Severity index for rheumatoid arthritis and its association with health care costs and biologic therapy use in Turkey

Objective: This study aimed to apply the previously validated severity index for rheumatoid arthritis (SIFRA) to prevalent rheumatoid arthritis (RA) groups in Turkey and determine the effect of RA severity on health care costs and biologic use. Methods: This retrospective study used the Turkish national health insurance database MEDULA (June 1, 2009-December 31, 2011). Prevalent RA patients were required to be age 18 to 99, have two RA diagnoses at least 60 days apart and be continuously enrolled 1 year prior to (baseline period) and post (follow-up period) index date, which was the first RA claim during the identification period (June 1, 2010-December 31, 2010). SIFRA was calculated for the baseline period. Total health care costs and biologic use were examined for the follow-up period. The chi-square test was used to determine the association between SIFRA score terciles and outcomes. Generalized linear models were applied to determine health care costs while multivariate logistic regression determined the effect of SIFRA on outcome measures for biologic use. Results: A total of 1,920 patients were identified. The mean SIFRA score was 14.21, and 7.05 (49.57%) of the mean composed of clinical and functional status variables, followed by 6.32 (44.47%) for medications, 0.48 (3.40%) for radiology and laboratory findings, and 0.32 (2.25%) for extra-articular manifestation. There was a significant variation in scores across cities. After controlling for age, gender, region, and comorbidity index, patients in the high SIFRA tercile were 5.16 times more likely to be prescribed biologics (p<0.001, confidence interval [CI]: 3.46-7.69), and incurred annual health care costs that were 2,091 higher (p<0.001, CI: 1,557 - 2,625) than those in the low SIFRA score tercile. Conclusion: RA severity varies throughout Turkey and is a significant determinant of health care costs and biologic therapy use. Therefore, future comparative effectiveness studies should include the severity measure in their analysis

Coronary Angiography Utilization and Costs for Coronary Artery Bypass Graft Surgery Patients in Turkey

INTRODUCTION: To assess excess use of coronary angiography prior to coronary artery bypass graft surgery and its association with mortality, health care costs, and hospital quality in Turkey. METHODS: Using Turkish National Health Insurance Data (2009–2011) that included patients who underwent cardiac surgery, coronary angiography utilization was identified. Propensity score matching was used to compare survival rates and annual health care costs of patients in a coronary angiography excess-use group (>1 angiogram) and in a standard-therapy group (1 angiogram). The empirical Bayesian approach was used to combine mortality and hospital volume for quality index. The relationship between hospital quality and excess use of coronary angiography was assessed using Chi-squared tests. RESULTS: Out of 20,126 patients identified, 7.27% of patients underwent excessive coronary angiography procedures (excess-use group), with an average annual cost at 9.7% higher than those who had a single angiography (standard-therapy group; P < 0.01). Operational mortality associated with excessive use was significantly higher as well (7.4% versus 5.4%, P < 0.02). There exists variation in the use of coronary angiography across cities and hospitals. Patients who underwent cardiac surgery in high-quality hospitals were less likely to have excessive angiography use than those in low-quality hospitals (7.0% versus 9.5%, P < 0.01). CONCLUSION: In Turkey, excess use of coronary angiography prior to coronary artery bypass graft surgery is associated with higher operational mortality, higher expenditures, and lower hospital quality

Health Care Costs Associated with Ankylosing Spondylitis in Turkey: An Analysis from Nationwide Real-World Data

Objectives. To explore health care costs associated with ankylosing spondylitis (AS) in Turkey. Methods. Research-identified data from a system that processes claims for all Turkish health insurance funds were analyzed. Adult prevalent and incident AS patients with two AS visits at least 60 days apart, identified between June 1, 2010 and December 31, 2010, with at least 1 year of continuous health plan enrollment for the baseline and follow-up years were included in the study. Pharmacy, outpatient, and inpatient claims were compiled over the study period for the selected patients. Generalized linear models were used to estimate the expected annual costs, controlling for baseline demographic and clinical characteristics. Results. A total of 2.986 patients were identified, of which 603 were incident cases and 2.383 prevalent cases. The mean ages were 39 and 41 years, respectively, and 44% and 38% were women for incident and prevalent cases. Prevalent patients had higher comorbidity scores (5.01 versus 2.24, P<0.001) and were more likely to be prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) (77% versus 72%, P<0.001) or biologics (35% versus 8%, P<0.006) relative to incident patients. Seventy-seven percent of prevalent patients were prescribed NSAIDs, followed by biologic and disease-modifying antirheumatic drugs (DMARDs). Total annual medical costs for incident AS patients were €2.253 and €4.233 for prevalent patients. Pharmacy costs accounted for a significant portion of total costs (88% for prevalent patient, 77% for incident patient), followed by physician office visit costs. Prior comorbidities and treatment type also significantly contributed to overall costs. Conclusion. Annual expenditures for AS patients in Turkey were comparable relative to European countries. Pharmaceutical expenditures cover a significant portion of the overall costs. Comparative effectiveness studies are necessary to further decrease health care costs of AS treatment

Comparison of Methods for Detection of Blastocystis Infection in Routinely Submitted Stool Samples, and also in IBS/IBD Patients in Ankara, Turkey

BACKGROUND: This study compared diagnostic methods for identifying Blastocystis in stool samples, and evaluated the frequency of detection of Blastocystis in patients with irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). RESULTS AND DISCUSSION: From a set of 105 stool specimens submitted for routine parasitological analysis, 30 were identified as positive for Blastocystis by the culture method. From that group of 30 positives, Lugol's stain, trichrome staining, and an immunofluorescence assay identified 11, 15, and 26 samples as positive respectively. Using culture as a standard, the sensitivity of Lugol's stain was 36.7%, trichrome staining was 50%, and the IFA stain was 86.7%. The specificity of Lugol's stain was 91%, trichrome staining was 100%, and the IFA stain was 97.3%. In the group of 27 IBS and IBD patients, using all methods combined, we detected Blastocystis in 67% (18/27) of the patients. Blastocystis was detected in 33% (2/6) of IBD patients and 76% (16/21) of IBS patients. For comparison, trichrome staining alone, the method most frequently used in many countries, would have only identified Blastocystis infection in 29% (6/21) of the IBS patients. No parasitic co-infections were identified in the IBS/IBD patients. Most Blastocystis-positive IBS/IBD patients were over 36 with an average length of illness of 4.9 years. CONCLUSIONS: Most IBS patients in this study were infected with Blastocystis. IFA staining may be a useful alternative to stool culture, especially if stool specimens have been chemically preserved

Hepatit B virus enfeksiyonu nedenli karaciğer nakillerde son yıllardaki değişim

In the last decade, both hepatitis B virus (HBV)prevalence and mortality related to HBV infection have decreased promptly.Worldwide HBV vaccination programs, precautions against HBV transmission andeffective anti-viral drugs on market play crucial role for this encouragingresult. Besides stopping or reversing the hepato-fibrogenesis induced by HBVinfection, fighting against HBV related acute severe hepatitis are alsoimproved recently. HBV associated cirrhosis is still the major cause ofLTx, particularly in developing countries,whereas in developed countries, therate of LTx due to HBV induced cirrhosis has declined over time. With theexpanding use of NUCs before LTx, and the use of NUCs and HBIg even after LTx,HBV recurrence after LTx is no longer an important reason for graft loss orpatient death. However, this positive impact is not yet reflecting survival,probably because of increasing recipient and donor ages. On the other hand, inthe era of Milan criteria, overall hepatocellular carcinoma (HCC) survival hasso increased that the number of transplanted HCC cases has almost doubled.However tumor recurrence is still the major cause of death, and treatment isstill problematic.Hepatit B virus (HBV) enfeksiyonu prevelansındaki veHBV ilişkili mortalitesindeki azalma son yıllarda oldukça dikkat çekicidir. Dünyaçapında yaygın olarak uygulanan HBV aşı programları ve HBV’ye karşı kullanımda olananti-viral ilaçların etkinliği bu başarıda başat rol oynamaktadır. HBV ile mücadelede,sadece HBV’ye bağlı karaciğer fibrozunun ilerlemesi veya geriye döndürülmesi değil,aynı zamanda HBV ilişkili şiddetli akut hepatit tablosunun tedavisinde güzel sonuçlaralınmaktadır. Gelişmekte olan ülkelerde HBV ilişkili siroz karaciğer nakli konusundahalen esas sebep iken, gelişmiş ülkelerde zaman içinde HBV nedenli karaciğer nakilsıklıkları ciddi oranda düşüş göstermiştir. Anti-viral ilaçların karaciğer nakliöncesi etkin kullanımı, HBIg tedavisinin nakil sonrasında yaygın olarak kullanımısayesinde karaciğer nakli sonrası HBV nüksü, mortalite ve greft kaybı konusundaeskisi kadar sorun olmaktan çıkmıştır. Bu başarının nakil sonrası sürviler üzerinebariz bir yansıması henüz olmamıştır. Buradaki esas sebep ise, alıcı ve verici yaşınınson yıllarda önemli oranda artış göstermesi olarak gösterilmektedir. Ekolarak,Milan kriterlerinin yaygın olarak klinik pratiğe girmesiyle karaciğer nakli yapılanhepatosellüler kanser (HCC) hasta sayısı da neredeyse ikiye katlamıştır. Ancak,HCC rekürrensi, nakil sonrası en önemli ölüm nedeni olarak devam etmektedir.Turkish Journal of Clinics and LaboratoryTurkish Journal of Clinics and Laborator

Utility Of M30, An Apoptotic Serum Marker, In Liver Diseases

The aim of this paper is to evaluate the role of apoptosis in some common liver diseases, and the utility of M30, an apoptotic serum marker, in the diagnosis of the severity of underlying hepatic injury. As is widely known, apoptosis is programmed cell death, and its deregulation results in an uncontrolled inflammatory process leading to upregulation of liver fibrogenesis. Both extrinsic and intrinsic pathways are crucial in apoptosis, and caspase cleavage of cytokeratin proteins occurs in both. Therefore, the measurement of caspase-cleaved cytokeratin fragments could be a novel method to assess the intensity of apoptotic cell numbers in epithelial tissue damage. M30 levels were found to increase not only in acute liver disorders, but also in some chronic liver injuries. We tried to summarize the recent studies focused on the role of apoptotic processes in liver diseases, mainly those that investigated the use of M30 in determining the severity of, or in predicting, ongoing liver injury.WoSScopu