use of chemotherapy, somatostatin analogs, hospitalization and other physician visits was observed during 1st DP, especially for pNET patients. Targeted therapy use was minimal at baseline and 1st DP; however it may increase in 2nd DP. CONCLUSIONS Among advanced NET patients, resource use is generally high and there appears to be increase in resource use upon DP, especially in patients with pNET. [Table: see text].

PRS38 DRUG PRESCRIBING PATTERN IN AMBULATORY CARE SETTINGS FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN 2006-2007

was 38.2 years (SD = 12.6) and 62.7% were female. 85.9% of our respondents were born outside Canada and 71.8% were ethnically from Asian areas. Effectiveness of the preventive treatment (Risk of developing active TB after treatment, −0.23, p < 0.001), Risk of developing liver damage (−0.16, p < 0.001), Length of treatment (−0.05, p < 0.001), Risk of developing skin rash (−0.03, p = 0.002), and Risk of developing fatigue (−0.03, p = 0.009) were significant determinants of respondents’ choices of preventive treatment. The negative preference estimates revealed that respondents were averse to higher risk of developing active TB, higher risk of developing liver damage, skin rash and fatigue, and longer period of treatment. Frequency of clinic visit was not a significant factor. Respondents’ preferences varied according to their socio-demographic characteristics, past experiences of TB, BCG vaccination status, and the reason for tuberculin skin test. CONCLUSIONS: The results suggest that respondents were consistently in favor of LTBI preventive treatment with higher effectiveness, less side effects and shorter length.

PRS46 TEN YEAR TRENDS IN PRESCRIPTION OF CHRONIC OBSTRUCTIVE PULMONARY MEDICATION AMONG ADULTS FROM 1996 TO 2005

treated with antibiotics were excluded. Analysis was restricted to those patient visitation cared by physician specialty with general practice, family practice, and internal medicine. Multivariate logit regression analysis was performed to assess the relationship between patient insurance status and the prescribing of broad-spectrum antibiotics controlling for age, gender, race and ethnicity, physician specialty, and comorbidities. RESULTS: Of 851 adults patients care for ARTI, 38% were prescribed one or more broad-spectrum antibiotics. In multivariate regression analysis, compared to those with private insurance, those with Medicaid, a public insurance program for low-income Americans, was associated with lower likelihood of prescribing of broadspectrum antibiotics (adjusted odds ratio (OR) 0.496, p = 0.003), so were those without health insurance (adjusted OR 0.499, p = 0.028), and those with Medicare, a public insurance program for the elderly or disabled adults (adjusted OR 0.666, p = 0.091). CONCLUSIONS: In the case of ARTI, those with private insurance were substantially more likely to be prescribed with broad-spectrum antibiotics, where the society may be better off if such overuse of antibiotics could be reduced.

PSY50 DISPARITY IN THE MANAGEMENT OF OBESITY IN AMBULATORY SETTING: A NAMCS 2006-07 ANALYSIS

Study Design: Retrospective cross-sectional study of visits to office-based physicians. Visit Identification: All patient visits with a diagnoses of obesity (ICD-9-CM: 278.00) or indicated as obese through check box in the record form. Variable of Interest: Obesity management, defined as  Prescription of at least one US-FDA approved medications for obesity treatment OR  Counseling for either weight reduction or diet/nutrition or exercise. Primary Independent Variable: Provider specialty(PCP’s v/s Specialists) Confounders: Age, race, sex, region, pay-type, co-morbidities and MSA. Statistical Analyses:  Descriptive statistics  Interaction & Confounding assessment Univariate logistic regression Multivariate logistic regression All analyses was conducted using SAS v 9.2