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Journal of Comparative Effectiveness Research

Robert Zivadinov, Kiren Kresa-Reahl, Bianca Weinstock-Guttman, Keith Edwards, Chakkarin Burudpakdee, Niels Bergsland, Michael G Dwyer, Bhupendra Khatri, Karthinathan Thangavelu, Jeffrey Chavin, Matt Mandel, Stanley Cohan
AIM: Head-to-head clinical trials of teriflunomide (TFM) versus dimethyl fumarate (DMF) have not been conducted. OBJECTIVES: To compare the real-world effectiveness of TFM versus DMF. METHODS: Anonymized data were collected from patients with relapsing MS initiating treatment with teriflunomide (N = 50) or DMF (N = 50). RESULTS: On follow-up magnetic resonance imaging (MRI) compared with baseline, with TFM versus DMF treatment, the proportion of patients with new/enlarging T2 or gadolinium-enhancing lesions was 30...
February 13, 2019: Journal of Comparative Effectiveness Research
Dominic Pilon, John J Sheehan, Holly Szukis, David Singer, Philippe Jacques, Dominique Lejeune, Patrick Lefebvre, Paul E Greenberg
AIM: To evaluate Medicaid spending and healthcare resource utilization (HRU) in treatment-resistant depression (TRD). MATERIALS & METHODS: TRD beneficiaries were identified from Medicaid claims databases (January 2010-March 2017) and matched 1:1 with major depressive disorder (MDD) beneficiaries without TRD (non-TRD-MDD) and randomly selected patients without MDD (non-MDD). Differences in HRU and per-patient-per-year costs were reported in incidence rate ratios (IRRs) and cost differences (CDs), respectively...
February 8, 2019: Journal of Comparative Effectiveness Research
Sreeram V Ramagopalan, Sophie Graham, Robert Carroll, Mireia Raluy-Callado, Beth L Nordstrom, Robert Donaldson, Chris Colby, Faisal Mehmud, Raza Alikhan
AIM: Nonvalvular atrial fibrillation (NVAF) requires long-term anticoagulation treatment, which may necessitate frequent primary care visits. MATERIALS & METHODS: NVAF patients initiating warfarin or apixaban in 2012-2017 were identified from linked primary (Clinical Practice Research Datalink) and secondary care (Hospital Episode Statistics) data. A propensity score matched Cox regression model compared discontinuation risk. Primary care visits were compared via negative binomial regression...
February 8, 2019: Journal of Comparative Effectiveness Research
Si-Tien Wang, Scott J Johnson, Dominic Mitchell, Ahmed M Soliman, Jamie B Vora, Sanjay K Agarwal
AIM: To assess the cost-effectiveness of elagolix versus leuprolide acetate in women with moderate to severe endometriosis pain. METHODS: A Markov model was developed. The efficacy of leuprolide acetate was derived from statistical prediction models using elagolix trial data. Model inputs were extracted from Phase III clinical trials and published literature. RESULTS: Compared with leuprolide acetate, elagolix generated positive net monetary benefit (NMB) assuming a payer's willingness-to-pay threshold of US$100,000 per quality-adjusted life year over a 1-year time horizon: US$5660 for elagolix 150 mg and US$6443 for elagolix 200 mg...
February 6, 2019: Journal of Comparative Effectiveness Research
Christina L Cool, David J Jacofsky, Kelly A Seeger, Nipun Sodhi, Michael A Mont
AIM: To evaluate 90-day episode-of-care (EOC) costs associated with robotic-arm assisted total knee arthroplasty (rTKA) versus manual TKA (mTKA). PATIENTS & METHODS: TKA procedures were identified in Medicare 100% data. Accounting for baseline differences, propensity score matching was performed 1:5. 90-day EOC and index costs, lengths-of-stay, discharge disposition and readmission rates were assessed. RESULTS:  A total of 519 rTKA and 2595 mTKA were included...
January 28, 2019: Journal of Comparative Effectiveness Research
Yunchang Wu, Yiqing Wu, Gaurav Gangoli, Anh Bourcet, Walter Danker, Qianyi Gong, Huan Zhan, Wendong Chen, Zheng Wang
AIM: To assess the clinical and economic impact of flowable gelatin hemostatic matrix (FGHM) in anterior cervical spine surgery (ACSS). PATIENTS & METHODS: A total of 451 patients with performed ACSS were included to compare FGHM with conventional hemostatic methods for clinical and cost outcomes using propensity score matching method. RESULTS: The comparisons of the matched 125 pairs observed that FGHM was associated with significantly lower blood transfusion volume (11...
January 25, 2019: Journal of Comparative Effectiveness Research
Lou Hochheiser, John Hornberger, Michelle Turner, Gary H Lyman
AIM: To assess multi-gene assay (MGA) effects on chemotherapy use, toxicities, recurrences, and costs in estrogen receptor-positive early breast cancer. METHODS: Meta-analysis performed using data from public databases. Results: Studies included 12,202 women. Relative to no testing, chemotherapy use was higher with 12-gene and 70-gene and lower with PAM50 (commercial) and 21-gene MGAs. Overall, 1643 distant recurrences occurred with no testing, declining by 231 (21-gene), 121 (70-gene), 54 (12-gene) and 94 (PAM50); only the 21-gene assay resulted in no risk of increasing the number of distant recurrences...
January 21, 2019: Journal of Comparative Effectiveness Research
Etienne Audureau, Ben Davis, Marie Hélène Besson, Joseph Saba, Joël Ladner
AIM: The objective was to investigate factors influencing patients' willingness to pay (WTP) and physician's views on the cost of therapy for two contrasted chronic diseases, chronic heart failure and psoriasis. METHODS: A cross-sectional survey was conducted in ten developing countries, using a stated WTP contingent valuation method. Multivariate analyses were performed by linear regression. RESULTS: Independent factors influencing patient WTP were income (+0...
January 16, 2019: Journal of Comparative Effectiveness Research
Elena D Serban, Mihai Manolache
AIM: To evaluate the effectiveness and safety of gelatin tannate (GT) for acute gastroenteritis (AGE) in children. MATERIALS & METHODS: In this retrospective, observational study, children admitted for AGE received GT ± oral rehydration solution (ORS; n = 46) or other antidiarrheal medications ± ORS (n = 46). Number and consistency of stools were recorded. RESULTS: Children were aged 6 months to 7.9 years. GT ± ORS reduced diarrhea duration (29...
January 15, 2019: Journal of Comparative Effectiveness Research
Richard F Pollock, Kirsi Norrbacka, Chris Cameron, Leonardo Mancillas-Adame, Mark Jeddi
AIM: The prevalence of Type 2 diabetes in Canada is estimated to be 7.6% and rising. Given the substantial economic burden associated with Type 2 diabetes treatment, optimizing healthcare expenditure is extremely important. In the present analysis, we evaluated the cost-effectiveness of dulaglutide 1.5 mg, a once-weekly glucagon-like peptide 1 agonist as third-line therapy relative to insulin glargine from the perspective of a Canadian healthcare payer. METHODS: A patient-level cost-utility model of Type 2 diabetes was developed to capture seven microvascular and macrovascular complications and severe and nonsevere hypoglycemia...
January 15, 2019: Journal of Comparative Effectiveness Research
Eugene A Grossi, Kimberly A Moore, Candace Gunnarsson
AIM: To estimate undiagnosed aortic stenosis (AS) in the Medicare population. METHODS: Patients enrolled (2011-2014) were eligible. After criteria were applied, time zero was the first record of an echocardiogram (ECHO) for the ECHO-AS cohort and randomly assigned for the no-ECHO cohort. The ECHO-AS cohort was propensity matched to patients in the no-ECHO cohort, and survival analysis was performed. RESULTS:  Of the 854,493 (25%) patients who received an ECHO, 1 in 4 were diagnosed with AS...
January 14, 2019: Journal of Comparative Effectiveness Research
Jose Osorio, Ryan J Imhoff, Peter J Mallow, Tina D Hunter, Laura Goldstein, Anil Rajendra, Gustavo Morales
AIM: Compare the 1-year costs of three catheter ablation technologies for the treatment of paroxysmal atrial fibrillation (PAF). MATERIALS & METHODS: A decision tree model was developed to estimate 1-year hospital costs associated with an index and potential repeat PAF ablation procedure using the Thermocool® Smarttouch® Catheter (ST), Thermocool SF Catheter (SF) or Arctic Front Advance Cryoballoon (CB). Model parameters were estimated using the results of two recently published studies...
January 10, 2019: Journal of Comparative Effectiveness Research
Omar Abdel-Rahman
AIM: This study aims at evaluating the performance of some of the imaging recommendations of the National Comprehensive Cancer Network (NCCN) for initial evaluation of bladder cancer. METHODS: Surveillance, epidemiology and end results program (2010-2015) was queried and patients with clinically (T1-T4) bladder cancer and complete information about clinical T/N (tumor/nodal) stage and metastatic sites were extracted. The following characteristics were evaluated in the current analysis: sensitivity, specificity, number needed to investigate (NNI), positive predictive value (PPV), negative predictive value and accuracy...
January 9, 2019: Journal of Comparative Effectiveness Research
Kumar Mukherjee, Khalid M Kamal
AIM: To compare perioperative complications, inpatient cost and length of stay between robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP) using National Inpatient Sample data from 2010 to 2015. PATIENTS & METHODS: A total of 69,009 records with RARP or ORP were analyzed using multivariate logistic regression and generalized linear models. RESULTS: The RARP had superior perioperative outcomes at a higher cost (adjusted mean difference = 2956; 95% CI: $2822-$3090) and shorter length of stay (mean difference = 0...
January 8, 2019: Journal of Comparative Effectiveness Research
Yawen Jiang, Weiyi Ni
AIM: To examine the factors related to the comparative effectiveness of clozapine. PATIENTS & METHODS: US insurance claims databases were used to identify schizophrenia patients. To examine the factors modifying the comparative effectiveness of clozapine in relation to other second-generation antipsychotics, a series of variables were interacted with a clozapine indicator in regressions. RESULTS: The impacts of clozapine on both persistence and adherence were significantly modified by prior hospitalization, prior epilepsy diagnosis and prior use of antianginal agents...
January 8, 2019: Journal of Comparative Effectiveness Research
Tine Geldof, Smita Rawal, Walter Van Dyck, Isabelle Huys
To achieve therapeutic innovation in oncology, already expensive novel medicines are often concomitantly combined to potentially enhance effectiveness. While this aggravates the pricing problem, comparing effectiveness of novel yet expensive (concomitant) treatments is much needed for healthcare decision-making to deliver effective but affordable treatments. This study reviewed published clinical trials and real-world studies of targeted and immune therapies. In total, 48 studies compared and/or combined multiple novel products on breast, colorectal, lung and melanoma cancers...
January 8, 2019: Journal of Comparative Effectiveness Research
Scott J Pollak, Laura Goldstein, Mehmet Daskiran, Iftekhar Kalsekar, Rahul Khanna
AIM: To compare health utilization among atrial fibrillation (AF) patients undergoing ablation with a contact force-sensing (CF) catheter versus a cryoballoon (CB) catheter. METHODS: AF patients who underwent ablation using the CF catheter (THERMOCOOL SMARTTOUCH® catheter) or CB catheter (Arctic Front™/Arctic Front Advance™ catheter) were identified from the Premier Healthcare database. Propensity score analyses were used to evaluate cost, length of stay and readmissions...
December 21, 2018: Journal of Comparative Effectiveness Research
Tzu-Chi Hsu, Chi-Chuan Wang
AIM: Oral UFT/leucovorin (UFT/LV) and intravenous 5-fluorouracil (FU)/LV are common adjuvant therapies for Stages II and III colorectal cancer. This study aims to determine the most cost-effective treatment alternative between UFT/LV and 5-FU/LV in Stages II and III colorectal cancer from Taiwan's National Health Insurance perspective. PATIENTS & METHODS: The costs were referenced directly from the National Health Insurance reimbursement price. Chemotherapy regimen considered for the cost analysis calculation was adapted from NSABP-C-06 study, and, a time saving calculation was also included...
December 18, 2018: Journal of Comparative Effectiveness Research
Tingjian Yan, Mallik Greene, Eunice Chang, Michael S Broder, Maëlys Touya, Jennifer Munday, Ann Hartry
AIM: To examine hospitalization risk factors in antipsychotic-treated patients with schizophrenia, bipolar I disorder (BD-I) or major depressive disorder (MDD). PATIENTS & METHODS: Using Truven Health MarketScan® Commercial, Medicaid and Medicare Supplemental data (01/01/2012-06/30/2016), logistic regression models were performed to identify risk factors for both psychiatric and all-cause hospitalization in three separate analyses. RESULTS: Significant risk factors included prior hospitalization (schizophrenia: odds ratio [95% CI]: 2...
December 17, 2018: Journal of Comparative Effectiveness Research
George Gourzoulidis, Nikos Maniadakis, Dimitrios Petrakis, John Souglakos, George Pentheroudakis, Georgia Kourlaba
AIM: To evaluate the cost-effectiveness of trifluridine and tipiracil hydrochloride (FTD/TPI) compared with best supportive care (BSC) or regorafenib for the treatment of patients with metastatic colorectal cancer who have been previously treated with or are not considered candidates for available therapies including fluoropyrimidine-, oxaliplatin- and irinotecan-based chemotherapies, anti-VEGF agents and anti-EGFR agents in Greece. METHODS: A partitioned survival model was locally adapted from a third-party payer perspective over a 10 year time horizon...
December 14, 2018: Journal of Comparative Effectiveness Research
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