37 research outputs found

    The high-cost, type 2 diabetes mellitus patient: an analysis of managed care administrative data

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    BACKGROUND: Type 2 diabetes mellitus (T2DM) affects 25.8 million individuals in the United States and exerts a substantial economic burden on patients, health care systems, and society. Few studies have categorized costs and resource use at the patient level. The goals of this study were to assess predictors of being a high-cost (HC) patient and compare HC T2DM patients with not high-cost (NHC) T2DM patients. METHODS: Using managed care administrative claims data, patients with two or more T2DM diagnoses between 2005 and 2010 were selected. Patients were followed for 1 year after their first observed T2DM diagnosis; patients not continuously enrolled during this period were excluded from the study. Study measures included annual health care expenditures by component (i.e., inpatient, outpatient, pharmacy, total). Patients accruing total costs in the top 10% of the overall cost distribution (i.e., patients with costs > 20,528)wereclassifiedasHCapriori;allotherpatientswereconsideredNHC.ToassesspredictorsofbeingHC,alogisticregressionmodelwasestimated,accountingfordemographics;underlyingcomorbidityburden(usingtheCharlsonComorbidityIndex[CCI]score);diagnosesofrenalimpairment,obesity,orhypertension;andreceiptofinsulin,oralantidiabeticsonly,ornoantidiabetics.RESULTS:Atotalof1,720,041patientsmettheinclusioncriteria;172,004wereHC.Themean(SD)CCIscoreforHCpatientswas4.3(3.0)versus2.1(1.7)forNHCpatients.Mean(SD;upper9520,528) were classified as HC a priori; all other patients were considered NHC. To assess predictors of being HC, a logistic regression model was estimated, accounting for demographics; underlying comorbidity burden (using the Charlson Comorbidity Index [CCI] score); diagnoses of renal impairment, obesity, or hypertension; and receipt of insulin, oral antidiabetics only, or no antidiabetics. RESULTS: A total of 1,720,041 patients met the inclusion criteria; 172,004 were HC. The mean (SD) CCI score for HC patients was 4.3 (3.0) versus 2.1 (1.7) for NHC patients. Mean (SD; upper 95% confidence interval-lower 95% confidence interval) annual per-patient costs were 56,468 (65,604;65,604; 56,778-56,157)amongHCpatientsand56,157) among HC patients and 4,674 (4,504;4,504; 4,695-4,652)amongNHCpatients.InpatientcareandpharmacycostswerehigherforHCpatientsthanforNHCpatients.ThestrongestpredictorofbeinganHCpatientwashavingaCCIscoreof2orgreater(oddsratio[OR]=4.896),followedbyadiagnosisofobesity(OR=2.106),renalimpairment(OR=2.368),andinsulinuse(OR=2.098).CONCLUSIONS:HighcostT2DMpatientsaccrueapproximately4,652) among NHC patients. Inpatient care and pharmacy costs were higher for HC patients than for NHC patients. The strongest predictor of being an HC patient was having a CCI score of 2 or greater (odds ratio [OR] = 4.896), followed by a diagnosis of obesity (OR = 2.106), renal impairment (OR = 2.368), and insulin use (OR = 2.098). CONCLUSIONS: High-cost T2DM patients accrue approximately 52,000 more in total annual health care costs than not high-cost T2DM patients. Patients were significantly more likely to be high-cost if they had comorbid conditions, a diagnosis of obesity, or used insulin

    Adherence to Antiretroviral Treatment and Correlation with Risk of Hospitalization among Commercially Insured HIV Patients in the United States

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    Purpose: A lower daily pill burden may improve adherence to antiretroviral treatment (ART) and clinical outcomes in patients with human immunodeficiency virus (HIV). This study assessed differences in adherence using the number of pills taken per day, and evaluated how adherence correlated with hospitalization. Methodology: Commercially insured patients in the LifeLink database with an HIV diagnosis (International Classification of Diseases, 9th Revision, Clinical Modification code 042.xx) between 6/1/2006 and 12/31/2008 and receipt of a complete ART regimen were selected for inclusion. Patients were grouped according to their daily pill count and remained on ART for at least 60 days. Outcomes included adherence and rates of hospitalization. Adherence was measured as the proportion of days between the start and end of the regimen in which the patient maintained supply of all initiated ART components. Logistic regressions assessed the relationship between pills per day, adherence, and hospitalization, controlling for demographics, comorbidities, and ART-naïve (vs. experienced) status. Results: 7,073 patients met the study inclusion criteria, and 33.4%, 5.8%, and 60.8 % received an ART regimen comprising one, two, or three or more pills per day, respectively. Regression analysis showed patients receiving a single pill per day were significantly more likely to reach a 95 % adherence threshold versus patients receiving three or more pills per day (odds ratio [OR] = 1.59; P,0.001). Regardless of the number of pills received per day, patients were over 40 % less likely to have

    Science with the Einstein Telescope: a comparison of different designs

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    The Einstein Telescope (ET), the European project for a third-generation gravitational-wave detector, has a reference configuration based on a triangular shape consisting of three nested detectors with 10 km arms, where in each arm there is a `xylophone' configuration made of an interferometer tuned toward high frequencies, and an interferometer tuned toward low frequencies and working at cryogenic temperature. Here, we examine the scientific perspectives under possible variations of this reference design. We perform a detailed evaluation of the science case for a single triangular geometry observatory, and we compare it with the results obtained for a network of two L-shaped detectors (either parallel or misaligned) located in Europe, considering different choices of arm-length for both the triangle and the 2L geometries. We also study how the science output changes in the absence of the low-frequency instrument, both for the triangle and the 2L configurations. We examine a broad class of simple `metrics' that quantify the science output, related to compact binary coalescences, multi-messenger astronomy and stochastic backgrounds, and we then examine the impact of different detector designs on a more specific set of scientific objectives.Comment: 197 pages, 72 figure

    Simulation and sensitivities for a phased IceCube-Gen2 deployment

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    A next-generation optical sensor for IceCube-Gen2

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    Optimization of the optical array geometry for IceCube-Gen2

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    Concept Study of a Radio Array Embedded in a Deep Gen2-like Optical Array

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    Sensitivity studies for the IceCube-Gen2 radio array

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