Showing papers by "Michael S. Broder published in 2014"
TL;DR: Children with uncontrolled epilepsy use significantly more healthcare resources and have a greater economic burden than children with stable epilepsy, indicating that comorbid conditions may add substantially to the disease burden.
141 citations
TL;DR: Comorbidities are common and increase utilization and cost in acromegaly patients, and cardiovascular complications nearly tripled the odds of hospitalization and increased annual mean cost by $13,331.
Abstract: The economic burden of acromegaly in the US has been largely unknown. We describe the prevalence of treatment patterns, complication rates, and associated healthcare utilization and costs of acromegaly in the US. Patients were identified between 1/1/2002 and 12/31/2009 in claims databases. During 1-year after each continuously-enrolled patient’s first acromegaly claim, pharmacy and medical claims were used to estimate outcomes. Regression models were used to adjust outcomes. There were 2,171 acromegaly patients (mean age: 45.3 years; 49.7 % female); 77.8 % received the majority of their care from non-endocrinologists. Pharmacologic treatment was used by 30.8 % of patients: octreotide-LAR in 18.6 %, dopamine agonists in 9.8 %, short-acting octreotide in 4.7 %, pegvisomant in 4.1 %, and lanreotide in 1.2 %; 56 % had biochemical monitoring. Comorbidities were common, ranging from 6.6 % (colon neoplasms) to 25.6 % (musculoskeletal abnormalities). Mean healthcare costs were $24,900. Adjusted analyses indicated comorbidities increased the odds of hospitalization: by 76 % for musculoskeletal abnormalities; 193 % for cardiovascular abnormalities; and 56 % for sleep apnea (p < 0.05). Odds of emergency department visits increased by 87 % (musculoskeletal) and 132 % (cardiovascular abnormalities) (p < 0.01). After adjustments, colon neoplasms were associated with $8,401 mean increase in costs; musculoskeletal abnormalities with $7,502, cardiovascular abnormalities with $13,331, sleep apnea with $10,453, and hypopituitarism with $6,742 (p < 0.01). Complications are common and increase utilization and cost in acromegaly patients. Cardiovascular complications nearly tripled the odds of hospitalization (OR 2.93) and increased annual mean cost by $13,331. Adequate management of this disease may be able to reduce health care utilization and cost associated with these complications and with acromegaly in general.
60 citations
TL;DR: Use of the 12-gene colon cancer Recurrence Score assay may lead to reductions in treatment intensity, and study limitations include retrospective design, data gathering during the first 2 years of assay availability only, and potential non-representativeness of respondents.
Abstract: Introduction:The 12-gene colon cancer Recurrence Score assay is a clinically validated predictor of recurrence risk in stage II colon cancer patients. A survey was performed characterizing the assay’s impact on treatment recommendations for these patients.Methods:US medical oncologists (n = 346) who ordered the assay for ≥3 stage II colon cancer patients were asked to complete a web-based survey regarding their most recent such patient. Physicians surveyed represented users of the assay within the first 2 years of commercial availability which may include ‘early adopters’.Results:Most of 116 eligible physicians were in community practice (86%), with median 14.5 years’ experience (range = 2–40). Mean patient age was 61 years (range = 32–85); 81% had T3 disease, and 38% had comorbidities. Of 76 patients tested for mismatch-repair/microsatellite-instability (MMR/MSI), 13 (17%) were MMR-deficient/MSI-high; 46 (61%) MMR-proficient/MSI-low; and 17 (22%) unknown. Most patients (84%) had ≥12 nodes examine...
17 citations
Journal Article•
TL;DR: This analysis shows that prophylaxis with palonosetron for the treatment of CINV is associated with higher acquisition treatment costs, but also with lower use of rescue medications and outpatient and inpatient services compared with ondansetron or other 5-HT3RAs in the United States.
Abstract: Chemotherapy-induced nausea and vomiting (CINV) is an adverse effect of cancer treatment. It may occur within a few minutes of or up to 24 hours after the administration of chemotherapy (ie, acute CINV), or it may occur more than 24 hours after treatment (ie, delayed CINV). CINV may last up to 7 days.1–7
Although there are several patient-specific factors that place patients at an increased risk for developing CINV (eg, female sex, low consumption of alcohol, history of motion or morning sickness, age under 50 years, previous CINV), the most contributory risk factor is the emetogenic potential of the chemotherapy regimen itself.8
KEY POINTS
▸ Poorly controlled CINV may lead to nutrient depletion, reduced functional ability, diminished quality of life, or the premature discontinuation of chemotherapy.
▸ Previous studies have examined the impact of CINV prophylaxis with palonosetron and other 5-HT3RAs on cost and utilization, but this is the first systematic review of the published literature on this topic.
▸ A total of 32 studies were included in this systematic literature review, of which 14 studies report costs and 25 reported utilization.
▸ This review indicates that palonosetron is associated with higher treatment costs but also with lower rescue medication use and outpatient and inpatient services use compared with other 5-HT3RAs.
▸ Based on this analysis, the use of palonosetron as a standard treatment may lead to reduced service utilization for CINV.
More than 90% of patients undergoing highly emetogenic chemotherapy (HEC) will experience emesis without antiemetic prophylaxis, and 30% to 90% of those undergoing moderately emetogenic chemotherapy (MEC) will vomit without the prophylactic administration of antiemetics.8 From 10% to 30% of the patients receiving low emetogenic risk chemotherapy (LEC), and <10% of patients receiving minimal emetogenic risk chemotherapy (MinEC), will experience emesis without the administration of antiemetics.3,6,7,9 The dose, frequency, and length of administration, as well as the combination of agents may impact the emetogenicity of the chemotherapy.7
Poorly controlled CINV may lead to nutrient depletion, reduced functional ability, diminished quality of life, or the premature discontinuation of chemotherapy.1-4,6,7,9 The use of prophylactic antiemetic medications in patients undergoing HEC may reduce the incidence of CINV to as low as 30%.7 A multidrug regimen containing a 5-hydroxytryptamine receptor antagonist (5-HT3RA) is the standard approach for CINV prophylaxis.7 Drugs in this category include dolasetron mesylate, granisetron, ondansetron, palonosetron, and tropisetron, with palonosetron recommended as the preferred 5-HT3RA for CINV prophylaxis with MEC by the guidelines of the National Comprehensive Cancer Network (NCCN), the Multinational Association of Supportive Care in Cancer/Economic Society for Medical Oncology (MASCC/ESMO), and the American Society of Clinical Oncology (ASCO).5,7,10
Secondary rescue medications are used to treat breakthrough CINV among patients who have received prophylaxis.7 These medications may include metoclopramide, lorazepam, diphenhydramine, olanzapine, prochlorperazine, or dexamethasone.
CINV increases direct costs (eg, medication, office visits, or hospitalizations) and indirect costs (eg, missed work).3,4,9 The effective prevention of CINV may reduce these costs. The clinical and economic impact of CINV underscore the importance of achieving CINV prophylaxis.3,4,9 Palonosetron—which has greater binding affinity and a longer half-life than the other 5-HT3RAs, binds allosterically, stimulates receptor internalization, demonstrates positive cooperativity, and cross talks with the neurokinin (NK)-1 signaling pathway—prevents both acute and delayed CINV more effectively than the other 5-HT3RAs.7,11-14
The extent to which the clinical benefit of 5-HT3RAs translates into reduced costs or utilization of healthcare services among patients with CINV has been shown in individual studies for subsets of outcomes,3,15 but no summary of the literature exists. We conducted a systematic literature review of published research on the healthcare costs and utilization associated with the use of 5-HT3RAs for the prevention of CINV in patients receiving chemotherapy, with the goal of comparing palonosetron with the other 5-HT3RAs.
15 citations
TL;DR: In an insured US cohort with chronic HCV infection, TECs with PEG-IFN-alfa/ribavirin were common and increased costs by approximately $6,000 per treated patient, which may be conservative because it excludes indirect costs.
Abstract: Treatment-emergent comorbid events (TECs) are common In patients initiating treatment with pegylated interferon alpha (PEG-IFN-alfa) and ribavirin for chronic hepatitis C virus (HCV) infection. The purpose of this study was to estimate the incidence and incremental cost of these events. In a retrospective cohort analysis of healthcare claims, we studied patients with HCV who were newly treated with PEG-IFN-alfa/ribavirin between 2006 and 2008. TECs were defined by new medical/pharmacy claims for predefined conditions in the 12 months after treatment initiation. The net incremental cost of the TECs was the difference between baseline and follow-up costs for these comorbidities and their treatment, excluding PEG-IFN-alfa/ribavirin costs. Of 3,795 newly treated patients, 1,269 (mean age 50.2, 36.2% female) met the selection criteria. New TECs were common, with 61.6% of patients having ≥1 event. Anemia was identified in 29.2% of patients, fatigue in 16.4%, depression in 11.5%, and neutropenia in 11.0%. The mean incremental cost for the predefined TEC in the postindex period was $6,377 ($2,782 for medical and $3,595 for pharmacy claims). In an insured US cohort with chronic HCV infection, TECs with PEG-IFN-alfa/ribavirin were common and increased costs by approximately $6,000 per treated patient. This estimate may be conservative because it excludes indirect costs. Costs might increase with new regimens that include a protease inhibitor because additional TECs may be expected. Better-tolerated therapies that reduce the financial burden on the healthcare system and improve patient experience are needed.
7 citations
TL;DR: A retrospective cohort study using a US commercial health insurance claims database to describe treatment patterns of myelodysplastic syndromes patients who progressed while on, failed to respond to, or became intolerant to hypomethylating agents and were eligible for 2nd-line therapy.
4 citations
TL;DR: A retrospective cohort study of US commercial health insurance claims data is conducted to describe, among patients considered to have failed initial HMA treatment, the economic burden and health resource utilization associated with MDS.
3 citations
TL;DR: Use of the 92-gene assay for diagnosing metastatic tumors of uncertain origin is associated with reduced misdiagnoses, increased survival, and improved quality of life, and incorporating the assay into current practice is a cost-effective approach to standardizing diagnostic methods while improving patient care.
Abstract: Objectives:To estimate the clinical and economic trade-offs involved in using a molecular assay (92-gene assay, CancerTYPE ID) to aid in identifying the primary site of difficult-to-diagnose metastatic cancers and to explore whether the 92-gene assay can be used to standardize the diagnostic process and costs for clinicians, patients, and payers.Methods:Four decision-analytic models were developed to project the lifetime clinical and economic impact of incorporating the 92-gene assay compared with standard care alone. For each model, total and incremental costs, life-years, quality-adjusted life-years (QALYs), incremental cost–effectiveness ratios (ICERs), and the proportion of patients treated correctly versus incorrectly were projected from the payer perspective. Model inputs were based on published literature, analyses of SEER (Surveillance Epidemiology and End Results) data, publicly available data, and interviews with clinical experts.Results:In all four models, the 92-gene assay increased th...
3 citations
2 citations
TL;DR: This data indicates that XRT reduces LR by 50% but has not impacted survival in women with DCIS who have undergone surgery alone.
Abstract: 11050 Background: About 20% of breast cancers (BC) are DCIS. Local recurrence (LR) rates with surgery alone are 15-60%; about 50% are invasive. Radiation (XRT) reduces LR by 50% but has not impacte...
1 citations
01 Jan 2014
TL;DR: For stage II colon cancer patients receiving Recurrence Score testing, 29% of treatment recommendations were changed and use of the assay may lead to reductions in treatment intensity.
Abstract: Introduction:The 12-gene colon cancer Recurrence Score assay is a clinically validated predictor of recurrence risk instage II colon cancer patients. A survey was performed characterizing the assay’s impact on treatmentrecommendations for these patients.Methods:USmedicaloncologists(n¼346)whoorderedtheassayfor 3stageIIcoloncancerpatientswereaskedtocomplete a web-based survey regarding their most recent such patient. Physicians surveyed representedusers of the assay within the first 2 years of commercial availability which may include ‘early adopters’.Results:Most of 116 eligible physicians were in community practice (86%), with median 14.5 years’ experience(range ¼2–40). Mean patient age was 61 years (range 32–85); 81% had T3 disease, and 38% hadcomorbidities. Of 76 patients tested for mismatch-repair/microsatellite-instability (MMR/MSI), 13 (17%)were MMR-deficient/MSI-high; 46 (61%) MMR-proficient/MSI-low; and 17 (22%) unknown. Most patients(84%) had 12 nodes examined. Median Recurrence Score result was 20 (range¼1–77). Before assay,treatment recommendations were specified for 92 (79%) patients, with no recommendation for 24 (21%).Of the 92 with pre-assay recommendations, chemotherapy was planned for 52 (57%) and observation for40 (43%); the assay changed recommendations for 27 (29%). Treatment intensity decreased for 18 (67%)andincreasedfornine(33%)patients;itwasmorelikelytodecreaseforlowerRecurrenceScorevaluesandincrease for higher values (p50.001).Conclusion:For stage II colon cancer patients receiving Recurrence Score testing, 29% of treatment recommendationswere changed. Use of the assay may lead to reductions in treatment intensity. Study limitations includeretrospective design, data gathering during the first 2 years of assay availability only, and potential non-representativeness of respondents.
01 Jan 2014
TL;DR: In this paper, the authors developed decision-analytic models to estimate the clinical and economic trade-offs involved in using a molecular assay (92-gene assay, CancerTYPE ID) to aid in identifying the primary site of difficult-to-diagnose metastatic cancers.
Abstract: Objectives: To estimate the clinical and economic trade-offs involved in using a molecular assay (92-gene assay, CancerTYPE ID) to aid in identifying the primary site of difficult-to-diagnose metastatic cancers and to explore whether the 92-gene assay can be used to standardize the diagnostic process and costs for clinicians, patients, and payers. Methods: Four decision-analytic models were developed to project the lifetime clinical and economic impact of incorporating the 92-gene assay compared with standard care alone. For each model, total and incremental costs, life-years, quality-adjusted life-years (QALYs), incremental cost–effectiveness ratios (ICERs), and the proportion of patients treated correctly versus incorrectly were projected from the payer perspective. Model inputs were based on published literature, analyses of SEER (Surveillance Epidemiology and End Results) data, publicly available data, and interviews with clinical experts. Results: In all four models, the 92-gene assay increased the proportion of patients treated correctly, decreased the proportion of patients treated with empiric therapy, and increased quality-adjusted survival. In the primary model, the ICER was $50,273/QALY; thus, the 92-gene assay is therefore cost effective when considering a societal willingness-to-pay threshold of $100,000/QALY. These findings were robust across sensitivity analyses. Conclusions: Use of the 92-gene assay for diagnosing metastatic tumors of uncertain origin is associated with reduced misdiagnoses, increased survival, and improved quality of life. Incorporating the assay into current practice is a cost-effective approach to standardizing diagnostic methods while improving patient care. Limitations of this analysis are the lack of data availability and resulting modeling simplifications, although sensitivity analyses showed these to not be key drivers of results.