Asthma controller delay and recurrence risk after an emergency department visit or hospitalization.

Background: Patients who have asthma-related emergency department (ED) visits or hospitalizations are at risk for recurrent exacerbation events. Our objectives were to assess whether receiving a controller medication at discharge affects risk of recurrence and whether delaying controller initiation alters this risk.

Methods: Asthma patients with an ED visit or inpatient (IP) stay who received a controller dispensing within 6 months were identified from healthcare claims.

Cost trends among commercially insured and Medicare Advantage-insured patients with chronic obstructive pulmonary disease: 2006 through 2009.

Background: Few estimates of health care costs related to chronic obstructive pulmonary disease (COPD) are available regarding commercially insured patients in the United States. The aims of this retrospective observational analysis of administrative data were to describe and compare health care resource use and costs related to COPD in the United States for patients with commercial insurance or Medicare Advantage with Part D benefits, and to assess cost trends over time.

Methods: Patient-level and visit-level health care costs in the calendar years 2006, 2007, 2008, and 2009 were assessed for patients with evidence of COPD.

Chronic kidney disease in gout in a managed care setting.

Background: To study the prevalence of chronic kidney disease (CKD) and its impact on allopurinol dosing and uric acid control among patients with gout.

Methods: This was a retrospective study using data from a large US health plan. Claims and laboratory data were analyzed for enrollees from the health plan database from January 2002 through December 2005.

Resource utilization with insulin pump therapy for type 2 diabetes mellitus.

Objectives: To evaluate the effects of switching from multiple daily injection (MDI) therapy to insulin pump therapy, also called continuous subcutaneous insulin infusion (CSII), on antidiabetic drug and healthcare resource utilization.

Study Design: This study was a retrospective analysis of administrative claims data from a large geographically diverse health plan in the United States from January 1, 2005, through April 30, 2008.

Methods: Changes in antidiabetic drug use, antidiabetic drug switching and augmentation, and healthcare utilization during the baseline period and after CSII initiation were assessed using paired t test.

Relationship between physician specialty and allopurinol prescribing patterns: a study of patients with gout in managed care settings.

Objective: Allopurinol is used to lower serum uric acid (sUA) levels in gout patients. The objective of this study was to investigate the influence of physician specialty on allopurinol treatment patterns and sUA control.

Design And Methods: This was a retrospective study using claims from a managed care database of US health plan enrollees.

Comparative resource utilization in medicaid-eligible patients with asthma treated with fixed-dose fluticasone propionate/salmeterol or fluticasone propionate monotherapy.

Objective: The aim of this work was to compare rates of asthma-related health service utilization for Medicaid-eligible pediatric and adult patients with asthma treated with fixed-dose fluticasone propionate/salmeterol (FSC) or fluticasone propionate (FP) monotherapy.

Methods: A retrospective, observational claims analysis was conducted with Medicaid enrollees aged ≥4 years with ≥1 diagnosis code for asthma and a prescription fill for FSC or FP between January 1, 2002, and November 1, 2005. The end date allowed a follow-up period of ≥60 days; Medicaid data were available through December 31, 2005, and were obtained from 2 sources: a large US-managed Medicaid provider affiliated with i3 Innovus, and the Thomson Medstat Marketscan (Ann Arbor, Michigan) Medicaid claims database.

Direct costs of chronic obstructive pulmonary disease among managed care patients.

Purpose: To estimate patient- and episode-level direct costs of chronic obstructive pulmonary disease (COPD) among commercially insured patients in the US.

Methods: In this retrospective claims-based analysis, commercial enrollees with evidence of COPD were grouped into five mutually exclusive cohorts based on the most intensive level of COPD-related care they received in 2006, ie, outpatient, urgent outpatient (outpatient care in addition to a claim for an oral corticosteroid or antibiotic within seven days), emergency department (ED), standard inpatient admission, and intensive care unit (ICU) cohorts. Patient- level COPD-related annual health care costs, including patient- and payer-paid costs, were compared among the cohorts.

Improved A1C by switching to continuous subcutaneous insulin infusion from injection insulin therapy in type 2 diabetes: A retrospective claims analysis.

Aims: This study was a real-world, retrospective evaluation of the clinical effectiveness of switching to continuous subcutaneous insulin infusion (CSII) among managed care enrollees with type 2 diabetes for whom multiple daily injections (MDI) had presumably failed.

Methods: Administrative claims with integrated A1C values from a large and geographically diverse health plan were analyzed.

Results: Statistically significant A1C reductions (from the baseline period to follow-up period, mean follow-up 17 months) were achieved with CSII.

Economic burden prior to COPD diagnosis: a matched case-control study in the United States.

Background: In the United States, chronic obstructive pulmonary disease (COPD) diagnosis is often a lengthy process, and consequently results in delays in treatment in early stages. Disease progression and complication may result in increased levels of healthcare service use. To understand the economic burden of COPD prior to diagnosis in the U.

Five-year routine cervical cancer screening rates and intervals in a US health plan.

Objective: Cervical cancer screening with liquid-based cytology or concurrent HPV screening may decrease positive predictive value and specificity of screening results. Following changes to leading guidelines for cervical cancer screening, policy-makers may benefit from more detailed statistics to improve management of routine screening intervals. This paper reports annual cervical cancer screening rates, intervals between routine screenings, population cost burden of routine screening, and concurrent HPV screening rates in the medical claims database of a large US health plan between 2000 and 2004.

Treatment failure rates and health care utilization and costs among patients with community-acquired pneumonia treated with levofloxacin or macrolides in an outpatient setting: a retrospective claims database analysis.

Background: Macrolide antibiotics and fluoroquinolones are extensively used in the treatment of community-acquired pneumonia (CAP).

Objective: This analysis was conducted to compare treatment failure rates and health care utilization and cost outcomes among patients with CAP treated with levo-floxacin (500 or 750 mg) or macrolides (azithromycin, clarithromycin, or erythromycin) in an outpatient setting.

Methods: This was a retrospective analysis of claims data from a large US health plan.

Secondary failure of glycemic control for patients adding thiazolidinedione or sulfonylurea therapy to a metformin regimen.

Objective: To assess glycemic control and secondary failure in patients adding thiazolidinedione or sulfonylurea therapy to a metformin regimen in a managed care setting.

Study Design: Retrospective cohort study using administrative claims data.

Methods: Participants (mean age, 51.

Loss of glycemic control in patients with type 2 diabetes mellitus who were receiving initial metformin, sulfonylurea, or thiazolidinedione monotherapy.

Study Objectives: To examine glycosylated hemoglobin (A1C) values longitudinally in patients who newly started metformin, sulfonylurea, or thiazolidinedione monotherapy; in a subset of patients whose A1C values were 7% or greater before starting therapy (baseline) and who achieved A1C goal (A1C < 7%) during therapy, rates of secondary failure (i.e., A1C value returned to > or = 7% during therapy) were compared for each drug.

Prevalence of comorbid conditions and prescription medication use among patients with gout and hyperuricemia in a managed care setting.

Background: : Comorbid disorders and multiple prescription drug use are common among patients with gout and/or hyperuricemia and may influence the clinical course and outcome of gout.

Objective: : We wanted to document the conditions and associated medications in a large group of patients with gout in a managed care setting.

Methods: : This study was a 2-year, retrospective, administrative claims analysis examining comorbid conditions and medication use among managed care enrollees with gout/hyperuricemia across the United States.

Patterns of asthma-related health care resource use in children treated with montelukast or fluticasone.

Objective: To examine the impact of controller monotherapy with montelukast or fluticasone on asthma-related health care resource use among children aged 2-14 years old.

Design And Methods: A retrospective claims-based analysis of asthmatic children, 2-14 years old, receiving a prescription (index) for montelukast or fluticasone between January 1, 1999 and June 30, 2000 was conducted. Children were matched by age and propensity score to obtain comparable treatment groups.

Resource utilization with fluticasone propionate and salmeterol in a single inhaler compared with other controller therapies in children with asthma.

Objective: To determine resource utilization in controller naïve children diagnosed with asthma receiving initial therapy with fluticasone propionate (FP) and salmeterol (SAL) in a single inhaler (FSC), FP alone, montelukast (MON), inhaled corticosteroid (ICS) + SAL from separate inhalers, or ICS + MON.

Research Design And Methods: A retrospective, observational, 18-month (6-month pre-index and 12-month follow-up) database study using medical and pharmacy claims from a 5 million member managed care organization. Multivariate modeling was used to evaluate post-index resource utilization and asthma-related costs.

Severe sepsis in managed care: analysis of incidence, one-year mortality, and associated costs of care.

Objective: To determine severe sepsis (SS) incidence, hospital mortality, 1-year mortality, and costs associated with care in a sample of enrollees in a nationally representative individual practice association (IPA)-network managed care organization (MCO).

Methods: This was a retrospective analysis of administrative claims data for commercial (not managed Medicare) members. We identified MCO members hospitalized for SS between July 1995 and December 1998.

Observational study of the effects of using montelukast vs fluticasone in patients matched at baseline.

Background: The relative effectiveness of inhaled corticosteroids and leukotriene receptor antagonists in asthma therapy continues to be the subject of clinical studies. Recent studies have examined the impact of these therapies using a retrospective design. Retrospective studies require special attention to nonrandom assignment of participants to treatment groups and, consequently, to the need to appropriately account for baseline differences.

Increasing prevalence of gout and hyperuricemia over 10 years among older adults in a managed care population.

Objective: To determine whether the prevalence of gout and/or clinically significant hyperuricemia increased in a managed care population over 10 years.

Methods: The study was a descriptive analysis utilizing an administrative claims database to ascertain 10-year trends in prevalence of gout and/or hyperuricemia. Prevalence rates were calculated cross-sectionally for each year (1990-99) and expressed/compared as rates per 1000 enrollees.

Compliance with allopurinol therapy among managed care enrollees with gout: a retrospective analysis of administrative claims.

Objective: Poor compliance with gout medications has been recognized, but seldom studied. We investigated compliance with allopurinol among managed care enrollees suspected to have gout.

Methods: This was a retrospective, administrative claims-based analysis of patients with gout.