Medicaid Expenditures for Cancer: Evidence from Medicaid-only Beneficiaries in Four States

This study estimates the cost burden of 6 prevalent invasive cancers—breast, cervical, colorectal, lung, melanoma, and prostate—on Medicaid programs in 4 states. The analyses use Medicaid claims and enrollment data for all Medicaid-only beneficiaries over age 18 in Georgia, Illinois, Louisiana, and Maine with at least 1 month of enrollment in fee-for-service Medicaid from 2000 to 2003. We applied ordinary least squares regression analysis to a data set created from Medicaid claims and enrollment data to estimate annual expenditures attributable to each cancer after controlling for age, race, gender, and comorbid conditions. Cancers and comorbid conditions were identified on the basis of claims with an appropriate diagnosis code. Cancers include both incident and prevalent cases. In 2003 dollars, annualized Medicaid expenditures attributable to the 6 cancers combined in the Medicaid-only population were $84.0 million in Georgia,$79.7 million in Illinois, $51.4 million in Louisiana, and$29.4 million in Maine. Attributable annualized per-capita Medicaid expenditures were highest for lung cancer, then colorectal cancer. After adjusting for sociodemographics and comorbidities, only 10% to 50% of medical expenditures among Medicaid-only beneficiaries with cancer were attributable to cancer. Estimates of the costs of care for Medicaid-eligible cancer patients are critical to understanding the implications of cancer for state and federal budgets. The Patient Protection and Affordable Care Act (ACA) of 2010 is expected to substantially expand the adult Medicaid population. These estimates provide important baseline information for assessing the potential effects of increased Medicaid enrollment on Medicaid expenditures for cancer

Cancer Treatment for Dual Eligibles: What Are the Costs and Who Pays?

This study quantifies treatment costs for melanoma and breast, cervical, colorectal, lung, and prostate cancer among patients with dual Medicare and Medicaid eligibility. The analyses use merged Medicare and Medicaid Analytic eXtract enrollment and claims data for dually eligible beneficiaries age18 in Georgia, Illinois, Louisiana, and Maine in 2003 (n=892,001). We applied ordinary least squares regression analysis to estimate annual expenditures attributable to each cancer after controlling for beneficiaries’ age, race/ethnicity, sex, and comorbid conditions, and state fixed effects. Cancers and comorbid conditions were identified on the basis of diagnosis codes on insurance claims. The most prevalent cancers were prostate (38.4 per 1,000 men) and breast (30.7 per 1,000 women). Dual eligibles with the study cancers had higher rates of other chronic conditions such as hypertension and arthritis than other beneficiaries. Total Medicare and Medicaid expenditures for dual eligibles with the study cancers ranged from $30,328 for those with lung cancer to$17,011 for those with breast cancer, compared with $10,664 for beneficiaries without the cancers. However, only 9$256 million ($314 million in 2012 dollars). Dual eligibles with these cancers also had high rates of other medical conditions. These comorbidities should be recognized, both in documenting cancer treatment costs and in developing programs and policies that promote timely cancer diagnosis and treatment

Removal Of Myeloid Cells From Autologous Leukocytes Used For Chimeric Antigen Receptor (Car) T Cell Manufacturing Improves Final Product Consistency And Yields

Early phase clinic trails of T cells genetically engineered to express Chimeric Antigen Receptors (CAR) have been promising. CD19-CAR T cells have been used successfully in a number of clinical trials to treat non-Hodgkin’s lymphoma and acute lymphocytic leukemia (ALL) and clinical trials of GD2-CAR T cells for the treatment of osteosarcoma and neuroblastoma are underway. Most CAR T cell manufacturing protocols make use of autologous peripheral blood mononuclear cell (PBMC) concentrates collected by apheresis, however, the lymphocyte-rich PBMC concentrates are also enriched for monocytes and contain small but variable quantities of red blood cells, platelets and neutrophils and prior to beginning CAR T cell manufacturing the PBMC concentrates are generally enriched for lymphocytes or CD3+ cells. We initially manufactured CD19- and GD2-CAR T cells using autologous PBMC concentrates enriched for T cells by selection with the anti-CD3/CD28 beads. These same anti-CD3/CD28 beads were used to stimulated T cell expansion. While the method was, in general, effective, we found that the quantities of GD2-CAR T cells produced were less than the quantities of CD19 CAR T cells produced. In addition, T cells from some patients failed to expand at all. Further investigation found that the presence of large quantities of monocytes or granulocytes in some PBMC concentrates which was associated with poor in vitro CAR T cell expansion. Myeloid derived suppressor cells (MDSCs) that inhibit T cell proliferation are present in sarcoma and ALL patients. These MDSCs may have a monocyte or neutrophil phenotype. We hypothesized that MDSCs in the PBSC concentrates bound non-specifically to the anti-CD3/CD28 beads and more rigorous enrichment of the starting material for lymphocytes would improve CAR T cell yields and reduce the incidence of manufacturing failures. We modified the T cell enrichment method to include a monocyte-depleting plastic adherence step. This change improved T cell expansion, but it was not completely effective at removing contaminating monocytes and granulocytes and did not completely eliminate manufacturing failures. To provide better depletion of monocytes and granulocytes we subjected PBMC concentrates to counter flow elutriation instrument. We manufactured 8 CD19- and 5 GD2-CAR T cell products from elutriated lymphocytes. All 13 CAR T cell manufacturing procedures yielded sufficient quantities of T cells to meet the dose criteria. The 13 CAR T cell products contained 2,166±1,113 x106 CD3+ cells and 1,064±877 x106 transduced CD3+ T cells. The CAR T cell products manufactured from elutriated lymphocytes yielded significantly more CD3+ cells and transduced CD3+ cells than that of those manufactured from anti-CD3/CD28 bead selected and plastic adherence selected cells. These results show CAR T cell manufacturing yields are greater and more consistent when manufacturing is initiated with lymphocytes that have few contaminating myeloid cells

School Boards and Effective Catholic School Governance: Selected Presentations from the 2012 Catholic Higher Education Collaborative Conference

The following article contains essays derived from presentations delivered to the Catholic Higher Education Collaborative (CHEC) Conference held at Marquette University in October, 2012

2009-2010 Mostly Music: Haydn

https://spiral.lynn.edu/conservatory_mostlymusic/1006/thumbnail.jp

15 kDa Granulysin versus GM-CSF for monocytes differentiation: analogies and differences at the transcriptome level

<p>Abstract</p> <p>Background</p> <p>Granulysin is an antimicrobial and proinflammatory protein with several isoforms. While the 9 kDa isoform is a well described cytolytic molecule with pro-inflammatory activity, the functions of the 15 kDa isoform is less well understood. Recently it was shown that 15 kDa Granulysin can act as an alarmin that is able to activate monocytes and immature dendritic cells. Granulocyte Macrophage Colony Stimulating Factor (GM-CSF) is a growth factor widely used in immunotherapy both for <it>in vivo </it>and <it>ex vivo </it>applications, especially for its proliferative effects.</p> <p>Methods</p> <p>We analyzed gene expression profiles of monocytes cultured with 15 kDa Granulysin or GM-CSF for 4, 12, 24 and 48 hours to unravel both similarities and differences between the effects of these stimulators.</p> <p>Results</p> <p>The analysis revealed a common signature induced by both factors at each time point, but over time, a more specific signature for each factor became evident. At all time points, 15 kDa Granulysin induced immune response, chemotaxis and cell adhesion genes. In addition, only 15 kDa Granulsyin induced the activation of pathways related to fundamental dendritic cell functions, such as co-stimulation of T-cell activation and Th1 development. GM-CSF specifically down-regulated genes related to cell cycle arrest and the immune response. More specifically, cytokine production, lymphocyte mediated immunity and humoral immune response were down-regulated at late time points.</p> <p>Conclusion</p> <p>This study provides important insights on the effects of a novel agent, 15 kDa granulysin, that holds promise for therapeutic applications aimed at the activation of the immune response.</p