Sameer R. Ghate

Cost and Comorbidities Associated with Opioid Abuse in Managed Care and Medicaid Patients in the United States: A Comparison of Two Recently Published Studies

ABSTRACT Opioid abuse places a large burden on the U.S. society. Two similarly designed studies recently identified the economic and health impact of opioid abuse in patients with private or Medicaid insurance. The prevalence of opioid abuse was estimated to be over 10 times higher in Medicaid beneficiaries than private insurance populations, 87 versus 8 per 10,000, respectively. Opioid abusers incurred annual medical costs that were

Hemorrhagic and Thrombotic Events Associated with Generic Substitution of Warfarin in Patients with Atrial Fibrillation: A Retrospective Analysis:

14,054 to

Fat Modulates the Relationship between Sarcopenia and Physical Function in Nonobese Older Adults

6650 higher than nonabusers in patients with private insurance or Medicaid beneficiaries, respectively (P < .01 for both). Annual costs were similar for abusers with private insurance (

Association Between Second-Generation Antipsychotics and Changes in Body Mass Index in Adolescents

15,884) or Medicaid beneficiaries (

PSY12 PROJECTED COST OF CARDIOMETABOLIC RISK FACTORS IN COMMERCIALLY INSURED NORMAL AND OVERWEIGHT PRIMARY CARE PATIENTS

13,658). Costs for nonabuser Medicaid beneficiaries were

OB3 CORRELATION OF WEIGHT TO CARDIOMETABOLIC RISK AS IDENTIFIED BY ICD-9 DIAGNOSIS CODES AND PRESCRIPTIONS IN PRIMARY CARE

7008 versus

All-Cause and Bleeding-Related Health Care Costs in Warfarin-Treated Patients with Atrial Fibrillation

1830 for those with private insurance, which likely reflects the lower health status of the overall Medicaid population. In both studies, the prevalence of comorbidities associated with substance abuse or chronic pain were significantly higher in abusers than nonabusers. These studies confirm that opioid abuse is associated with comorbidities that increase direct medical costs for patients with private insurance and for Medicaid beneficiaries, increasing the societal burden of opioid abuse.

Development of a practical screening tool to predict low muscle mass using NHANES 1999-2004

BACKGROUND: Substitution of generic warfarin for imprint warfarin (Coumadin; DuPont/Bristol-Myers Squibb) has been a controversial issue due to bioavailability and bioequivalence concerns. OBJECTIVE: To assess the risk of thrombotic and hemorrhagic events following substitution of warfarin formulations in patients with atrial fibrillation (AF). METHODS: Historical cohort analysis was performed using a commercial insurance claims database. Adults with a diagnosis of AF between January 2003 and December 2007, with 16 or more months of continuous eligibility, a warfarin prescription within 30 days after index AF diagnosis, and at least 3 warfarin prescription fills during the follow-up period were included. Individuals with AF diagnosis or warfarin prescription during the pre-index period were excluded. Cox proportional hazard regression models controlling for sex and baseline comorbidities (Charlson comorbidity index, CCI) were used to evaluate the risks of thrombotic and hemorrhagic events following warfarin formulation switches. RESULTS: Of 37,756 subjects included in the analysis (mean age 70.96 years, 42.3% females), 12,996 (34.4%) switched warfarin formulations, 20,292 (53.7%) used only 1 generic product, and 4468 (11.8%) used only Coumadin during follow-up. Compared with continued use of Coumadin, switching from that product to the generic formulation was associated with a significantly higher risk of thrombotic events (HR = 1.81; 95% CI 1.42 to 2.31). Similar findings were observed for switching from generic warfarin to Coumadin (HR = 1.76; 95% CI 1.35 to 2.30), and from 1 generic to another generic product (HR = 1.89; 95% CI 1.57 to 2.29). Similarly, switching from Coumadin to generic warfarin (HR = 1.51; 95% CI 1.17 to 1.93), generic warfarin to Coumadin (HR = 1.60; 95% CI 1.23 to 2.1), and from 1 generic to another generic product (HR = 1.74; 95% CI 1.45 to 2.11) were associated with significantly higher risk of hemorrhage than remaining on Coumadin. CONCLUSIONS: Switching warfarin formulations exposed patients with AF to a higher risk of bleeding events compared to remaining on a single product. Maintaining patients on a product with consistent bioavailability may optimize the risk-benefit balance of anticoagulation therapy.

Cost Implications of Formulary Decisions on Oral Anticoagulants in Nonvalvular Atrial Fibrillation

It is intuitive to think that sarcopenia should be associated with declines in physical function though recent evidence questions this assertion. This study investigated the relationship between absolute and relative sarcopenia, with physical performance in 202 nonobese (mean BMI = 26.6 kg/ht2) community-dwelling older (mean age = 73.8 ± 5.9 years) adults. While absolute sarcopenia (appendicular skeletal mass (ASM)/ht2) was either not associated, or weakly associated with physical performance, relative sarcopenia (ASM/kg) demonstrated moderate (r = 0.31 to r = 0.51, P < 0.01) relationships with performance outcomes in both males and females. Knee extension strength (r = 0.27) and leg extension power (r = 0.41) were both related to absolute sarcopenia (P < 0.001) in females and not in males. Strength and power were associated with relative sarcopenia in both sexes (from r = 0.47 to r = 0.67, P < 0.001). The ratio of lean mass to total body mass, that is, relative sarcopenia, is an important consideration relative to physical function in older adults even in the absence of obesity. Stratifying these individuals into equal tertiles of total body fat revealed a trend of diminished regression coefficients across each incrementally higher fat grouping for performance measures, providing further evidence that total body fat modulates the relationship between sarcopenia and physical function.

Association Between Cardiometabolic Risk Factors and Body Mass Index Based on Diagnosis and Treatment Codes in an Electronic Medical Record Database

PURPOSE To assess the association of second-generation antipsychotics (SGAs) with changes in body mass index (BMI) among adolescents compared with a matched untreated comparison group. METHODS A retrospective cohort study was conducted using an electronic medical record database between January 2004 and July 2009. Adolescents (12-19 years old), newly initiated on SGAs formed the exposure group and untreated adolescents formed the comparison group matched (3:1) to the antipsychotic group based on age, gender, and month of index SGA. Both the exposure and comparison groups were followed for slightly more than a year (395 days). Baseline and follow-up BMI were evaluated for both groups and percentage change from baseline BMI to follow-up BMI was calculated. Multivariate linear regression was conducted to assess the impact of SGAs on percent change in follow-up BMI from baseline controlling for demographic characteristics, baseline medications, comorbidities, and other covariates. RESULTS The mean percentage increase in follow-up BMI from baseline for antipsychotic group was significantly higher than the comparison group (p < .01). After adjusting for covariates, adolescents on olanzapine had the highest percentage increase in follow-up BMI from baseline (5.84%, 95% confidence interval [CI], 4.07-7.61) followed by aripiprazole (4.36%; 95% CI, 3.08-5.64), risperidone (3.65%; 95% CI, 2.61-4.68), and quetiapine (1.53%; 95% CI, .53-2.52) compared with the comparison group. CONCLUSION This study further validates a growing concern of increased BMI in adolescents on SGA therapy.