NKX6-1 Is a Less Sensitive But Specific Biomarker of Chromophobe Renal Cell Carcinoma.

NKX6-1 is a transcription factor that plays a key role in the development, differentiation, and identity maintenance of beta cells of pancreatic islets. Although NKX6-1 expression has also been discovered in pancreatic well-differentiated neuroendocrine tumors (WDNETs) and duodenal WDNETs, its expression in chromophobe renal cell carcinoma (chRCC) is unexplored. Analysis of mRNA expression and immunohistochemistry of NKX6-1 was performed using the kidney cancer cohort from The Cancer Genome Atlas (TCGA) and paraffin-embedded whole-tissue slides from our 196 collected cases, including 48 chRCCs (43 classic and 5 eosinophilic subtypes), 24 renal oncocytomas (ROs), 46 clear cell renal cell carcinomas, 41 papillary renal cell carcinomas, 14 renal urothelial carcinomas, 7 low-grade oncocytic renal tumors (LOTs), 8 eosinophilic solid and cystic renal cell carcinomas, 3 succinate dehydrogenase-deficient renal cell carcinomas, and 5 renal oncocytic tumors, not otherwise specified.

FOXI1 expression in chromophobe renal cell carcinoma and renal oncocytoma: a study of The Cancer Genome Atlas transcriptome-based outlier mining and immunohistochemistry.

FOXI1 is a forkhead family transcription factor that plays a key role in differentiation and functional maintenance for the renal intercalated cell (IC). The diagnostic utility of FOXI1 is rarely studied thus far. Comparative analyses of FOXI1 mRNA expression in normal kidney tissue and different renal neoplasms including chromophobe renal cell carcinoma (chRCC), renal oncocytoma (RO), and other renal cell carcinomas were conducted using transcriptomic data from The Cancer Genome Atlas (TCGA), Gene Expression Omnibus, and single-cell RNA-seq datasets, in combination with integrative analyses using mutant data, karyotype data, and digital slides for cases with anomalous FOXI1 expression in TCGA.

Frequent KRAS mutations in oncocytic papillary renal neoplasm with inverted nuclei.

Aims: Papillary renal neoplasm with reverse polarity (PRNRP) is a newly documented rare tumour type. Its molecular pathological features have thus far been very little studied.

Methods And Results: There were 13 PRNRP cases including 3 The Cancer Genome Atlas (TCGA) cases and our 10 cases in this study.

Prolonged length of stay associated with air leak following pulmonary resection has a negative impact on hospital margin.

Background: Protracted hospitalizations due to air leaks following lung resections are a significant source of morbidity and prolonged hospital length of stay (LOS), with potentially significant impact on hospital margins. This study aimed to evaluate the relationship between air leaks, LOS, and financial outcomes among discharges following lung resections.

Materials And Methods: The Medicare Provider Analysis and Review file for fiscal year 2012 was utilized to identify inpatient hospital discharges that recorded International Classification of Diseases (ICD-9) procedure codes for lobectomy, segmentectomy, and lung volume reduction surgery (n=21,717).

New thinking on clinical utility: hard lessons for molecular diagnostics.

Objectives: To describe 5 basic requirements for planning, implementing, and proving clinical utility for diagnostic tests, drawing on recent reimbursement decisions.

Study Design: Review of recent reimbursement decisions by Palmetto GBA's MolDx program, and summary of lessons learned.

Methods: Qualitative review of publicly available coverage and reimbursement decisions, plus our industry experience.

Cost-effectiveness analysis of Mammostrat® compared with Oncotype DX® to inform the treatment of breast cancer.

Purpose: To compare the cost-effectiveness of the tumor subtyping assays Mammostrat® and Oncotype DX® for assessing risk of recurrence in early-stage breast cancer and the potential benefit of adjuvant chemotherapy.

Methods: Cost-effectiveness analysis from a US third-party payer perspective. A 10 year Markov model was developed to estimate costs and effects of using each method of risk assessment.

Cost effectiveness analysis of a next generation risk assessment score for cardiovascular disease.

Objectives: The goal of this study is to determine the cost-effectiveness of MIRISK VP, a next generation coronary heart disease risk assessment score, in correctly reclassifying and appropriately treating asymptomatic, intermediate risk patients.

Study Design: A Markov model was employed with simulated subjects based on the Multi-Ethnic Study of Atherosclerosis (MESA). This study evaluated three treatment strategies: (i) practice at MESA enrollment, (ii) current guidelines, and (iii) MIRISK VP in MESA.

Cost of placement and complications associated with osseointegrated bone-conducting hearing prostheses: a retrospective analysis of medicare billing data.

Objective: To report the cost of placement and complications related to osseointegrated bone-conducting hearing prostheses (OBHPs) in a Medicare population.

Materials And Methods: We performed a retrospective analysis of nationwide Medicare claims data for operative and nonoperative complications associated with the placement of percutaneous OBHPs between the first quarter of 2007 and the second quarter of 2009 for which there were 6 subsequent quarters of follow-up. We used Medicare Standard Analytical Files (SAF), which contain a 5% random sample of Medicare fee-for-service beneficiaries, excluding those that also were enrolled in a managed-care organization.

Transition to a novel advanced integrated vitrectomy platform: comparison of the surgical impact of moving from the Accurus vitrectomy platform to the Constellation Vision System for microincisional vitrectomy surgery.

Background: Microincisional vitrectomy surgery (MIVS) is the current standard surgical approach for pars plana vitrectomy. Historically, the most common surgical platform for vitrectomy surgery, since its introduction in 1997, has been the Accurus vitrectomy system. Recent introduction of the next generation of vitrectomy platforms has generated concerns associated with transitioning to new technology in the operating room environment.

Cost-effectiveness analysis of continuous-flow left ventricular assist devices as destination therapy.

Background: Continuous-flow left ventricular assist devices (LVADs) have become the dominant devices for mechanical circulatory support, but their cost-effectiveness is undetermined. This study assessed the cost-effectiveness of continuous-flow devices for destination therapy versus optimal medical management in advanced heart failure and compared the results with previous estimates for pulsatile devices.

Methods And Results: A Markov model was developed to assess cost-effectiveness.

Temporal changes in hospital costs for left ventricular assist device implantation.

Background: A recent prospective, randomized controlled trial demonstrated that a continuous-flow (CF) left ventricular assist device (LVAD) resulted in improved survival at 12 and 24 months compared to a pulsatile-flow (PF) device. The current study examines the hospitalization costs associated with treatment of New York Heart Failure Class IV patients when implanted with a CF LVAD and compares them to previously reported costs of a PF LVAD in the same population.

Methods: Hospital billing data were analyzed for CF LVAD patients in the HeartMate II Destination Therapy trial to determine costs associated with the implantation admission.

Evaluation of economic efficiencies in clinical retina practice: activity-based cost analysis and modeling to determine impacts of changes in patient management.

Background: The purpose of this study is to report the use of activity-based cost analysis to identify areas of practice efficiencies and inefficiencies within a large academic retinal center and a small single-specialty group. This analysis establishes a framework for evaluating rapidly shifting clinical practices (anti-vascular endothelial growth factor therapy, microincisional vitrectomy surgery) and incorporating changing reimbursements for care delivery (intravitreal injections, optical coherence tomography [OCT]) to determine the impact on practice profitability. Pro forma modeling targeted the impact of declining reimbursement for OCT imaging and intravitreal injection using a strategy that incorporates activity-based cost analysis into a direct evaluation schema for clinical operations management.

Cost-effectiveness of 70-gene MammaPrint signature in node-negative breast cancer.

Objective: To evaluate the cost-effectiveness of 70-gene MammaPrint signature (Agendia Inc, Huntington Beach, CA) vs Adjuvant! Online software (AS) (http://www.adjuvantonline.com) in patients 60 years or younger with early-stage breast cancer.

Development of an activity-based costing model to evaluate physician office practice profitability.

Objective: Newer treatment regimens for age-related macular degeneration have significantly affected traditional and non-traditional retinal services across all types of practice settings around the country as they seek to find a balance among delivering best patient care, keeping operating costs under control, and maintaining profitability.

Design: A systematic retrospective review of a multi-city, multi-physician retinal practice's accounting system to obtain data on revenues, expenses, and profit. Data reviewed were from practice management systems to obtain claims level data on clinical procedures across 7 primary activity centers: non-laser surgery, laser surgery, office visits, optical coherence tomography (OCT), non-OCT diagnostics, drugs and drug injections, and research.

Sleep apnea testing and outcomes in a large cohort of Medicare beneficiaries with newly diagnosed heart failure.

Rationale: Previous studies have demonstrated a high prevalence of sleep apnea (SA) in patients with chronic heart failure (HF), which is associated with higher rates of morbidity, mortality, and health care use.

Objectives: To investigate the reported incidence, treatment, outcomes, and economic cost of SA in new-onset HF in a large U.S.

Economic burden of plantar fasciitis treatment in the United States.

Although plantar fasciitis (PF) is prevalent among adults in the United States, few studies have quantified the economic burden of this condition. In the present study, which was based on PF treatment patterns identified by Riddle and Schappert in 2004, we quantified the costs of treatment and explored the magnitude of the burden on third-party payers. Costs for these established treatment options were obtained from 2007 fee schedules and relative value units released by the Centers for Medicare and Medicaid Services.

Surgical treatment patterns among Medicare beneficiaries newly diagnosed with lumbar spinal stenosis.

Background Context: Lumbar spinal stenosis (LSS) is a prevalent degenerative condition in the elderly that can be managed medically or with surgical treatments. Recent studies have shown an increase in the utilization of surgery in the United States and great regional variations. An understanding of treatment patterns and costs in a population-based setting will help identify subgroup differences to help inform strategies for optimal care in patients with LSS.

Costs and rehabilitation use of stroke survivors: a retrospective study of Medicare beneficiaries.

Objective: To examine mortality, costs, and rehabilitation use in patients with stroke and stroke-related hemiparesis during a 4-year period following stroke onset.

Method: This study was a retrospective, longitudinal claims analysis. Patients newly diagnosed with stroke and discharged from the hospital were identified from a 5% random sample of Medicare beneficiaries.

Economic evaluation of medication, laser trabeculoplasty and filtering surgeries in treating patients with glaucoma in the US.

Objective: Despite the significant clinical and economic burden associated with glaucoma, studies evaluating the long-term costs of existing treatments are limited. This study compared the 5-year costs of three treatment strategies: medication, laser trabeculoplasty, and filtering surgeries in managing patients with primary open-angle glaucoma whose intra-ocular pressures were not adequately controlled by two medications.

Research Design And Methods: A Markov model was developed to simulate the transition of treatment progression over a 5-year period to evaluate the total treatment costs associated with each strategy.

The economic impact of aspergillosis: analysis of hospital expenditures across patient subgroups.

Objective: To measure the impact of invasive aspergillosis infection on US hospital costs and financial performance across different patient populations.

Methods: Hospital discharge data for patients with a primary or secondary diagnosis of aspergillosis were extracted from the 2003 Nationwide Inpatient Sample (NIS) and the fiscal year 2003 (FYO3) Medicare Provider Analysis and Review (MedPAR) file. The data on patient demographics, length of stay (LOS), hospital charges, estimated costs, and reimbursement levels were reported.

Cost-effectiveness analysis of antifungal prophylaxis in patients undergoing hematopoietic stem cell transplantation.

Background: Micafungin sodium is indicated for the prophylaxis of Candida infections in patients undergoing hematopoietic stem cell transplantation (HSCT). One Phase III, multi-institutional, randomized, doubleblind comparative trial involving 882 adult and pediatric patients found that micafungin was more effective, in terms of significantly lower rates of systemic fungal infections and empiric antifungal therapy (AFT), than fluconazole as antifungal prophylaxis during the neutropenic phase following HSCT. Thus, despite the higher cost of micafungin versus fluconazole, micafungin prophylaxis may be associated with reduced costs.

The impact of esophageal candidiasis on hospital charges and costs across patient subgroups.

Objective: Assess the impact of esophageal candidiasis on US hospital inpatient charges, length of stay (LOS), and costs across clinically relevant subgroups.

Methods: Total hospital charge (THC) and LOS data extracted from the 2005 National Inpatient Sample (NIS) were compared for patients with and without esophageal candidiasis within the top 20 most commonly assigned Diagnosis Related Groups (DRGs) for the disease. Total hospital costs were estimated using hospital charges in the 2005 Medicare Provider Analysis and Review (MEDPAR) file and hospital cost-to-charge ratios published in the Center for Medicare and Medicaid Service's (CMS) 2005 Inpatient Prospective Payment System Standardization File.

A multiple-domain framework of clinical, economic, and patient-reported outcomes for evaluating benefits of intervention in atopic dermatitis.

Atopic dermatitis (AD) increases health care utilization, affects patient quality of life, places a burden on caregivers, decreases patient/parent productivity, and adds to health care costs. Few studies have examined the effect of specific treatment modalities across a variety of AD-related outcomes. This prospective, multicenter, open-label longitudinal study of adult and pediatric patients with moderate to severe AD was conducted to evaluate the effect of a specific therapeutic intervention on AD-related outcomes over a period of 6 months.

Efficacy and economics of topical calcineurin inhibitors for the treatment of atopic dermatitis.

Atopic dermatitis is a chronic, relapsing inflammatory skin disease that frequently affects infants and children. The worldwide prevalence of atopic dermatitis is estimated to be 5-20% of the pediatric population. Studies have shown that atopic dermatitis is associated with considerable economic costs and decreased quality of life.

Hospital costs for left ventricular assist devices for destination therapy: lower costs for implantation in the post-REMATCH era.

Background: The use of left ventricular assist devices (LVADs) as an alternative to transplant, or destination therapy (end of life support), is an increasingly important option for patients with end-stage heart failure. Prior studies have examined hospital costs for LVAD implants performed during investigational studies (e.g.