Digoxin Toxicity and Use of Digoxin Immune Fab: Insights From a National Hospital Database.

Objectives: This study was developed to determine contemporary management of digoxin toxicity and clinical outcomes.

Background: Although the use of digoxin in heart failure management has declined, toxicity remains a prevalent complication.

Methods: The Premier Perspective Comparative Hospital Database (Premier Inc.

Administration and Burden of Subcutaneous Immunotherapy for Allergic Rhinitis in U.S. and Canadian Clinical Practice.

Background: Allergy immunotherapy (AIT) is the only available treatment that alters the natural course of allergies and has possible disease-modifying effects. AIT is administered primarily via subcutaneous injection delivered in a physician's office. Few studies have been conducted in the United States or Canada to evaluate the costs of subcutaneous immunotherapy (SCIT).

Prevalence and healthcare costs of obesity-related comorbidities: evidence from an electronic medical records system in the United States.

Objective: This study estimated the economic burden of obesity-related comorbidities (ORCs) in the US, at both the person and population levels.

Methods: The Geisinger Health System provided electronic medical records and claims between January 2004 and May 2013 for a sample of 153,561 adults (50% males and 97% white). Adults with < 2 years of data, who were underweight (body mass index (BMI) < 18.

The Economic Burden of Obesity by Glycemic Stage in the United States.

Background: Electronic medical records and insurance claims data from the Geisinger Health System were examined to assess the real-world healthcare costs of being overweight or obese at different glycemic stages, including normal glycemia, pre-diabetes (PreD), and type 2 diabetes (T2D).

Methods: The medical history of the sample subjects was segmented into different glycemic stages via diagnosis codes, glycosylated hemoglobin A1c or fasting plasma glucose laboratory results, and use of antidiabetic drugs. Healthcare resource utilization captured by the claims and associated costs (in 2013 values) were examined for each glycemic stage.

Variation in the risk of progression between glycemic stages across different levels of body mass index: evidence from a United States electronic health records system.

Objective: The purpose of this study was to assess how the risks of glycemic stage transitions observed in clinical practice vary with body mass index (BMI). These transitions included progression from euglycemia ('normal') to prediabetes (PreD) and from PreD to type 2 diabetes (T2D), as well as from normal directly to T2D, and reversions from PreD to normal.

Methods: We examined the Geisinger Health System electronic health records and insurance claims data, segmenting a subject's medical history into normal, PreD, and/or T2D glycemic stages via diagnosis codes, glycosylated hemoglobin A1c (HbA1c) or fasting plasma glucose lab results, and use of anti-diabetic drugs.

Tumor necrosis factor-blocker dose escalation in rheumatoid arthritis patients in a pharmacy benefit management setting.

Introduction: Dose escalation with tumor necrosis factor (TNF)-blockers is poorly characterized in pharmacy benefit management (PBM) settings.

Methods: This retrospective study used integrated pharmacy and medical claims from the PBM Medco to characterize dose escalation among rheumatoid arthritis (RA) patients treated with etanercept and adalimumab. Data from adults with RA with pharmacy claims for etanercept or adalimumab between 1/1/2007 and 12/31/2009 and continuous enrollment for ≥ 6 months before and ≥ 12 months after first (index) pharmacy claim were analyzed.

Quality of life and healthcare utilisation in cystic fibrosis: a multicentre study.

The aim of our study was to discover the health status and healthcare utilisation associated with pulmonary exacerbations in cystic fibrosis (CF) and chronic Pseudomonas aeruginosa infection. Patients with CF from five UK CF centres attended two visits, 8-12 weeks apart. They were classified at visit 1 as being in one of the three health states: no current pulmonary exacerbation; "mild" (no hospitalisation) pulmonary exacerbation; and "severe" (hospitalisation) pulmonary exacerbation.

Increasing the use of arteriovenous fistula in hemodialysis: economic benefits and economic barriers.

The Fistula First Initiative set a goal of 66% arteriovenous (AV) fistula-based access among US hemodialysis patients. This study modeled the impact of achieving the target AV fistula placement rate on Medicare expenditures and on dialysis patient survival and also reviewed economic disincentives for providers that will inhibit achieving this target. The model projects lifetime costs and survival in the US 2003 incident hemodialysis population.

Practice patterns for managing Helicobacter pylori infection and upper gastrointestinal symptoms.

Objective: To assess adherence with guidelines for testing and treatment of Helicobacter pylori infection and upper gastrointestinal symptoms.

Study Design: Retrospective longitudinal cohort analysis of patient-level medical and pharmacy claims from 75 US managed care plans.

Methods: Persons with new claims for antisecretory medication, H pylori tests, or endoscopies were selected from among 2 million plan members continuously enrolled from 2001 to 2004 and were grouped by initial clinical diagnosis (3456 with peptic ulcer disease [PUD], 14,593 with nonulcer dyspepsia [NUD], and 36,233 with gastroesophageal reflux disease [GERD]).

Selective cyclooxygenase-2 inhibition and cardiovascular effects: an observational study of a Medicaid population.

Background: The differential effects of selective cyclooxygenase-2 (COX-2) inhibitors compared with nonspecific nonsteroidal anti-inflammatory agents (NSAIDs) on platelet aggregation and prostacyclin/thromboxane balance have led to concerns that COX-2 inhibitors may increase the risk for cardiovascular thrombotic events. Empirical studies have generally been limited to analyses of secondary end points with low event rates in clinical trials and single event rates in observational studies, all of which have come to conflicting conclusions. This observational cohort study examines the cardiovascular risk of COX-2 inhibitors compared with nonspecific NSAIDs in Maryland Medicaid enrollees, a high-risk population.