Effect of a continuous measure of adherence with infliximab maintenance treatment on inpatient outcomes in Crohn’s disease

Chureen T Carter,1 Heidi C Waters,1 Daniel B Smith21Health Economics and Outcomes Research, Janssen Scientific Affairs, LLC, Horsham, PA, USA; 2Statistics, IMS Health, Watertown, MA, USABackground: To assess the impact of a continuous measure of adherence with infliximab maintenance treatment in Crohn's disease (CD) during the first year of treatment on CD-related health care utilization, CD-related hospitalizations, inpatient costs, and length of hospital stay.Patients and methods: A retrospective claims analysis using the IMS LifeLink Health Plan Claims Database (September 1, 2004, to June 30, 2009) was conducted. Continuous enrollment for 12 months before and 12 months after the index date was required. Patients were required to have at least two claims with an International Classification of Diseases, 9th Revision, Clinical Modification diagnosis code for CD (555.xx) pre-index and be aged ≥ 18 years at index. Patients with three infusions during the first 56 days post-index and at least one infusion following day 56 post-index were considered to have maintenance therapy. Adherence and nonadherence were defined as a medication possession ratio of ≥ 80% and < 80%, respectively.Results: Four hundred forty-eight patients were included in the analysis (mean age, 42.6 years; 56% female; mean ± standard deviation [SD] and median number of infliximab infusions, 7.35 ± 1.60 and 8). The number of patients who met the definition of adherence was 344 (77%). CD-related health care utilization was not significantly impacted by adherence except for ancillary services and radiology. Fewer adherent patients were hospitalized compared with nonadherent patients (9% versus 16%; P = 0.03). Adherent patients had fewer mean ± SD and median days in the hospital (5.5 ± 3.4 and 5 days) compared with nonadherent patients (13.1 ± 14.2 and 8 days; P = 0.01). Mean ± SD and median hospital costs were significantly greater for nonadherent patients (40,822 ± 49,238 and $28,864) compared with adherent patients ($13,704 ± $10,816 and$9938; P = 0.002).Conclusion: Adherence with maintenance infliximab over 12 months was associated with lower rates of CD-related hospitalizations and inpatient costs and a shorter length of hospital stay.Keywords: costs, Crohn's disease, hospitalization, infliximab, length of stay, medication adherenc

How does quality enter into health care purchasing decisions?

A number of employers, business consortia, and public purchasers are promoting value-based purchasing as a way to improve the quality of patient care. Some purchasers are using publicly available information on health plan and provider performance to make their health plan and provider choices, while others are using their market power to drive improvements in patient care and safety. This article examines six key strategies used by purchasers

Work Loss, Healthcare Utilization, and Costs among US Employees with Chronic Pain

Background: Chronic pain in the workplace significantly affects individuals who experience a variety of conditions resulting in increased financial burden to their employers. The objective of this study was to determine the economic impact of chronic non-cancer pain by measuring the number and cost of days missed from work and the amount paid for healthcare related to chronic pain. Methods: Retrospective analysis of a sample of employees from the MEDSTAT Health and Productivity Management database, using absence data and short-term disability claims, as well as inpatient, outpatient, and pharmacy claims. Participants were employees from six large US corporations during 1997-1999 with full-time work status and claims totaling at least 90 days' supply of opioid medication and a medical visit with a diagnosis for a painful condition during the study period. Work loss was estimated by using location-specific wage rates to estimate the value of time missed from work in dollars ($US, 1998 values). Healthcare costs were calculated from the amount paid for the employees' claims for outpatient office visits, hospitalizations, and prescription medications. Results: 2459 employees met the inclusion criteria, of whom 1512 (61.5$US39.4 million in wages during the 3-year period. Combined medical and pharmacy costs were $US4607 per employee per year for pain-related healthcare overall. The estimated total impact of chronic pain for each employer who contributed to the data set was approximately$US2.1 million per employer per year. Discussion: The findings demonstrate that employees with chronic pain experience frequent sickness absences and short-term disability days and consume a considerable amount of healthcare resources. Given the economic impact of chronic pain, employers and managed care organizations should evaluate the potential benefits in productivity resulting from workplace initiatives such as ergonomic modifications, rest breaks, or pain management programs.Cost-analysis, Health-economics, Pain

A multicenter, non-interventional study to evaluate patient-reported experiences of living with psoriasis

<p><i>Background</i>: Moderate to severe plaque psoriasis (with or without psoriatic arthritis) places significant burden on patients’ lives. <i>Objective</i>: Explore and document patients’ experiences of living with psoriasis, including symptoms, treatments, impact on daily lives and patient-reported functioning. <i>Methods</i>: In a US-based, non-interventional study, narrative interviews were conducted at baseline and again within 16 weeks. In interviews, patients with moderate to severe psoriasis indicated symptoms, ranked symptoms according to level of bother and indicated areas of their lives affected by psoriasis. Transcripts of interviews were coded for themes. Measurements of psoriasis severity including BSA, PGA and PASI were recorded. <i>Results</i>: Symptoms reported most frequently included flaking/scaling (non-scalp areas), itching/scratching and rash, while the most bothersome symptoms were itching/scratching, flaking/scaling (non-scalp areas) and skin pain. Frequently reported impact areas were social and emotional. <i>Conclusion</i>: Broad-reaching interviews with patients with psoriasis show that these patients suffer in many aspects of their lives and in ways not indicated by typical psoriasis severity measures. Patients with psoriatic arthritis reported symptoms and disease-related complications at higher rates than those without arthritis. Physicians’ explorations of the effect of psoriasis on patients’ life events could aid in managing these patients.</p

Digital recruitment and enrollment in a remote nationwide trial of screening for undiagnosed atrial fibrillation: Lessons from the randomized, controlled mSToPS trial

Objectives: The advent of large databases, wearable technology, and novel communications methods has the potential to expand the pool of candidate research participants and offer them the flexibility and convenience of participating in remote research. However, reports of their effectiveness are sparse. We assessed the use of various forms of outreach within a nationwide randomized clinical trial being conducted entirely by remote means. Methods: Candidate participants at possibly higher risk for atrial fibrillation were identified by means of a large insurance claims database and invited to participate in the study by their insurance provider. Enrolled participants were randomly assigned to one of two groups testing a wearable sensor device for detection of the arrhythmia. Results: Over 10 months, the various outreach methods used resulted in enrollment of 2659 participants meeting eligibility criteria. Starting with a baseline enrollment rate of 0.8% in response to an email invitation, the recruitment campaign was iteratively optimized to ultimately include website changes and the use of a five-step outreach process (three short, personalized emails and two direct mailers) that highlighted the appeal of new technology used in the study, resulting in an enrollment rate of 9.4%. Messaging that highlighted access to new technology outperformed both appeals to altruism and appeals that highlighted accessing personal health information. Conclusions: Targeted outreach, enrollment, and management of large remote clinical trials is feasible and can be improved with an iterative approach, although more work is needed to learn how to best recruit and retain potential research participants. Trial registration: Clinicaltrials.gov NCT02506244. Registered 23 July 2015. Keywords: Clinical trials, Clinical research, Digital technology, Remote enrollment, Remote monitoring, Outreac