scholarly journals Comparison of Real-world Outcomes Between Patients Treated with Tapentadol ER or Oxycodone CR

10.36469/9905 ◽  
2015 ◽  
Vol 2 (2) ◽  
pp. 221-232
Author(s):  
Mike Durkin ◽  
Jacqueline Pesa ◽  
Jessica Lopatto ◽  
Rachel Halpern ◽  
Damon Van Voorhis ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Department Visit ◽  
Healthcare Costs ◽  
Index Date ◽  
Opioid Therapy ◽  
Care Utilization ◽  
Research Database ◽  
Before And After ◽  
Pain Patients

Background: The objective of this study was to compare health care utilization and costs between matched cohorts of chronic pain patients treated with the opioids tapentadol extended release (ER) or oxycodone controlled release (CR). Methods: This retrospective study used claims data from the Optum Research Database. Commercial and Medicare Advantage adult patients with ≥1 prescription fill for oxycodone CR or tapentadol ER between September 1, 2011 and September 30, 2012 were eligible. The date of the first observed oxycodone CR or tapentadol ER claim was the index date. Patients had continuous health plan enrollment for 6 months before and after the index date, ≥ 90 days supply of opioid therapy, and no index drug claims in the preindex period. Patients were propensity score matched in a 1:2 ratio (tapentadol ER : oxycodone CR). Results: The attributes of the matched cohorts (1,120 tapentadol ER and 2,240 oxycodone CR patients) appeared similar. In the 6 month post-index period, lower proportions of the tapentadol ER cohort than the oxycodone CR cohort had ≥1 inpatient stay (14.6% versus 20.5%; p<0.001) and ≥1 emergency department visit (33.4% versus 37.5%; p=0.021). The tapentadol ER compared with the oxycodone CR cohort had higher mean pharmacy costs ($4,263 versus $3,694; p <0.001), lower mean inpatient costs ($3,625 versus $6,309; p<0.001), and lower mean total healthcare costs ($16,510 versus $19,330; p=0.004). Conclusions: During follow-up, total mean healthcare costs were lower among tapentadol ER patients than oxycodone CR patients, and tapentadol ER patients were less likely to have an inpatient admission or emergency department visit.

P0788HEALTHCARE RESOURCE UTILIZATION AND COSTS IN A DAPA-CKD-LIKE POPULATION USING A CONTEMPORARY US HEALTHCARE COHORT

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Tope Olufade ◽  
Lois Lamerato ◽  
Juan Jose Garcia Sanchez ◽  
Like Jiang ◽  
Joanna Huang ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Health System ◽  
Healthcare System ◽  
Resource Utilization ◽  
Healthcare Costs ◽  
Index Date ◽  
Healthcare Resource ◽  
Healthcare Resource Utilization

Abstract Background and Aims Recent studies have shown an association between Sodium Glucose Co-Transporter 2 inhibitor (SGLT-2i) class of drugs and lower healthcare costs compared with other glucose lowering therapy, in type 2 diabetes (T2D) patients mainly as a result of reduced rates of cardiovascular and other T2D-associated outcomes. The DAPA-CKD Trial (A study to evaluate the effect of dapagliflozin on renal outcomes and CV mortality in patients with CKD) is the first SGLT-2i renal outcomes trial to test the efficacy and safety of an SGLT-2i, dapagliflozin, in patients with CKD with and without T2D. The objective of this study is to assess the healthcare resource utilization and cost in a “DAPA-CKD-like population” (eGFR 25-75ml/min/1.73m2 and UACR 200-5000mg/g) using a contemporary US healthcare system. Method Data from the Henry Ford Health System (HFHS) were used to identify persons with CKD stages 2 through 4 between 2006 and 2016 (based on eGFR labs) and patients were followed through 2018. Persons with no confirmatory eGFR > 90 days from index date, death within 30 days, history of renal transplant, and evidence of renal replacement therapy, or progression to CKD stage 5 during the baseline period (6 months pre or post index date) were excluded. Inpatient admissions, inpatient days, emergency department encounters, and ambulatory care encounters with primary care, specialty care and overall were assessed. Cumulative utilization was evaluated for all patients and evaluation based on the follow-up time. Patients were censored on date of death, last contact with the Health System or at December 31st, 2018. The utilization rates are the total observed utilization divided by follow-up time and reported as an annual rate. Billing records for all care with HFHS were used to estimate costs. Results 6,557 patients (mean age 62.9 years, 46.2% male) met the eligibility criteria and are included in the study cohort. The population was stratified by UACR (0-<30, 30–199, 200–5,000mg/g). The DAPA-CKD-like population (200-5000mg/g) was associated with significantly higher annualized per-patient healthcare costs, $39,222/yr (UACR 200-5000mg/g) vs. $19,547/yr (UACR <30mg/g). This increased healthcare utilization was predominantly driven by increased acute care, including hospital admissions, inpatient days and emergency department visits. Persons in the highest UACR category were almost three times more likely to have a hospital admission compared to the lowest UACR (rates 0.55/year vs. 0.20/year, respectively; see Figure below). Persons in the lowest UACR category had more primary care visits per year compared with those with highest UACR (5.81 vs 5.21). In contrast, the highest number of outpatient specialist visits per year was reported for the DAPA-CKD-like population (7.55 vs. 6.74). Conclusion This analysis of a contemporary US healthcare system demonstrated that there exists a high disease burden in the DAPA-CKD-like population as seen by the substantial increase in healthcare resource utilization and costs compared to other cohorts of patients with a lower UACR. These results highlight the need for innovative therapies to improve patient outcomes in this population.

Follow-up Care After an Emergency Department Visit for Asthma in a Pediatric Military Population: Clinical Interventions and Outcomes

CHEST Journal ◽  
2015 ◽  
Vol 148 (4) ◽  
pp. 674A
Author(s):  
Michael Smiley ◽  
Nick Sicignano ◽  
Elizabeth Allen ◽  
Rees Lee ◽  
Deena Chisolm
Keyword(s):  
Emergency Department ◽  
Emergency Department Visit ◽  
Military Population ◽  
Clinical Interventions ◽  
Follow Up Care

An Evaluation of Health Care Utilization, Risk of Infection and Bleeding Among MDS Patients During Periods of Transfusion Dependence or Independence with or without Lenalidomide Therapy

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3151-3151
Author(s):  
B. Douglas Smith ◽  
Dalia Mahmoud ◽  
Henry J Henk ◽  
Zeba M. Khan
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Research Funding ◽  
Index Date ◽  
Care Utilization ◽  
Watch And Wait ◽  
Active Therapy ◽  
Erythroid Response ◽  
Clinically Significant

Abstract Abstract 3151 Introduction A goal of therapy with lenalidomide (LEN) for MDS pts is hematologic improvement, commonly an erythroid response, which results in transfusion independence (TI). However, it is possible that LEN impacts other non-anemia manifestations of MDS, such as significant bleeding (defined as GI, intracranial, hospitalized bleeds, and bleeding deaths), infections. This retrospective claims analysis examined the occurrence of these events as well as health care utilization (ER visits and hospitalizations), for pts with MDS during periods of transfusion dependence (TD) without active therapy compared to periods of TI with or without LEN. Methods: Claims data from a US national commercial health plan were retrospectively reviewed to assess the impact of TD and therapy with LEN on common medical events. Pts ≥ 18 yrs with ≥ 1 claim for MDS (ICD-9-CM diagnosis codes 238.72–238.75) between 01 Jan 07 and 31 Dec 09 were assessed using the 1st MDS diagnosis date as the index date. Continuous enrollment in a commercial or Medicare Advantage plan with a medical and pharmacy benefit for 6 mos before the index date (baseline period) and for a variable period after the index date (follow-up period) was required. Four unique cohorts of pt follow up were identified to analyze pt outcomes. Three groups of TI periods were examined: periods not on any active therapy ‘watch and wait’ (A) periods on any length of LEN therapy (B) and long periods on LEN therapy (> 3 refills) (C) as 90% of responding pts do so after 3 cycles. In addition, TD periods on no active therapy (D) were assessed. The dose of LEN administered varied across pts and time periods analyzed. Common medical events of infection, bleeding, ER visits and hospitalizations were evaluated within each period type. TD was defined as ≥ 2 RBC transfusions in 8 wks and TI as pts on <2 transfusions in 8 weeks. Because length of each time period varied, results are presented as incidence rate per person-year to allow comparison across cohorts adjusting for variable exposure time. Results: A total of 3, 574 pts with MDS were categorized on the basis of transfusions and LEN use resulting in 3, 608 observation periods analyzed. Each pt could account for multiple periods. Average age was 66 yrs and 51% were male. TD periods were associated with the highest incidence of infection and bleeding events compared to any of the TI periods (A, B, or C). In addition hospitalizations and ER visits were highest for TD periods compared to any of the TI periods. Interestingly, the incidence of events during TI periods on longer courses of LEN (≥ 3 LEN cycles) (C) approached that of periods of TI without active therapy (watch and wait) (A). Conclusions: This retrospective database analysis highlights the possible impact of LEN on 2 important clinical manifestations of MDS. As expected, the incidence of infection and clinically significant bleeding was greatest during TD periods. However, the incidence of these events in TI on LEN for > 3 cycles approached that of TI pts not requiring medical therapy (watch and wait) and highlights a potential broader impact of LEN therapy. The effect of LEN in inducing erythroid response in pts with MDS, especially with the 5q- karyotype, is well established; however, these results indicate LEN may also impact the underlying biology of MDS as seen by a lower incidence of infection and clinically significant bleeds during TI periods on LEN (B, C). Furthermore, these data support the concept that effective therapy periods on LEN are not associated with higher rates of medical events and LEN therapy should be considered for eligible TD pts. Disclosures: Smith: Celgene: Consultancy; Genzyme: Consultancy; Incyte: Consultancy; Infinity: Consultancy; Merck-Serono: Research Funding; Synta: Research Funding; Celator: Research Funding; Calistoga: Research Funding; BMS: Research Funding; Novartis: Research Funding. Mahmoud:Celgene: Employment. Khan:Celgene: Employment.

33 Improving Specialty Follow-up Care after an Emergency Department Visit Using a Unique Referral System

2012 ◽  
Vol 60 (4) ◽  
pp. S14
Author(s):  
F.C. Messina ◽  
C. Weaver ◽  
A. Trammel ◽  
M. McDaniel ◽  
D. Ervin ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Department Visit ◽  
Referral System ◽  
Follow Up Care
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