Healthcare costs and resource utilization of asthma in Germany: a claims data analysis

Jacob C, Bechtel B, Engel S, et al. Healthcare costs and resource utilization of asthma in Germany: a claims data analysis. EUROPEAN JOURNAL OF HEALTH ECONOMICS. 2016;17(2):195-201.Introduction Asthma is associated with a substantial economic burden on the German Statutory Health Insurance. Aims and objectives To determine costs and resource utilization associated with asthma and to analyze the impact of disease severity on subgroups based on age and gender. Methods A claims database analysis from the statutory health insurance perspective was conducted. Patients with an ICD-10-GM code of asthma were extracted from a 10 % sample of a large German sickness fund. Five controls for each asthma patient matched by age and gender were randomly selected from the same database. Costs and resource utilization were calculated for each individual in the asthma and control group. Incremental asthma-related costs were calculated as the mean cost difference. Based on prescribed asthma medication, patients were classified as intermittent or persistent. In addition, age groups of B5, 6-18, and >18 years were analyzed separately and gender differences were investigated. Results Overall, 49,668 individuals were included in the asthma group. On average, total annual costs per patient were (sic)753 higher (p = 0.000)compared to the control group ((sic)2,168 vs. (sic)1,415). Asthma patients had significantly higher (p = 0.000)outpatient ((sic)217), inpatient ((sic)176), and pharmacy costs ((sic)259). Incremental asthma-related total costs were higher for patients with persistent asthma compared to patients with intermittent asthma ((sic)1,091 vs. (sic)408). Women aged[18 years with persistent asthma had the highest difference in costs compared to their controls ((sic.)1,207; p < 0.0001). Corresponding healthcare resource utilization was significantly higher in the asthma group (p = 0.000). Conclusions The treatment of asthma is associated with an increased level of healthcare resource utilization and significantly higher healthcare costs. Asthma imposes a substantial economic burden on sickness funds

Observational study on the impact of initiating tiotropium alone versus tiotropium with fluticasone propionate/salmeterol combination therapy on outcomes and costs in chronic obstructive pulmonary disease

Abstract Background This retrospective cohort study compared the risks of exacerbations and COPD-related healthcare costs between patients with chronic obstructive pulmonary disease (COPD) initiating tiotropium (TIO) alone and patients initiating triple therapy with fluticasone-salmeterol combination (FSC) added to TIO. Methods Managed-care enrollees who had an index event of ≥ 1 pharmacy claim for TIO during the study period (January 1, 2003-April 30, 2008) and met other eligibility criteria were categorized into one of two cohorts depending on their medication use. Patients in the TIO+FSC cohort had combination therapy with TIO and FSC, defined as having an FSC claim on the same date as the TIO claim. Patients in the TIO cohort had no such FSC use. The risks of COPD exacerbations and healthcare costs were compared between cohorts during 1 year of follow-up. Results The sample comprised 3333 patients (n = 852 TIO+FSC cohort, n = 2481 TIO cohort). Triple therapy with FSC added to TIO compared with TIO monotherapy was associated with significant reductions in the adjusted risks of moderate exacerbation (hazard ratio 0.772; 95% confidence interval [CI] 0.641, 0.930) and any exacerbation (hazard ratio 0.763; 95% CI 0.646, 0.949) and a nonsignificant reduction in COPD-related adjusted monthly medical costs. Conclusions Triple therapy with FSC added to TIO compared with TIO monotherapy was associated with significant reductions in the adjusted risks of moderate exacerbation and any exacerbation over a follow-up period of up to 1 year. These improvements were gained with triple therapy at roughly equal cost of that of TIO alone.</p

Healthcare Utilization and Costs of Systemic Lupus Erythematosus in Medicaid

Objective. Healthcare utilization and costs associated with systemic lupus erythematosus (SLE) in a US Medicaid population were examined. Methods. Patients ≥ 18 years old with SLE diagnosis (ICD-9-CM 710.0x) were extracted from a large Medicaid database 2002–2009. Index date was date of the first SLE diagnosis. Patients with and without SLE were matched. All patients had a variable length of followup with a minimum of 12 months. Annualized healthcare utilization and costs associated with SLE and costs of SLE flares were assessed during the followup period. Multivariate regressions were conducted to estimate incremental healthcare utilization and costs associated with SLE. Results. A total of 14,777 SLE patients met the study criteria, and 14,262 were matched to non-SLE patients. SLE patients had significantly higher healthcare utilization per year than their matched controls. The estimated incremental annual cost associated with SLE was $10,984, with the highest increase in inpatient costs (P<0.001). Cost per flare was$11,716 for severe flares, $562 for moderate flares, and$129 for mild flares. Annual total costs for patients with severe flares were $49,754. Conclusions. SLE patients had significantly higher healthcare resource utilization and costs than non-SLE patients. Patients with severe flares had the highest costs

Search for Z' bosons decaying to pairs of heavy Majorana neutrinos in proton-proton collisions at s\sqrt{s} = 13 TeV

International audienceA search for the production of pairs of heavy Majorana neutrinos (N$_\ell$) from the decays of Z' bosons is performed using the CMS detector at the LHC. The data were collected in proton-proton collisions at a center-of-mass energy of $\sqrt{s}$ = 13 TeV, with an integrated luminosity of 138 fb$^{-1}$. The signature for the search is an excess in the invariant mass distribution of the final-state objects, two same-flavor leptons (e or $\mu$) and at least two jets. No significant excess of events beyond the expected background is observed. Upper limits at 95% confidence level are set on the product of the Z' production cross section and its branching fraction to a pair of N$_\ell$, as functions of N$_\ell$ and Z' boson masses ($m_{\mathrm{N}_\ell}$ and $m_\mathrm{Z'}$, respectively) for $m_\mathrm{Z'}$ from 0.4 to 4.6 TeV and $m_{\mathrm{N}_\ell}$ from 0.1 TeV to $m_\mathrm{Z'}$/2. In the theoretical framework of a left-right symmetric model, exclusion bounds in the $m_{\mathrm{N}_\ell}$-$m_\mathrm{Z'}$ plane are presented in both the electron and muon channels. The observed upper limit on $m_\mathrm{Z'}$ reaches up to 4.42 TeV. These are the most restrictive limits to date on the mass of N$_\ell$ as a function of the Z' boson mass

Search for new physics using effective field theory in 13 TeV pppp collision events that contain a top quark pair and a boosted ZZ or Higgs boson

A data sample containing top quark pairs ($\mathrm{t\bar{t}}$) produced in association with a Lorentz-boosted Z or Higgs boson is used to search for signs of new physics using effective field theory. The data correspond to an integrated luminosity of 138 fb$^{-1}$ of proton-proton collisions produced at a center-of-mass energy of 13 TeV at the LHC and collected by the CMS experiment. Selected events contain a single lepton and hadronic jets, including two identified with the decay of bottom quarks, plus an additional large-radius jet with high transverse momentum identified as a Z or Higgs boson decaying to a bottom quark pair. Machine learning techniques are employed to discriminate between $\mathrm{t\bar{t}}$Z or $\mathrm{t\bar{t}}$H events and events from background processes, which are dominated by $\mathrm{t\bar{t}}$ + jets production. No indications of new physics are observed. The signal strengths of boosted $\mathrm{t\bar{t}}$Z and $\mathrm{t\bar{t}}$H production are measured, and upper limits are placed on the $\mathrm{t\bar{t}}$Z and $\mathrm{t\bar{t}}$H differential cross sections as functions of the Z or Higgs boson transverse momentum. The effects of new physics are probed using a framework in which the standard model is considered to be the low-energy effective field theory of a higher energy scale theory. Eight possible dimension-six operators are added to the standard model Lagrangian and their corresponding coefficients are constrained via fits to the data

Measurement of the cross section of top quark-antiquark pair production in association with a W boson in proton-proton collisions at s \sqrt{s} = 13 TeV

The production of a top quark-antiquark pair in association with a W boson ($\textrm{t}\overline{\textrm{t}}\textrm{W}$) is measured in proton-proton collisions at a center-of-mass energy of 13 TeV. The analyzed data was recorded by the CMS experiment at the CERN LHC and corresponds to an integrated luminosity of 138 fb$^{−1}$. Events with two or three leptons (electrons and muons) and additional jets are selected. In events with two leptons, a multiclass neural network is used to distinguish between the signal and background processes. Events with three leptons are categorized based on the number of jets and of jets originating from b quark hadronization, and the lepton charges. The inclusive $\textrm{t}\overline{\textrm{t}}\textrm{W}$ production cross section in the full phase space is measured to be 868 ± 40(stat) ± 51(syst) fb. The $\textrm{t}\overline{\textrm{t}}\textrm{W} ^{+}$ and $\textrm{t}\overline{\textrm{t}}\textrm{W} ^{−}$ cross sections are also measured as 553 ± 30(stat) ± 30(syst) and 343 ± 26(stat) ± 25(syst) fb, respectively, and the corresponding ratio of the two cross sections is found to be $1.61\pm 0.15{\left(\textrm{stat}\right)}_{-0.05}^{+0.07}\left(\textrm{syst}\right)$. The measured cross sections are larger than but consistent with the standard model predictions within two standard deviations, and represent the most precise measurement of these cross sections to date.[graphic not available: see fulltext

Search for nonresonant Higgs boson pair production in the four leptons plus twob jets final state in proton-proton collisions at s \sqrt{s} = 13 TeV

The first search for nonresonant production of Higgs boson pairs (HH) with one H decaying into four leptons and the other into a pair of b quarks is presented, using proton-proton collisions recorded at a center-of-mass energy of $\sqrt{s}$ = 13 TeV by the CMS experiment. The analyzed data correspond to an integrated luminosity of 138 fb$^{−1}$. A 95% confidence level upper limit of 32.4 is set on the signal strength modifier μ, defined as the ratio of the observed HH production rate in the $\textrm{HH}\to {\textrm{ZZ}}^{\ast}\textrm{b}\overline{\textrm{b}}\to 4\ell \textrm{b}\overline{\textrm{b}}$ decay channel to the standard model (SM) expectation. Possible modifications of the H trilinear coupling λ$_{HHH}$ with respect to the SM value are investigated. The coupling modifier κ$_{λ}$, defined as λ$_{HHH}$ divided by its SM prediction, is constrained to be within the observed (expected) range −8.8 (−9.8) < κ$_{λ}$< 13.4 (15.0) at 95% confidence level.[graphic not available: see fulltext

Search for long-lived particles decaying to a pair of muons in proton-proton collisions at s \sqrt{s} = 13 TeV

An inclusive search for long-lived exotic particles decaying to a pair of muons is presented. The search uses data collected by the CMS experiment at the CERN LHC in proton-proton collisions at $\sqrt{s}$ = 13 TeV in 2016 and 2018 and corresponding to an integrated luminosity of 97.6 fb$^{−1}$. The experimental signature is a pair of oppositely charged muons originating from a common secondary vertex spatially separated from the pp interaction point by distances ranging from several hundred μm to several meters. The results are interpreted in the frameworks of the hidden Abelian Higgs model, in which the Higgs boson decays to a pair of long-lived dark photons Z$_{D}$, and of a simplified model, in which long-lived particles are produced in decays of an exotic heavy neutral scalar boson. For the hidden Abelian Higgs model with m(Z$_{D}$) greater than 20 GeV and less than half the mass of the Higgs boson, they provide the best limits to date on the branching fraction of the Higgs boson to dark photons for cτ(Z$_{D}$) (varying with m(Z$_{D}$)) between 0.03 and ≈0.5 mm, and above ≈0.5 m. Our results also yield the best constraints on long-lived particles with masses larger than 10 GeV produced in decays of an exotic scalar boson heavier than the Higgs boson and decaying to a pair of muons.[graphic not available: see fulltext

Observation of electroweak W+W− pair production in association with two jets in proton-proton collisions at <math altimg="si1.svg"><msqrt><mrow><mi>s</mi></mrow></msqrt><mo linebreak="goodbreak" linebreakstyle="after">=</mo><mn>13</mn><mspace width="0.2em"/><mtext>TeV</mtext></math>

International audienceAn observation is reported of the electroweak production of a W+W− pair in association with two jets, with both W bosons decaying leptonically. The data sample corresponds to an integrated luminosity of 138fb−1 of proton-proton collisions at s=13TeV, collected by the CMS detector at the CERN LHC. Events are selected by requiring exactly two opposite-sign leptons (electrons or muons) and two jets with large pseudorapidity separation and high dijet invariant mass. Events are categorized based on the flavor of the final-state leptons. A signal is observed with a significance of 5.6 standard deviations (5.2 expected) with respect to the background-only hypothesis. The measured fiducial cross section is 10.2±2.0fb and this value is consistent with the standard model prediction of 9.1±0.6fb