The Association Between Alpha-1 Adrenergic Receptor Antagonists and In-Hospital Mortality From COVID-19.

Effective therapies for coronavirus disease 2019 (COVID-19) are urgently needed, and pre-clinical data suggest alpha-1 adrenergic receptor antagonists (α-AR antagonists) may be effective in reducing mortality related to hyperinflammation independent of etiology. Using a retrospective cohort design with patients in the Department of Veterans Affairs healthcare system, we use doubly robust regression and matching to estimate the association between baseline use of α-AR antagonists and likelihood of death due to COVID-19 during hospitalization. Having an active prescription for any α-AR antagonist (tamsulosin, silodosin, prazosin, terazosin, doxazosin, or alfuzosin) at the time of admission had a significant negative association with in-hospital mortality (relative risk reduction 18%; odds ratio 0.

Cost-effectiveness of a nurse-delivered, inpatient smoking cessation intervention.

Randomized controlled trials have shown that inpatient tobacco cessation interventions are highly efficacious and cost-effective. However, the degree to which smoking interventions implemented in nonrandomized, real-world practice settings are effective, and consequently, cost-effective, remains unclear. This study evaluated the cost-effectiveness of a nurse-delivered, inpatient smoking cessation intervention, Tobacco Tactics, compared with usual care within the context of an observational, real-world study design.

Off-Pump Versus On-Pump Impact: Diabetic Patient 5-Year Coronary Artery Bypass Clinical Outcomes.

Background: For diabetic patients who require coronary artery bypass graft (CABG) operation, controversy persists whether an off-pump or an on-pump approach may be advantageous. This US-based, multicenter, randomized, controlled trial, Department of Veterans Affairs Randomization On versus Off Bypass Follow-up Study, compared diabetic patients' 5-year clinical outcomes for off-pump versus on-pump procedures.

Methods: From 2002 to 2008, 835 medically treated (ie, oral hypoglycemic agent or insulin) diabetic patients underwent either off-pump (n = 402) or on-pump (n = 433) CABG.

Impact of Primary Care Intensive Management on High-Risk Veterans' Costs and Utilization: A Randomized Quality Improvement Trial.

Background: Primary care models that offer comprehensive, accessible care to all patients may provide insufficient resources to meet the needs of patients with complex conditions who have the greatest risk for hospitalization.

Objective: To assess whether augmenting usual primary care with team-based intensive management lowers utilization and costs for high-risk patients.

Design: Randomized quality improvement trial.

The Healing and Empowering Alaskan Lives Toward Healthy-Hearts (HEALTHH) Project: Study protocol for a randomized controlled trial of an intervention for tobacco use and other cardiovascular risk behaviors for Alaska Native People.

Background: Tobacco use and tobacco-related diseases disproportionately affect Alaska Native (AN) people. Using telemedicine, this study aims to identify culturally-tailored, theoretically-driven, efficacious interventions for tobacco use and other cardiovascular disease (CVD) risk behaviors among AN people in remote areas.

Design: Randomized clinical trial with two intervention arms: 1) tobacco and physical activity; 2) medication adherence and a heart-healthy AN diet.

Comparison of Accessibility, Cost, and Quality of Elective Coronary Revascularization Between Veterans Affairs and Community Care Hospitals.

Importance: The Veterans Affairs (VA) Community Care (CC) Program supplements VA care with community-based medical services. However, access gains and value provided by CC have not been well described.

Objectives: To compare the access, cost, and quality of elective coronary revascularization procedures between VA and CC hospitals and to evaluate if procedural volume or publicly reported quality data can be used to identify high-value care.

Cost-effectiveness of extended cessation treatment for older smokers.

Aims: We examined the cost-effectiveness of extended smoking cessation treatment in older smokers.

Design: Participants who completed a 12-week smoking cessation program were factorial randomized to extended cognitive behavioral treatment and extended nicotine replacement therapy.

Setting: A free-standing smoking cessation clinic.

Comparison of costs and utilization among buprenorphine and methadone patients.

Aims: Buprenorphine is an effective alternative to methadone for treatment of opioid dependence, but economic concerns represent a barrier to implementation. The economic impacts of buprenorphine adoption by the US Veterans Health Administration (VHA) were examined.

Design: Prescriptions of buprenorphine, methadone treatment visits, health-care utilization and cost, and diagnostic data were obtained for 2005.

Administrative delays and chronic disability in patients with acute occupational low back injury.

Objectives: This study assessed whether an organizational factor, delays to claim acceptance or administrative delays, had an influence on outcomes for individuals with acute back injuries in the workers' compensation system.

Methods: Multivariate logistic regression was used to test whether individuals who experienced administrative delays were more likely to develop chronic disability than those who did not experience delays.

Results: Beyond the first 2 weeks, each interval of administrative delay was associated with increased odds of developing chronic disability.

Effect of incentives for medication adherence on health care use and costs in methadone patients with HIV.

Background: The potential benefits of anti-retroviral therapy for HIV is not fully realized because of difficulties in adherence with demanding treatment regimens, especially among injection drug users.

Methods: HIV-positive methadone patients who were less than 80% adherent with their primary anti-retroviral therapy were randomized to a trial of incentives for on-time adherence. Adherence was rewarded with an escalating scale of vouchers redeemable for goods.

Prescription drug co-payments and cost-related medication underuse.

Co-payments have been linked to the slowing growth in pharmaceutical spending over the last five years. However, patients with health problems frequently have difficulty affording their pharmacotherapy and fail to take their medication as prescribed. We examine the relationship between co-payment amounts and four types of cost-related underuse: taking fewer doses, postponing taking a medication, failing to fill a prescription at all, and taking medication less frequently than prescribed.

Behavioral interventions and cost-effectiveness analysis.

Behavioral health interventions are often gauged with a dichotomous outcome, "success" or "failure." Hidden by this dichotomy is a series of behavior changes that can be followed with the Transtheoretical Model (stages of change). There has been little consideration, however, about whether this information can and should be used in cost-effectiveness analysis.