Research Fellowship Programs in the Department of Health Policy

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Impact of atypical long-acting injectable versus oral antipsychotics on rehospitalization rates and emergency room visits among relapsed schizophrenia patients: a retrospective database analysis

BACKGROUND: Among schizophrenia patients relapsed on an oral antipsychotic (AP), this study compared the impact of switching to atypical AP long-acting injectable therapy (LAT) versus continuing oral APs on hospitalization and emergency room (ER) visit recurrence. METHODS: Electronic records from the Premier Hospital Database (2006-2010) were analyzed. Adult patients receiving oral APs during a schizophrenia-related hospitalization were identified and, upon relapse (i.e., rehospitalization for schizophrenia), were stratified into (a) patients switching to atypical LAT and (b) patients continuing with oral APs. Atypical LAT relapse patients were matched 1:3 with oral AP relapse patients, using a propensity score model. Andersen-Gill Cox proportional hazards models assessed the impact of atypical LAT versus oral AP on time to multiple recurrences of all-cause hospitalizations and ER visits. No adjustment was made for multiplicity. RESULTS: Atypical LAT (N = 1032) and oral AP (N = 2796) patients were matched and well-balanced with respect to demographic (mean age: 42.1 vs 42.4 years, p = .5622; gender: 43.6% vs 44.6% female, p = .5345), clinical, and hospital characteristics. Over a mean 30-month follow-up period, atypical LATs were associated with significantly lower mean number of rehospitalizations (1.25 vs 1.61, p < .0001) and ER visits (2.33 vs 2.67, p = .0158) compared with oral APs, as well as fewer days in hospital (mean days: 13.46 vs. 15.69, p = .0081). Rehospitalization (HR 0.81, 95% CI 0.76–0.87, p < .0001) and ER visit (HR 0.88, 95% CI 0.87–0.93, p < .0001) rates were significantly lower for patients receiving atypical LAT versus oral APs. CONCLUSIONS: This hospital database analysis found that in relapsed schizophrenia patients, atypical LATs were associated with lower rehospitalization and ER visit rates than oral APs

Health-related quality of life in patients with relapsed/refractory multiple myeloma treated with pomalidomide and dexamethasone ± subcutaneous daratumumab: Patient-reported outcomes from the APOLLO trial

In the phase 3 APOLLO trial, daratumumab in combination with pomalidomide and dexamethasone (D-Pd) significantly reduced the rate of disease progression or death by 37% relative to Pd alone in patients with relapsed/refractory multiple myeloma (RRMM) who had received ≥1 prior line of therapy including lenalidomide and a proteasome inhibitor. Here, we present patient-reported outcomes (PROs) from APOLLO. Median treatment duration was 11.5 months with D-Pd and 6.6 months with Pd. PRO compliance rates were high and similar in both groups. No changes from baseline were observed for EORTC QLQ-C30 global health status scores in either group, while physical and emotional functioning, disease symptoms, and adverse effects of treatment remained at baseline levels with D-Pd but worsened with Pd. Reductions (p < 0.05) in pain and fatigue were seen at several time points with D-Pd versus Pd. Overall, these results suggest patients' health-related quality of life remained stable when daratumumab was added to Pd, with several results favoring D-Pd versus Pd. These findings complement the significant clinical improvements observed with D-Pd and support its use in patients with RRMM.The APOLLO study was sponsored by the European Myeloma Network (EMN) in collaboration with Janssen Research & Development, LLC. Medical writing and editorial support were provided by Justine Lempart, PhD, and Linda V. Wychowski, PhD, of Eloquent Scientific Solutions and were funded by Janssen Global Services, LL

The association between pulse wave velocity and cognitive function: the Sydney Memory and Ageing Study

OBJECTIVES Pulse wave velocity (PWV) is a measure of arterial stiffness and its increase with ageing has been associated with damage to cerebral microvessels and cognitive impairment. This study examined the relationship between carotid-femoral PWV and specific domains of cognitive function in a non-demented elderly sample. METHOD Data were drawn from the Sydney Memory and Ageing Study, a cohort study of non-demented community-dwelling individuals aged 70–90 years, assessed in successive waves two years apart. In Wave 2, PWV and cognitive function were measured in 319 participants. Linear regression was used to analyse the cross-sectional relationship between arterial stiffness and cognitive function in the whole sample, and separately for men and women. Analysis of covariance was used to assess potential differences in cognition between subjects with PWV measurements in the top and bottom tertiles of the cohort. Covariates were age, education, body mass index, pulse rate, systolic blood pressure, cholesterol, depression, alcohol, smoking, hormone replacement therapy, apolipoprotein E ε4 genotype, use of anti-hypertensive medications, history of stroke, transient ischemic attack, myocardial infarction, angina, diabetes, and also sex for the whole sample analyses. RESULTS There was no association between PWV and cognition after Bonferroni correction for multiple testing. When examining this association for males and females separately, an association was found in males, with higher PWV being associated with lower global cognition and memory, however, a significant difference between PWV and cognition between males and females was not found. CONCLUSION A higher level of PWV was not associated with lower cognitive function in the whole sample.Joel Singer, Julian N. Trollor, John Crawford, Michael F. O’Rourke, Bernhard T. Baune, Henry Brodaty, Katherine Samaras, Nicole A. Kochan, Lesley Campbell, Perminder S. Sachdev, Evelyn Smit

Use of mediation analysis to evaluate the role of adherence on the comparative effects of atypical antipsychotics in schizophrenia

Schizophrenia is a serious mental illness requiring lifelong treatment and antipsychotics are used to alleviate debilitating symptoms. Increasingly, payers are implementing formulary controls affecting access to these essential medications, though other barriers to use exist. While the comparative effects of antipsychotics have been assessed, findings from recently published meta-analyses and other study methodologies are inconsistent. Some suggested a benefit, others not, for long-acting injectable (LAI) over oral antipsychotics. The primary objective of this research was to measure the indirect effects of LAI and oral atypical antipsychotics on hospital re-admission, mediated through an adherence causal pathway. Mediation is an analytical approach to understand causal pathways and address important research questions regarding how interventions may transmit effects on outcomes. The use of mediation analysis for comparative effectiveness research (CER) is underutilized. (Abstract shortened by ProQuest.

Benchmarking HRM and the benchmarking of benchmarking: best practices from outside the square in the Australian finance industry

Organisations with low absenteeism and low turnover can be distinguished from organisations with high absenteeism and turnover through the identification and implementation of sophisticated and strategic best practices such as benchmarking relative cost position, developing a corporate ethic, valuing the negotiation of an enterprise agreement, and not having a written OHS policy. Several of the remaining 16 practices identified in the literature as best practices, including benchmarking customer service, having a policy addressing recruitment, selection and promotion, were shown to be standard industry practice in the AFI. The findings suggest that benchmarking allows organisations to identify and replicate the innovations of competitors, but competitive advantage requires innovation rather than replication