Prevalence and Economic Burden of Epilepsy in the Institutionalized Medicare Fee-for-Service Population.

Background: Based on data from 2003 to 2007, the prevalence of epilepsy was significantly higher in the institutionalized elderly population than in the noninstitutionalized population, but the recent prevalence and economic impact of epilepsy specifically in the institutionalized Medicare population have not been reported.

Objectives: To estimate the prevalence and economic burden of epilepsy and inpatient utilization rates among institutionalized Medicare beneficiaries and to provide a 10-year projection of their population size and the associated costs.

Methods: We performed a cross-sectional analysis of the institutionalized Medicare population with and without epilepsy using Medicare 5% sample claims data from 2013 and 2014.

The cost impact to Medicare of shifting treatment of worsening heart failure from inpatient to outpatient management settings.

Purpose: The aim of this study was to quantify the potential cost savings to Medicare of shifting the site of treatment for worsening heart failure (HF) from inpatient to outpatient (OP) settings for a subset of worsening HF episodes among the Medicare fee-for-service (FFS) population.

Materials And Methods: A cross-sectional analysis of a random 5% sample of 2014 FFS Medicare beneficiaries was conducted. Incidence and cost of worsening HF episodes in both inpatient and OP settings were identified.

The Clinical and Economic Burden of Hyperkalemia on Medicare and Commercial Payers.

Background: Hyperkalemia (serum potassium >5.0 mEq/L) may be caused by reduced kidney function and drugs affecting the renin-angiotensin-aldosterone system and is often present in patients with chronic kidney disease (CKD).

Objective: To quantify the burden of hyperkalemia in US Medicare fee-for-service and commercially insured populations using real-world claims data, focusing on prevalence, comorbidities, mortality, medical utilization, and cost.

Cardiovascular event incidence and cost in type 2 diabetes mellitus: a Medicare claims-based actuarial analysis.

Objective: To assess the economic burden of cardiovascular events in Medicare beneficiaries with type 2 diabetes mellitus (T2DM).

Methods: This claims-based actuarial analysis queried 2013 and 2014 Medicare 5% samples, defining a denominator of fee-for-service beneficiaries. Average per patient per month allowed cost ($PPPM) was calculated for T2DM, demographically adjusted non-T2DM, and denominator.

Cost comparison of laparoscopic colectomy versus open colectomy in colon cancer.

Background: Laparoscopic colectomy has been shown to be safe, oncologically comparable, and clinically beneficial over open colectomy for colon cancer, but utilization remains low. Objectives To evaluate the cost of laparoscopic colectomy vs open colectomy for colon cancer.

Methods: The authors conducted a retrospective claims data analysis using the 2012 and 2013 Truven Health Analytics MarketScan Commercial Claims and Encounter Database.

Open vs. Minimally Invasive Hysterectomy: Commercially Insured Costs and Readmissions.

Purpose: To analyze commercial payer differences in the average costs and readmission rates between inpatient open hysterectomies and three types of outpatient hysterectomies: laparoscopic, laparoscopic assisted, and vaginal.

Design/methodology: A retrospective claims data analysis was conducted using the 2012 and 2013 Truven Health Analytics MarketScan Commercial Claims and Encounter Database.The study was limited to women 18-64 years old who had pharmacy coverage, 12 months of commercial insurance coverage in 2012, and at least 1 month in 2013.

A new perspective on the value of minimally invasive colorectal surgery-payer, provider, and patient benefits.

Background: The clinical benefits of minimally invasive surgery (MIS) are proven, but overall financial benefits are not fully explored. Our goal was to evaluate the financial benefits of MIS from the payer's perspective to demonstrate the value of minimally invasive colorectal surgery.

Methods: A Truven MarketScan claim-based analysis identified all 2013 elective, inpatient colectomies.

Inpatient Utilization and Costs for Medicare Fee-for-Service Beneficiaries with Heart Failure.

Background: Although the medical and economic burden of heart failure in the United States is already substantial, it will likely grow as the population ages and life expectancy increases. Not surprisingly, most of the heart failure burden is borne by individuals aged ≥65 years, many of whom are in the Medicare population. The population-based utilization and costs of inpatient care for Medicare beneficiaries with heart failure are not well understood by payers and providers.

Comparison of Treatment Costs for Breast Cancer, by Tumor Stage and Type of Service.

Background: Diagnosis of breast cancer at early stages is associated with better clinical and survival outcomes. How the costs of care vary depending on the stage at which breast cancer was diagnosed has not been thoroughly examined.

Objective: To quantify the stage-dependent average per capita cost of breast cancer treatment for a commercially insured population of women with newly diagnosed breast cancer.

Longitudinal Commercial Claims-Based Cost Analysis of Diabetic Retinopathy Screening Patterns.

Background: Diabetic retinopathy is one of the most common complications of diabetes. The screening of patients with diabetes to detect retinopathy is recommended by several professional guidelines but is an underutilized service.

Objective: To analyze the relationship between the frequency of retinopathy screening and the cost of care in adult patients with diabetes.

Cost Differences Between Open and Minimally Invasive Surgery.

Purpose: To analyze the cost difference between minimally invasive surgery (MIS) and open surgery from a commercial payer perspective for colectomy, ventral hernia repair, thoracic resection (resection of the lung), and hysterectomy.

Design: A retrospective claims data analysis was conducted using the 2011 and 2012 Truven Health Analytics MarketScan Commercial Claims and Encounter Database. Study eligibility criteria included age 18-64 years, pharmacy coverage, ≥ 1 month of eligibility in 2012, and a claim coded with 1 of the 4 surgical procedures of interest; the index year was 2012.

Stigma towards borderline personality disorder: effectiveness and generalizability of an anti-stigma program for healthcare providers using a pre-post randomized design.

Background: Stigmatization among healthcare providers towards mental illnesses can present obstacles to effective caregiving. This may be especially the case for borderline personality disorder (BPD). Our study measured the impact of a three hour workshop on BPD and dialectical behavior therapy (DBT) on attitudes and behavioral intentions of healthcare providers towards persons with BPD as well as mental illness more generally.

The value of colonoscopic colorectal cancer screening of adults aged 50 to 64.

Objectives: The purpose of this study was to determine the value of life-years saved due to colorectal cancer (CRC) screening with colonoscopy for the population aged 50 to 64 years. The cost perspective is that of a private (commercial) insurer, while the value perspective includes survival past age 65 years, when most of the US population is insured by Medicare. We focused on colonoscopy because it is not only diagnostic but also therapeutic; because positive results on other screening tests generally are followed up with colonoscopy; and to build on previous study results that colonoscopy is ultimately more cost-effective than other screening, even considering its expense.

The economic burden of ischemic stroke and major hemorrhage in medicare beneficiaries with nonvalvular atrial fibrillation: a retrospective claims analysis.

Background: Understanding the economic implications of oral anticoagulation therapy requires careful consideration of the risks and costs of stroke and major hemorrhage. The majority of patients with atrial fibrillation (AF) are aged ≥65 years, so focusing on the Medicare population is reasonable when discussing the risk for stroke.

Objective: To examine the relative economic burden associated with stroke and major hemorrhage among Medicare beneficiaries who are newly diagnosed with nonvalvular atrial fibrillation (NVAF).

Resource utilization and cost in a commercially insured population with schizophrenia.

Background: Schizophrenia is a serious public health concern and a leading cause of disability. Previous studies have shown this disease is associated with an economic burden of more than $60 billion annually in direct and indirect costs in the United States.

Objective: To analyze the annual and longitudinal costs associated with the treatment of patients with schizophrenia from a payer perspective.

Medical claim cost impact of improved diabetes control for medicare and commercially insured patients with type 2 diabetes.

Background: Diabetes prevalence is increasing in the United States, yet the control of critical clinical metrics (e.g., hemoglobin A1c [A1c], blood pressure, and lipids) remains suboptimal.

Pathways, outcomes, and costs in colon cancer: retrospective evaluations in two distinct databases.

Purpose: The goal of this study was to use two separate databases to evaluate the clinical outcomes and the economic impact of adherence to Level I Pathways, an evidence-based oncology treatment program in the treatment of colon cancer.

Patients And Methods: The first study used clinical records from an electronic health record (EHR) database to evaluate survival according to pathway status in patients with colon cancer. Disease-free survival in patients receiving adjuvant treatment and overall survival in patients receiving first-line therapy for metastatic disease was calculated.

Pathways, outcomes, and costs in colon cancer: retrospective evaluations in 2 distinct databases.

Objective: The goal of this study was to use 2 separate databases to evaluate the clinical outcomes and the economic impact of adherence to Level I Pathways, an evidence-based oncology treatment program in the treatment of colon cancer.

Patients And Methods: The first study used clinical records from an electronic health record (EHR) database to evaluate survival according to pathway status in patients with colon cancer. Disease-free survival in patients receiving adjuvant treatment and overall survival in patients receiving first-line therapy for metastatic disease was calculated.

Variation in adherence with Global Initiative for Chronic Obstructive Lung Disease (GOLD) drug therapy guidelines: a retrospective actuarial claims data analysis.

Objectives: Chronic obstructive pulmonary disease (COPD) is an irreversible and often progressive disease that requires lifelong adherence to complicated drug therapy regimens. The well established Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend specific drug therapy protocols, yet patient adherence to drug therapy and physician adherence to prescribing guidelines is reported to be suboptimal. In this claims based analysis of COPD patients, drug therapy treatment patterns including inhaled corticosteroids and long acting bronchodilator use were evaluated by COPD severity level.

Estimates of commercial population at high risk for cardiovascular events: impact of aggressive cholesterol reduction.

Objectives: To model the financial and health outcomes impact of intensive statin therapy compared with usual care in a high-risk working-age population (actively employed, commercially insured health plan members and their adult dependents). The target population consists of working-age people who are considered high-risk for cardiovascular disease events because of a history of coronary heart disease.

Study Design: Three-year event forecast for a sample population generated from the National Health and Nutrition Examination Survey data.

Taking stock of wellness.

The health cost crisis has spawned a thriving cost-control industry that offers an ever-growing number of "solutions." The authors of this article encourage employers to go back to the basics in evaluating these offerings, including their wellness policies and programs. This article describes the many ways different employers do wellness, the evidence base for wellness, how employers should target wellness candidates, and the elements of success and failure for wellness initiatives.

Comparing hospice and nonhospice patient survival among patients who die within a three-year window.

There is a widespread belief by some health care providers and the wider community that medications used to alleviate symptoms may hasten death in hospice patients. Conversely, there is a clinical impression among hospice providers that hospice might extend some patients' lives. We studied the difference of survival periods of terminally ill patients between those using hospices and not using hospices.

Antidepressant use in older people: family physicians' knowledge, attitudes, and practices.

Objective: To explore the knowledge, attitudes, and practices of primary care physicians regarding treatment of depression in older people.

Design: Mailed survey.

Setting: Offices of primary care physicians.

Medicare cost in matched hospice and non-hospice cohorts.

Hospice care is perceived as enhancing life quality for patients with advanced, incurable illness, but cost comparisons to non-hospice patients are difficult to make. The very large Medicare expenditures for care given during the end of life, combined with the pressure on Medicare spending, make this information important. We sought to identify cost differences between patients who do and do not elect to receive Medicare-paid hospice benefits.

Appropriateness of coronary revascularization for patients with chronic stable angina or following an acute myocardial infarction: multinational versus Dutch criteria.

Objective: We convened a multinational panel to develop appropriateness criteria for percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft (CABG). To assess the applicability of these criteria, we applied them to patients referred for coronary revascularization. Finally, to understand how multinational criteria may differ from criteria developed by a panel of physicians from one country, we compared the appropriateness ratings using the multinational panel's criteria and those made using similar criteria previously developed by a panel of Dutch physicians.