Migraine Frequency and Health Utilities: Findings from a Multisite Survey

AbstractObjectivesAssess the relationship between migraine frequency and health utility.MethodsPatients aged ≥18 years diagnosed with episodic migraine were enrolled at three US sites representing varied models of health-care delivery. All subjects completed a questionnaire that included demographic and clinical information, a migraine-specific disability questionnaire, and the Health Utilities Index Mark 3 (HUI3). The HUI3 is a generic health status and health-related quality-of-life measure. HUI3 health status data are translated into utility scores anchored by 0 (dead) and 1 (perfect health).ResultsThe study enrolled 150 patients. The mean age was 44 years and 87% were female. Mean (±SD) monthly migraine frequency was 4.4 ± 3.6, with 34% reporting ≤2 migraines per month and 20% reporting >6 migraines per month. The mean (±SD) HUI3 score was 0.62 ± 0.26. After controlling for study center, demographics, comorbidities, migraine characteristics, and level of migraine disruptiveness, migraine frequency was found to be significantly (P < 0.05) and negatively associated with HUI3 scores. Subjects with >6 migraines per month had an adjusted mean HUI3 score of 0.41; the corresponding mean for those reporting ≤2 migraines per month was 0.67. Migraine frequency was positively associated with higher levels of disability for the emotion, cognition, and pain components of the HUI3.ConclusionsAmong this group of care-seeking patients, migraineurs' health utilities were inversely related to headache frequency. Although these data may not be generalizable to the entire migraine population, they may be useful in assessing the comparative cost-effectiveness of preventive migraine therapies

Impact of Atrial Fibrillation on Stroke‐Related Healthcare Costs

Background: Limited data exist on the economic implications of stroke among patients with atrial fibrillation (AF). This study assesses the impact of AF on healthcare costs associated with ischemic stroke (IS), hemorrhagic stroke (HS), or transient ischemic attack (TIA). Methods and Results: A retrospective analysis of MarketScan claims data (2005‐2011) for AF patients ≥18 years old with ≥1 inpatient claim for stroke, or ≥1 ED or inpatient claim for TIA as identified by ICD‐9‐CM codes who had ≥12 months continuous enrollment prior to initial stroke. Initial event‐ and stroke‐related costs 12 months post‐index were compared among patients with AF and without AF. Adjusted costs were estimated, controlling for demographics, comorbidities, anticoagulant use, and baseline resource use. Data from 23 807 AF patients and 136 649 patients without AF were analyzed. Unadjusted mean cost of the index event was $20 933 for IS,$59 054 for HS, $8616 for TIA hospitalization, and$3395 for TIA ED visit. After controlling for potential confounders, adjusted mean incremental costs (index plus 12‐month post‐index) for AF patients were higher than those for non‐AF patients by: $4726,$7824, and $1890 for index IS, HS, TIA (identified by hospitalization), respectively, and$1700 for TIA (identified by ED) (all P<0.01). In multivariate regression analysis, AF was associated with a 20% (IS), 13% (HS), and 18% (TIA) increase in total stroke‐related costs. Conclusion: Stroke‐related care for IS, HS, and TIA is costly, especially among individuals with AF. Reducing the risk of AF‐related stroke is important from both clinical and economic standpoints

Potencjalne zmniejszenie kosztów leczenia cukrzycy związane z poprawą kontroli glikemii

WSTĘP. W literaturze są dostępne jedynie ograniczone dane dotyczące wpływu kontroli glikemii na koszty leczenia chorych na cukrzycę. Celem tej pracy było zbadanie potencjalnego wpływu ściślejszej kontroli glikemii na niektóre wczesne powikłania cukrzycy i koszty ich leczenia. MATERIAŁ I METODY. Przeprowadzono retrospektywne badanie obejmujące dużą grupę chorych na cukrzycę, zarejestrowanych w komputerowej bazie danych kliniki Fallon od 1 stycznia 1994 roku do 30 czerwca 1998 roku. Chorych podzielono na trzy grupy w zależności od stężenia HBA1C: cukrzycy wyrównanej ( 10%). Oceniano częstość hospitalizacji z powodu takich zaburzeń towarzyszących cukrzycy, jak: niektóre zakażenia, epizody hiper- i hipoglikemii, zaburzenia elektrolitowe, a także koszty leczenia. Aby wyeliminować wpływ przypadkowych parametrów w poszczególnych grupach, zastosowano wieloczynnikową analizę statystyczną, obejmującą okres 3 lat. WYNIKI. Z 2394 chorych na cukrzycę około 10% (251 osób) hospitalizowano przynajmniej raz z powodu wczesnych powikłań choroby &#8212; łącznie odnotowano 447 przyjęć. Ustalono, że w okresie objętym analizą liczba hospitalizacji w grupie chorych na cukrzycę wyrównaną wynosiła 13 na 100 chorych, w grupie cukrzycy względnie wyrównanej &#8212; 16 na 100, a w grupie chorych na cukrzycę niewyrównaną &#8212; 31 hospitalizacji na 100 chorych (p < 0,05). Skorygowane średnie koszty wynosiły odpowiednio około 970, 1380 i 3040 USD. U osób z późnymi powikłaniami choroby, którzy stanowili 30% badanej populacji, częstość przyjęć i koszty związane z hospitalizacjami były wyższe. Częstość ta w poszczególnych grupach wynosiła 30, 38 i 74 na 100 pacjentów, natomiast średnie koszty leczenia &#8212; odpowiednio 2610, 3810 i 8320 USD w poddanym analizie okresie 3 lat. WNIOSKI. W typowej praktyce lekarskiej poprawa kontroli glikemii wiąże się ze zmniejszeniem częstości hospitalizacji z powodu wczesnych powikłań cukrzycy, a w związku z tym z redukcją kosztów leczenia w okresie 3-letnim. Te potencjalne korzyści mogą wpływać na decyzje o wdrożeniu nowych metod leczenia cukrzycy

Prevalence of menopausal symptoms among mid-life women: findings from electronic medical records

BACKGROUND: To assess the prevalence of menopausal symptoms among women prescribed hormone therapy (HT) using electronic medical record data from a regional healthcare organization. METHODS: Retrospective data from the Reliant Medical Group from 1/1/2006-12/31/2011 were assessed for 102 randomly-selected patients. Study eligibility criteria included: females aged 45 to 65; prescribed oral or transdermal HT; no history of breast cancer, venous thromboembolism, stroke, gynecological cancer, or hysterectomy; continuously enrolled in the health plan for 1 year before and after the first observed HT prescription. Prevalence of menopause-related symptoms was analyzed descriptively at both the patient and visit levels. RESULTS: Mean age of patients was 54 years. The most common menopausal symptoms were: hot flushes (40%), night sweats (17%), insomnia (16%), vaginal dryness (13%), mood disorders (12%), and weight gain (12%). Among the 102 patients, 163 individual visits listing menopausal symptoms were identified, of which hot flushes (71 visits) were the most common symptom identified. CONCLUSION: Our findings provide recent data on the types of menopausal symptoms experienced by mid-life women prescribed HT. Electronic medical records may be a rich source of data for future studies of menopausal symptoms in this population

Trends in healthcare utilization among older Americans with colorectal cancer: A retrospective database analysis

<p>Abstract</p> <p>Background</p> <p>Analyses of utilization trends (cost drivers) allow us to understand changes in colorectal cancer (CRC) costs over time, better predict future costs, identify changes in the use of specific types of care (eg, hospice), and provide inputs for cost-effectiveness models. This retrospective cohort study evaluated healthcare resource use among US Medicare beneficiaries diagnosed with CRC between 1992 and 2002.</p> <p>Methods</p> <p>Cohorts included patients aged 66+ newly diagnosed with adenocarcinoma of the colon (n = 52,371) or rectum (n = 18,619) between 1992 and 2002 and matched patients from the general Medicare population, followed until death or December 31, 2005. Demographic and clinical characteristics were evaluated by cancer subsite. Resource use, including the percentage that used each type of resource, number of hospitalizations, and number of hospital and skilled nursing facility days, was evaluated by stage and subsite. The number of office, outpatient, and inpatient visits per person-year was calculated for each cohort, and was described by year of service, subsite, and treatment phase. Hospice use rates in the last year of life were calculated by year of service, stage, and subsite for CRC patients who died of CRC.</p> <p>Results</p> <p>CRC patients (mean age: 77.3 years; 44.9% male) used more resources than controls in every category (<it>P </it>< .001), with the largest differences seen in hospital days and home health use. Most resource use (except hospice) remained relatively steady over time. The initial phase was the most resource intense in terms of office and outpatient visits. Hospice use among patients who died of CRC increased from 20.0% in 1992 to 70.5% in 2004, and age-related differences appear to have evened out in later years.</p> <p>Conclusion</p> <p>Use of hospice care among CRC decedents increased substantially over the study period, while other resource use remained generally steady. Our findings may be useful for understanding CRC cost drivers, tracking trends, and forecasting resource needs for CRC patients in the future.</p

Are ethnic disparities in HbA1c levels explained by mental wellbeing? Analysis of population-based data from the Health Survey for England

Aims: It is unclear how ethnic differences in HbA1c levels are affected by individual variations in mental wellbeing. Thus, the aim of this study was to assess the extent to which HbA1c disparities between Caucasian and South Asian adults are mediated by various aspects of positive psychological functioning. Methods: Data from the 2014 Health Survey for England was analysed using bootstrapping methods. A total of 3894 UK residents with HbA1c data were eligible to participate. Mental wellbeing was assessed using the Warwick-Edinburgh Mental Well-Being Scale. To reduce bias BMI, blood pressure, diabetes status, and other factors were treated as covariates. Results: Ethnicity directly predicted blood sugar control (unadjusted coefficient -2.15; 95% CI -3.64, -0.67), with Caucasians generating lower average HbA1c levels (37.68 mmol/mol (5.6%)) compared to South Asians (39.87 mmol/mol (5.8%)). This association was mediated by positive mental wellbeing, specifically concerning perceived vigour (unadjusted effect 0.30; 95% CI 0.13, 0.58): South Asians felt more energetic than Caucasians (unadjusted coefficient -0.32; 95% CI -0.49, -0.16), and greater perceived energy predicted lower HbA1c levels (unadjusted coefficient -0.92; 95% CI -1.29, -0.55). This mediator effect accounted for just over 14% of the HbA1c variance, and was negated after adjusting for BMI. Conclusions: Caucasian experience better HbA1c levels compared with their South Asian counterparts. However, this association is partly confounded by individual differences in perceived energy levels, which is implicated in better glycaemic control, and appears to serve a protective function in South Asians