Vijay N. Joish

The economic impact of GERD and PUD: examination of direct and indirect costs using a large integrated employer claims database

ABSTRACT Objective: The objective of this study was to examine the relationship of work loss associated with gastro-esophageal reflux disease (GERD) and peptic ulcer disease (PUD) in a large population of employed individuals in the United States (US) and quantify the economic impact of these diseases to the employer. Methods: A proprietary database that contained workplace absence, disability and workers’ compensation data in addition to prescription drug and medical claims was used to answer the objectives. Employees with a medical claim with an ICD-9 code for GERD or PUD were identified from 1 January 1997 to 31 December 2000. A cohort of controls was identified for the same time period using the method of frequency matching on age, gender, industry type, occupational status, and employment status. Work absence rates and health care costs were compared between the groups after adjusting for demographic, and employment differences using analysis of covariance models. Results: There were significantly lower ( p < 0.05) prescription, and outpatient costs in the controls compared to the disease groups, although the eta-square values were very low. The mean work absence attributed to sick days was 2.8 (± 2.3) for controls, 3.4 (± 2.5) for GERD, 3.2 (± 2.6) for PUD, and 3.2 (± 2.3) days for GERD + PUD. For work loss, a significantly higher ( p < 0.05) rate of adjusted all-cause absenteeism and sickness-related absenteeism were observed between the disease groups versus the controls. In particular, controls had an average of 1.2 to 1.6 days and 0.4 to 0.6 lower all-cause and sickness-related absenteeism compared to the disease groups. The incremental economic impact projected to a hypothetical employed population was estimated to be

Adherence and Persistence with Single-Dosage Form Extended-Release Niacin/Lovastatin Compared with Statins Alone or in Combination with Extended-Release Niacin:

3441 for GERD,

A cost-benefit analysis of vision screening methods for preschoolers and school-age children.

1374 for PUD, and

The direct costs of untreated comorbid insomnia in a managed care population with major depressive disorder

4803 for GERD + PUD per employee per year compared to employees without these diseases. Conclusions: Direct medical cost and work absence in employees with GERD, PUD and GERD + PUD represent a significant burden to employees and employers.

Evaluating Diagnosis and Treatment Patterns of COPD in Primary Care

Background: Lipid-lowering therapies have been shown to reduce cardiovascular events and mortality; patient cooperation with therapy varies. A fixed-dose combination product, extended-release niacin/lovastatin (ERNL), has been shown to be beneficial in lipid management; however, little is known regarding patient behavior with ERNL therapy. Objective: To evaluate patient adherence and persistence with ERNL, statin monotherapy (SM), extended-release niacin (ERN) monotherapy, and ERN plus a statin (ERN-S). Methods: Prescription claims for lipid-lowering therapies were obtained from a pharmacy benefits manager between 2002 and 2003. Claims for a total of 2389 patients were analyzed for adherence and persistence, using medication possession ratios (MPRs) and proportions of days covered (PDCs). Adherence and persistence were defined, respectively, as an MPR or PDC greater than or equal to 0.80. Logistic regression was conducted to detect differences among groups. Covariates included age, gender, copay, and number of lipid-lowering therapies, a surrogate for disease severity. Results: Average MPR scores were relatively high in all groups at 0.88, 0.81, 0.89, and 0.90 for ERNL, SM, ERN, and ERN-S, respectively. The adjusted odds ratio for adherence was lowest for SM (0.69), which was statistically significant compared with ERN-S (1.43), but not ERNL (1.00) or ERN (0.74). Persistence outcomes were poor in all groups. By the fourth quarter, patients receiving ERN-S (OR 1.31) had significantly greater persistence than those receiving ERN (OR 0.41) and SM (0.61), but not those receiving ERNL (OR 1.00). Conclusions: Managed care patients tended to be adherent to chronic lipid-lowering therapies, based on a mean MPR greater than 0.8. However, most patients failed to persist for at least 6 months.

Insomnia-related comorbidities and economic costs among a commercially insured population in the United States

Abstract Introduction The purpose of this study was to determine costs and benefits of visual acuity screening (VAS) or photoscreening (PS) in children. Methods A societal-perspective, decision-analytic model compared VAS and PS conducted in three age groups: children 6 to 18 months, 3 to 4 years, and 7 to 8 years old. Literature estimates of sensitivity, specificity, and prevalence were used. Cost estimates and referral rates for surgical treatment were derived from a managed care database and the United States Social Security Administration. Results All the benefit-to-cost ratios exceeded 1.0, meaning that all screening programs studied had benefits that exceeded the cost of screening. The total net benefit was highest for PS in children of 3 to 4 years of age (

Development and validation of a diabetes mellitus severity index: a risk-adjustment tool for predicting health care resource use and costs.

19,412) and the least for VAS in children 7 to 8 years of age (

Burden of Chronic Sleep Maintenance Insomnia Characterized by Nighttime Awakenings

15,179). The benefit-to-cost ratio was highest for the VAS in children 3 to 4 years of age (

The influence of co-morbidities on prescribing pharmacotherapy for insomnia: evidence from US national outpatient data 1995–2004

162) and least for PS in infants 6 to 18 month old (

Validation of the sleep impact scale in patients with major depressive disorder and insomnia

140). Sensitivity of the PS instrument and VAS charts were the most influential variables in determining the most cost-beneficial program. Conclusions Based on the best available data, the net benefit of PS in 3 to 4 year old preschool children is greater than VAS in children 7 to 8 years of age, PS in toddlers, and VAS in children 3 to 4 years of age.