ORCID Profile
0000-0002-6460-6779
Current Organisations
University of Pittsburgh
,
University of Melbourne
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Health Policy | Policy and Administration
Health Policy Economic Outcomes | Health Policy Evaluation |
Publisher: Frontiers Media SA
Date: 18-02-2020
Publisher: Elsevier BV
Date: 03-2018
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.THROMRES.2016.10.006
Abstract: The comparative cost-effectiveness of all oral anticoagulants approved up to date has not been evaluated from the US perspective. The objective of this study was to compare the cost-effectiveness of edoxaban 60mg, apixaban 5mg, dabigatran 150mg, dabigatran 110mg, rivaroxaban 20mg and warfarin in stroke prevention in atrial fibrillation patients at high-risk of bleeding (defined as HAS-BLED score≥3). We constructed a Markov state-transition model to evaluate lifetime costs and quality-adjusted life years (QALYs) with each of the six treatments from the perspective of US third-party payers. Probabilities of clinical events were obtained from the RE-LY, ROCKET-AF, ARISTOTLE and ENGAGE AF-TIMI trials costs were derived from the Healthcare Cost and Utilization Project, and other studies. Because edoxaban is only indicated in patients with creatinine clearance ≤95ml/min, we re-ran our analyses after excluding edoxaban from the analysis. Treatment with edoxaban 60mg cost $77,565/QALY gained compared to warfarin, and apixaban 5mg cost $108,631/QALY gained compared to edoxaban 60mg. When edoxaban was not included in the analysis, treatment with apixaban 5mg cost $84,128/QALY gained, compared to warfarin. Dabigatran 150mg, dabigatran 110mg and rivaroxaban 20mg were dominated strategies. For patients with creatinine clearance between 50 and 95ml/min, apixaban 5mg was the most cost-effective treatment for willingness-to-pay thresholds (WTP) above $115,000/QALY gained, and edoxaban 60mg was cost-effective when the WTP was between $75,000 and $115,000/QALY gained. For patients with creatinine clearance >95ml/min, apixaban 5mg was the most cost-effective treatment for WTP thresholds above $80,000/QALY gained.
Publisher: Wiley
Date: 07-01-2016
DOI: 10.1002/HEC.3311
Abstract: Under the standard Medicare Part D benefit structure, copayments for medications change discontinuously at certain levels of accumulative drug spending. Beneficiaries pay 25% of the cost of medications in the initial phase, 100% in the coverage gap, and 5% in the catastrophic phase. We examine whether in iduals anticipate these copayment changes and adjust their consumption in advance. We use variation in birth-months of beneficiaries who enroll in Part D plans when they first turn 65. Birth-months generate exogenous variation in the end-of-year price because those who enroll earlier in the year are more likely to reach the coverage gap than those who enroll later. We study the impact of variation in end-of-year price on the first three months of medication use immediately following enrollment. We use difference-in-differences to adjust for seasonal trends in use, by comparing our main study group with those who receive low-income subsidies, and therefore do not face a coverage gap. We find strong evidence of anticipatory behavior, with an implied elasticity with respect to future prices ranging from -0.2 to -0.5. In addition, we find that beneficiaries modify their consumption by changing the quantity of prescriptions filled, instead of switching between brand-name and generic drugs. Copyright © 2016 John Wiley & Sons, Ltd.
Publisher: Springer Science and Business Media LLC
Date: 13-07-2011
Publisher: Wiley
Date: 28-07-2005
Publisher: Wiley
Date: 14-08-2013
DOI: 10.1002/HEC.2981
Publisher: Massachusetts Medical Society
Date: 02-07-2009
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.DRUGALCDEP.2018.06.033
Abstract: Concurrent opioid and benzodiazepine use is associated with a three-fold increase in the risk of opioid-related overdose. No study has evaluated geographic variation in the concurrent use of opioids and benzodiazepines in US Medicare. We compared state, hospital-referral region (HRR), and county-level variation in concurrent opioid and benzodiazepine use among US Medicare opioid users and examined the heterogeneity in concurrent use within states. Using 2013-2014 US Medicare Part D claims, we identified non-cancer beneficiaries who used opioids in 2014 (n = 268,678). The outcome was concurrent opioid and benzodiazepine use. We constructed logistic regression models to isolate state, HRR, and county-level variation not explained by patient characteristics, and evaluated how county and HRR quintiles are distributed within state quintiles. The adjusted probability of concurrent use ranged from 16.7%-29.6% across states, 12.1%-37.0% across HRRs, and 0%-65.2% across counties. State-level variation masks substantial county-level variation: only 18% of counties located in the lowest state quintile were in the lowest county quintile, and only 23% of counties located in the highest state quintile were in the highest county quintile. We also observed variation in concurrent use across HRRs within states, but it was not as dispersed. For ex le, 52% of the HRRs located in the highest state quintile were in the highest HRR quintile. Large variation in concurrent use of opioids and benzodiazepines exists across the US. State variation masks substantial local variation, which beckons for polices to monitor concurrent opioid and benzodiazepine use at the county level.
Publisher: Springer Science and Business Media LLC
Date: 07-02-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2017
DOI: 10.1161/STROKEAHA.116.015150
Abstract: Little is known about the clinical outcomes associated with posthemorrhage anticoagulation resumption for atrial fibrillation. This study had 2 objectives: first, to evaluate anticoagulation use after a first major bleed on warfarin or dabigatran and, second, to compare effectiveness and safety outcomes between patients discontinuing anticoagulation after a major bleed and patients restarting warfarin or dabigatran. Using 2010 to 2012 Medicare Part D data, we identified atrial fibrillation patients who experienced a major bleeding event while using warfarin (n=1135) or dabigatran (n=404) and categorized them by their posthemorrhage use of anticoagulation. We followed them until an ischemic stroke, recurrent hemorrhage, or death through December 31, 2012. We constructed logistic regression models to evaluate factors affecting anticoagulation resumption and Cox proportional hazard models to compare the combined risk of ischemic stroke and all-cause mortality and the risk of recurrent bleeding between treatment groups. Resumption of anticoagulation with warfarin (hazard ratio [HR] 0.76 95% confidence interval [CI] 0.59–0.97) or dabigatran (HR 0.66 95% CI 0.44–0.99) was associated with lower combined risk of ischemic stroke and all-cause mortality than anticoagulation discontinuation. The incidence of recurrent major bleeding was higher for patients prescribed warfarin after the event than for those prescribed dabigatran (HR 2.31 95% CI 1.19–4.76) or whose anticoagulation ceased (HR 1.56 95% CI 1.10–2.22), but did not differ between patients restarting dabigatran and those discontinuing anticoagulation (HR 0.65 95% CI 0.32–1.33). Dabigatran was associated with a superior benefit/risk ratio than warfarin and anticoagulation discontinuation in the treatment of atrial fibrillation patients who have survived a major bleed.
Publisher: Elsevier BV
Date: 12-2011
Publisher: American Psychiatric Association Publishing
Date: 03-2017
DOI: 10.1176/APPI.PS.201600119
Abstract: The study evaluated the presence of mental health providers in the Medicare Shared Savings Program (MSSP) accountable care organizations. On the basis of data for all 105,155 providers participating in the 220 MSSPs in 2012 and 2013, MSSPs were classified by whether they included psychiatrists, psychologists, or clinical social workers. Descriptive statistics were calculated, including the number and type of mental health providers. The inclusion of mental health providers varied substantially over time and across MSSPs. Only 52% of MSSPs included at least one mental health provider in April 2012. This proportion increased to 64% in July 2012 and was 61% in January 2013. MSSPs including mental health providers had a mean average of 26 such practitioners (minimum of 1, median of 11, and maximum of 240). Although the MSSP model generally incentivized high-quality, coordinated care, it has largely overlooked mental health services.
Publisher: Elsevier BV
Date: 07-2010
Publisher: American Medical Association (AMA)
Date: 09-08-2010
Publisher: American Medical Association (AMA)
Date: 07-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2010
Publisher: Oxford University Press (OUP)
Date: 14-12-2010
Publisher: American Psychiatric Association Publishing
Date: 08-2016
Publisher: Elsevier BV
Date: 09-2012
Publisher: Wiley
Date: 18-11-2023
DOI: 10.1002/HEC.4637
Abstract: The Affordable Care Act included a provision to gradually eliminate the Medicare prescription drug coverage gap between 2011 and 2020, which substantially lower medication costs in the gap. Using 2007–2016 Medicare claims data, we estimate how filling the gap affects in iduals' out‐of‐pocket spending and medication use, separately for branded and generic drugs. One important difficulty in estimating the policy impact is that around the same time, many blockbuster drugs commonly used by the Medicare population experienced patent expiration and began to see generic entry. Because generic entries affected different therapeutic classes at different times, we run difference‐in‐differences models by therapeutic category at the beneficiary‐month level to isolate the effect of the gap closure from that of generic entry. Overall, we find that filling the gap substantially reduced out‐of‐pocket spending and increased the use of branded drugs, which had larger discount rates during the analysis period. Beneficiaries reaching the gap, at older ages, or with comorbidities experienced larger reduction in out‐of‐pocket spending. We show that without accounting for generic entry, the effect of filling the coverage gap on medication use is underestimated for branded drugs and overestimated for generic drugs.
Publisher: Elsevier BV
Date: 07-2018
DOI: 10.1016/J.AMJCARD.2018.03.012
Abstract: The objective of the study was to examine how the comparative effectiveness and safety of direct oral anticoagulants (DOACs) and warfarin differ across subgroups of patients with atrial fibrillation defined by stroke risk (CHA2DS2-VASc score ≤3, 4 to 5, ≥6). Using Medicare claims data, we identified patients newly diagnosed with atrial fibrillation in 2013 to 2014 who initiated warfarin (n=12,354), apixaban (n=2,358), dabigatran (n=1,415), or rivaroxaban (n=5,139), and categorized them according to their CHA2DS2-VASc score (≤3, 4 to 5, ≥6). Primary outcomes included the combined risk of ischemic stroke, other thromboembolic event and death, and the risk of bleeding. We constructed Cox proportional hazard models that included terms for treatment, CHA2DS2-VASc subgroup, and the interaction between them, and controlled for demographics and a comprehensive list of clinical characteristics. We found that DOACs were generally more effective than warfarin, but this effect was most pronounced in the lowest risk subgroup. Specifically, the hazard ratio for the primary effectiveness outcome with apixaban compared with warfarin was 0.46 (95% confidence interval [CI] 0.32 to 0.65) for CHA2DS2-VASc ≤3, 0.71 (95% CI 0.61 to 0.86) for 4 to 5, and 0.86 (95% CI 0.74 to 1.01) for ≥6 (p value for interaction = 0.005). The comparative safety profile of DOACs versus warfarin did not change with CHA2DS2-VASc score. In conclusion, DOACs are more effective than warfarin, but this effect is more pronounced in patients with lower risk of stroke. Further research is needed to validate these findings in other patient cohorts and uncover their underlying mechanisms.
Publisher: Health Affairs (Project Hope)
Date: 03-2015
Publisher: Health Affairs (Project Hope)
Date: 06-2014
Publisher: American Medical Association (AMA)
Date: 26-09-2011
Publisher: Elsevier BV
Date: 11-2021
DOI: 10.1016/J.HEALTHPOL.2021.09.005
Abstract: This study examines whether greater private-sector participation in aged care can lead to better outcomes by comparing quality of care and prices of residential aged care facilities across three ownership types: government-owned, private not-for-profit and for- profit facilities. Australia, like many other countries, has been implementing market-oriented reforms aiming to promote greater consumer choice and increase the role of markets and private-sector participation in aged care. Using retrospective facility-level data, the study relates several measures of quality of care and a measure of price to ownership types while controlling for facility characteristics. The data covered six financial years (2013/14-2018/19) and contained 2,900 residential aged-care facilities, capturing almost all facilities in Australia. About 55% were private not-for-profit, 30% private for-profit and 15% government-owned. Government-owned facilities provide higher quality of care in most quality measures and charge the lowest average price than private for-profit and not-for-profit facilities. Reforms promoting private-sector participation in aged care are unlikely to result in effective competition to drive quality up or prices down unless sources of market failure are addressed. In Australia, the lack of public reporting of quality and the complex pricing structure are key issues that prevent market forces and consumer choice from working as intended.
Publisher: Wiley
Date: 03-2016
DOI: 10.1111/JGS.14000
Publisher: Health Affairs (Project Hope)
Date: 05-2007
Abstract: Citing evidence from studies conducted by Frank Lichtenberg, some health policy advocates have argued that, on average, use of new prescription drugs reduces total health care costs. While recognizing that the cross-sectional research design cannot guard against many biases that could overstate the results, we replicated the original study results and examined the findings' sensitivity to different analytical approaches. Using the same data, we were able to replicate the original results however, the original findings are not maintained under plausible alternative assumptions. More rigorous research on specific drugs and conditions is necessary before one can claim that newer drugs lower total health care costs.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2018
DOI: 10.1097/MLR.0000000000000903
Abstract: Medicare Shared Savings Program Accountable Care Organizations (ACOs) may focus more on primary care given ACO financial incentives. We examine variation in primary care treatment of 8 prevalent chronic conditions across ACOs and the factors affecting the variation, and compare the role of primary care in ACOs and non-ACOs. We conduct regression models at the ACO-level to identify factors predicting higher proportions of chronic condition visits delivered by primary care providers (PCPs) using 2013 Medicare claims and enrollment data. We compare the distribution of visits to PCPs, specialists and advanced practice providers between ACO-attributed and non–ACO-attributed beneficiaries. At the ACO-level, the proportion of patients who are white and of the local population who are college educated, the complexity of the patient population, and the supply of specialists were negatively associated with the proportion of chronic condition visits delivered by PCPs, whereas the percentage of contracted physicians within the ACO who were PCPs was positively associated. These results varied when subanalyses were conducted for each specific chronic condition. ACO care for chronic conditions was managed similar to that of care for non-ACO Medicare beneficiaries in 2013, but that some ACOs utilize PCPs to manage chronic conditions more than others. Many ACOs may underutilize PCPs, and thus could actively shift care to less expensive primary care for potential savings to payers. Barriers to that shift could include low numbers of PCPs contracted in the ACO, and existing referral patterns and patient relationships with specialists.
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.AMJCARD.2017.07.092
Abstract: No studies have performed direct pairwise comparisons of the effectiveness and safety of warfarin and the new oral anticoagulants (NOACs) apixaban, dabigatran, and rivaroxaban. Using 2013 to 2014 claims from a 5% random s le of Medicare beneficiaries, we identified patients newly diagnosed with atrial fibrillation who initiated apixaban, dabigatran, rivaroxaban, warfarin, or no oral anticoagulation therapy in 2013 to 2014. Outcomes included the composite of ischemic stroke, systemic embolism (SE) and death, any bleeding event, gastrointestinal bleeding, intracranial bleeding, and treatment persistence. We constructed Cox proportional hazard models to compare outcomes between each pair of treatment groups. The composite risk of ischemic stroke, SE, and death was lower for NOACs than for warfarin: hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.76 to 0.98 for apixaban 0.73, 95% CI 0.63 to 0.86 for dabigatran and 0.82, 95% CI 0.75 to 0.89 for rivaroxaban, all compared with warfarin. There were no differences in effectiveness across NOACs. The risk of any bleeding was lower with apixaban than with warfarin, but higher with rivaroxaban than with warfarin. Apixaban (HR 0.69, 95% CI 0.60 to 0.79) and dabigatran (HR 0.79, 95% CI 0.69 to 0.92) were associated with lower bleeding risk than rivaroxaban. Treatment persistence was highest for apixaban (82%), and lowest for dabigatran and warfarin (64%) (p value <0.001). Compared with warfarin, NOACs are more effective in preventing stroke but their risk of bleeding varies, with rivaroxaban having higher risk than warfarin. Altogether, apixaban had the most favorable effectiveness, safety, and persistence profile.
Publisher: SAGE Publications
Date: 2020
Abstract: To identify characteristics associated with an increased risk of cardiovascular events in patients diagnosed with Alzheimer disease (AD) and treated with antidementia medications. Demographics, diagnoses, and medication usage of 30 433 Medicare patients were analyzed using 2006 to 2013 claims data and a combined model of screening, ranking and stepwise logistic regressions to evaluate factors associated with composite outcomes of 6 cardiovascular events. Incidence rate of at least 1 cardiovascular event was 25.1%. Fifty-five factors were identified from the 10 381 candidate variables by the combined model with a c-statistic of 67% and an accuracy of 75%. Factors associated with increased risk of cardiovascular events include history of heart rhythm disorders, alteration of consciousness (odds ratio [OR]: 1.25 95% confidence interval [CI]: 1.14-1.36), and usage of β-blockers (OR: 1.19 95% CI: 1.13-1.27). Clinicians should consider the increased risk of cardiovascular events in patients with AD with heart rhythm disorders and on β-blockers.
Publisher: American Medical Association (AMA)
Date: 2015
Publisher: Massachusetts Medical Society
Date: 29-07-2010
DOI: 10.1056/NEJMP1004872
Publisher: Informa UK Limited
Date: 14-07-2015
DOI: 10.3109/13561820.2015.1040114
Abstract: The enactment of the Affordable Care Act expands coverage to millions of uninsured Americans and creates a new workforce landscape. Interprofessional Collaborative Practice (ICP) is no longer a choice but a necessity. In this paper, we describe four innovative approaches to interprofessional practice at the University of Pittsburgh Medical Center. These models demonstrate innovative applications of ICP to inpatient and outpatient care, relying on non-physician providers, training programs, and technology to deliver more appropriate care to specific patient groups. We also discuss the ongoing evaluation plans to assess the effects of these interprofessional practices on patient health, quality of care, and healthcare costs. We conclude that successful implementation of interprofessional teams involves more than just a reassignment of tasks, but also depends on structuring the environment and workflow in a way that facilitates team-based care.
Publisher: Wiley
Date: 28-09-2010
Publisher: BMJ
Date: 03-2021
DOI: 10.1136/BMJOPEN-2020-046857
Abstract: To investigate factors associated with the use of telehealth by general practitioners (GPs) during COVID-19. A nationally representative longitudinal survey study of Australian doctors analysed using regression analysis. General practice in Australia during the COVID-19 pandemic. 448 GPs who completed both the 11th wave (2018–2019) of the Medicine in Australia: Balancing Employment and Life (MABEL) Survey and the MABEL COVID-19 Special Online Survey (May 2020). Proportion of all consultations delivered via telephone (audio) or video (audiovisual) proportion of telehealth consultations delivered via video. 46.1% of GP services were provided using telehealth in early May 2020, with 6.4% of all telehealth consultations delivered via video. Higher proportions of telehealth consultations were observed in GPs in larger practices compared with solo GPs: between +0.21 (95% CI +0.07 to +0.35) and +0.28 (95% CI +0.13 to +0.44). Greater proportions of telehealth consultations were delivered through video for GPs with appropriate infrastructure and for GPs with more complex patients: +0.10 (95% CI +0.04 to +0.16) and +0.04 (95% CI +0.00 to +0.08), respectively. Lower proportions of telehealth consultations were delivered via video for GPs over 55 years old compared with GPs under 35 years old: between −0.08 (95% CI −0.02 to −0.15) and −0.15 (95% CI −0.07 to −0.22), and for GPs in postcodes with a higher proportion of patients over 65 years old: −0.005 (95% CI −0.001 to -0.008) for each percentage point increase in the population over 65 years old. GP characteristics are strongly associated with patterns of telehealth use in clinical work. Infrastructure support and relative pricing of different consultation modes may be useful policy instruments to encourage GPs to deliver care by the most appropriate method.
Publisher: American Medical Association (AMA)
Date: 25-03-2013
Publisher: BMJ
Date: 06-2020
DOI: 10.1136/BMJOPEN-2019-035377
Abstract: Mounting evidence now indicates that preoperative opioid use is associated with an array of complications following total joint replacement (TJR). However, evidence of these risks remains fragmented. A comprehensive and well-integrated understanding of this body of evidence is necessary to appropriately inform treatment decisions, the allocation of limited healthcare resources, and the direction of future clinical research. The proposed systematic review and meta-analysis aims to identify and synthesise the available evidence of an association between opioid use prior to TJR and postoperative complications, categorised by complication type. We will search MEDLINE, EMBASE, CINAHL, PsycINFO, and Web of Science from inception to April 2020. Observational and experimental studies that compare preoperative opioid users who have undergone elective TJR to opioid naïve TJR patients will be included. The primary outcomes will be postoperative complications, which will be categorised as either mortality, morbidity, or joint-related complications. The secondary outcomes will be persistent postoperative opioid use, readmission, and length of stay. In idual study quality will be assessed using the relevant NIH–NHLBI study quality assessment tools. Findings will be reported in narrative and tabular form, and, where possible, odds ratios (dichotomous outcomes) or standardised mean differences (continuous outcomes) will be reported with 95% confidence intervals. Where appropriate, random effect meta-analyses will be conducted for each outcome, and heterogeneity will be quantified using the I 2 statistic and Cochran’s Q test. This study will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analyses Of Observational Studies in Epidemiology (MOOSE) guidelines. Ethics approval will not be required as no primary or private data are being collected. Findings will be disseminated through peer-reviewed publication and presentation at academic conferences. CRD42020153047.
Publisher: Elsevier BV
Date: 07-2020
Publisher: Springer Science and Business Media LLC
Date: 24-12-2013
Publisher: Springer Science and Business Media LLC
Date: 14-09-2016
Publisher: Health Affairs (Project Hope)
Date: 02-2012
Publisher: Massachusetts Medical Society
Date: 18-11-2010
DOI: 10.1056/NEJMP1010220
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 16-12-2022
DOI: 10.1097/MLR.0000000000001668
Abstract: The objective of this study was to study how changes in insurance benefit design affect medication use of older adults with mental disorders. US Medicare claims data from 2007 to 2018. Exploiting the gradual elimination of the Medicare prescription drug coverage gap beginning in 2011, we examine the effects on medication use and out-of-pocket spending by drug type with a difference-in-differences approach. We identify subpopulations by mental disorder and compare the estimates across mental health groups and to the general Medicare population. Closing the gap substantially reduced in iduals’ out-of-pocket spending, and the reduction was larger for those with more severe mental disorders. The policy led to a statistically significant increase in branded drugs used for the Medicare population (0.91 P .01 12.12% increase), beneficiaries with severe mental disorders (2.71 P .01 11.13% increase), and common mental disorders (2.63 P .01 11.62% increase), whereas such effect for beneficiaries with Alzheimer disease and dementia (AD) is substantially smaller (0.44 P .01 1.83% increase). In contrast, the policy decreased generic drugs used by about 3%–5% for all groups. Overall, beneficiaries without mental health illness have a statistically significant increase in total medication use (2.05%) following the coverage gap closure, while all 3 mental health groups have either no statistically significant changes or a small reduction in total mediation use (AD, −1.26%). Patients’ responses to price changes vary across mental disorders and by drug type. The impact on branded drug utilization among those with AD is particularly small. Our findings suggest that lowering medication costs has differential impacts across diseases and may not be sufficient to improve adherence for all conditions, in particular those with severe mental health disorders such as AD.
Publisher: American Medical Association (AMA)
Date: 22-10-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-01-2018
Abstract: In March 2014, the American Heart Association updated their guidelines for the management of oral anticoagulation ( OAC ) in atrial fibrillation, recommending OAC for all patients with CHA 2 DS 2 ‐ VAS c ≥2. Previously, only patients with CHADS 2 ≥2 were recommended for anticoagulation. This study compared effectiveness and safety outcomes of OAC among patients who would receive OAC using the 2014 guidelines but not the 2011 guidelines. Using claims data from a 5% s le of 2013–2014 Medicare beneficiaries, we identified patients with initially diagnosed atrial fibrillation between 2013 and 2014 and selected those who would receive OAC under the 2014 guidelines but not the 2011 guidelines (those with CHA 2 DS 2 ‐ VAS c score ≥2 or CHADS 2 score ). Patients were categorized according to their use of OAC after first atrial fibrillation diagnosis (2937 users and 2914 nonusers). Primary outcomes included the composite of ischemic stroke, systemic embolism and death, and any bleeding event. Cox proportional hazard models were constructed to compare the risk of primary outcomes between the 2 groups, while controlling for patient demographic and clinical characteristics. There was no difference in the combined risk of stroke, systemic embolism, and death between the treatment groups (hazard ratio, 1.00 95% confidence interval, 0.84–1.20). The risk of bleeding was higher for patients receiving OAC than for patients not receiving OAC (hazard ratio, 1.70, 95% confidence interval, 1.46–1.97). The benefit of OAC is not well defined in this patient population, and new studies that minimize residual confounding are needed to fully understand the risk/benefit of OAC in patients with atrial fibrillation and low to moderate stroke risk.
Publisher: American Psychiatric Association Publishing
Date: 10-2015
Publisher: American Medical Association (AMA)
Date: 14-03-2011
Publisher: Wiley
Date: 09-06-2015
DOI: 10.1111/JEP.12389
Publisher: Massachusetts Medical Society
Date: 11-2012
Publisher: Springer Science and Business Media LLC
Date: 11-03-2017
Publisher: Springer Science and Business Media LLC
Date: 13-02-2017
Publisher: American Medical Association (AMA)
Date: 07-2015
Publisher: Academy of Managed Care Pharmacy
Date: 03-2016
Publisher: Wiley
Date: 17-09-2010
Publisher: American Psychiatric Association Publishing
Date: 02-2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2017
Publisher: Health Affairs (Project Hope)
Date: 10-2012
Publisher: Elsevier BV
Date: 07-2014
DOI: 10.1016/J.VACCINE.2014.06.047
Abstract: While vaccines not covered by China's Expanded Program on Immunization can be received voluntarily with out-of-pocket payment, the uptake of self-paid vaccines in China is low. To investigate willingness to pay (WTP) for self-paid vaccines and its determinants in China. We interviewed 2160 randomly selected households with children 0-3 years old, in 108 communities from three provinces in 2013. A bidding game method was used to elicit WTP for two self-paid vaccines: 7-valent pneumococcal conjugate vaccine and influenza vaccine. We conducted multivariate linear regressions to determine factors affecting the WTP. Median WTP for pneumococcal conjugate vaccine and influenza vaccine were Chinese Yuan 200 and 60 (10 US Dollars). 92% and 55% of respondents, respectively were not willing to pay the market price for these two vaccines. Lower price barrier and higher ability to pay were associated with higher WTP. Those with better vaccine or disease-related knowledge, higher perceived vulnerability and severity of diseases were willing to pay more. However, perceived effectiveness and safety barriers to vaccination had no significant effects on the WTP. Recommendations from peers and healthcare providers increased the WTP. Fathers and grand parents of children had a higher WTP than their mothers. The WTP decreased with age, but was not affected by education and occupation. The majority of in iduals, in our study, were not willing to pay the market price for self-paid vaccines against high-burden diseases in China. The economic barriers to vaccination should therefore be removed to increase the demand. Region-specific information about disease burden, fiscal capacity and cost-effectiveness is important for the development of local financing policy in order to cover vaccination costs. Interventions targeting psychosocial factors, such as health education and communication with providers and peers, could also be effective in increasing the uptake of these vaccinations.
Publisher: Academy of Managed Care Pharmacy
Date: 02-2017
DOI: 10.18553/JMCP.2017.23.2.247
Abstract: Global pharmaceutical sales for anticancer drugs were $74.4 billion in 2014, ranking first for drugs by therapeutic class. Countries may differ substantially in the approval and coverage decisions for anticancer drugs. To compare the approval and coverage decisions for new anticancer drugs between the United States and 4 other countries: the United Kingdom, France, Australia, and Canada. We identified all new anticancer drug indications approved by the FDA between January 1, 2009, and December 31, 2013. For each country, we reviewed the organizations, processes, criteria, and special considerations used to make approval and coverage decisions for the drug indications approved. We further quantified and compared the variations across the 5 countries in the approval and coverage decisions as of June 30, 2014, for new anticancer drug indications. "Of 45 anticancer drug indications approved in the United States between January 1, 2009, and December 31, 2013, 67% (30) were approved by the European Medicines Agency, and 53% (24) were approved in Canada and Australia before December 31, 2013. The U.S. Medicare program covered all 45 drug indications, and as of June 30, 2014, the United Kingdom covered 87% (26) of those approved in Europe- 58% (26) of the drug indications covered by Medicare. France, Canada, and Australia covered 42% (19), 29% (13), and 24% (11) of the drug indications covered by Medicare, respectively". [corrected]. Approval and reimbursement decisions vary substantially by country. The United States had the fewest access restrictions, and Australia was the most restrictive of the 5 countries that were examined. No outside funding supported this study, and the authors report no conflicts of interest. Study concept and design were contributed primarily by Zhang, along with Hernandez and Hueser. All authors participated in data collection, and data interpretation was performed by Zhang and Hernandez, along with Hueser. The manuscript was written and revised by Zhang and Hernandez, along with Hueser.
Publisher: Wiley
Date: 04-02-2017
DOI: 10.1002/HEC.3320
Abstract: Public hospital reform is one priority area in the healthcare system reform that China launched in 2009. The Chinese government invested over $10bn for pilot projects in public hospital reform in rural China. However, little evidence exists on their effects. Using a quasi-natural experiment design, we evaluated the effects of a public hospital pilot project in Hubei province on inpatient spending. We obtained inpatient claims data from 1/1/2011 through 6/30/2013 for enrollees in the New Cooperative Medical Scheme in two counties: Danjiangkou, one of the pilot counties selected for reform in September 2012, and Laohekou, a similar, adjacent county serving as the control group. Using a difference-in-differences approach with propensity score weighting, we found that total inpatient spending increased ¥1160 (95% CI 1155-1166), out-of-pocket spending increased ¥385 (95% CI 382-389), length of stay increased 0.51 days (95% CI 0.50-0.52), but inpatient medication spending decreased ¥147 (95% CI 145-150), post-policy in Danjiangkou, relative to the control group. The overall reimbursement rate increased by 5.7 percentage points. One of the goals of the recent public hospital reform is to make inpatient services affordable to patients. We found that although patients spent less on inpatient medications, total out-of-pocket spending increased considerably after reform. Copyright © 2016 John Wiley & Sons, Ltd.
Publisher: Oxford University Press (OUP)
Date: 15-09-2017
DOI: 10.2146/AJHP161011
Abstract: The steps involved, the resources needed, and the challenges associated with applying predictive analytics in healthcare are described, with a review of successful applications of predictive analytics in implementing population health management interventions that target medication-related patient outcomes. In healthcare, the term Predictive analytics that leverage big data will become an indispensable tool for clinicians in mapping interventions and improving patient outcomes.
Publisher: Oxford University Press (OUP)
Date: 31-07-2015
DOI: 10.1093/AJH/HPV125
Publisher: American Psychiatric Association Publishing
Date: 04-2009
Publisher: American Medical Association (AMA)
Date: 27-10-2020
Publisher: American Medical Association (AMA)
Date: 03-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2017
DOI: 10.1161/STROKEAHA.117.017683
Abstract: Underuse of oral anticoagulation in stroke prevention in atrial fibrillation is common however, it remains unknown how it varies geographically. The objective of this study was to evaluate geographic variation in oral anticoagulation use and in the initiation of new oral anticoagulants (NOACs). Using 2013 to 2014 claims data from a 5% random s le of Medicare beneficiaries, we identified patients newly diagnosed with atrial fibrillation who initiated NOACs (n=8659), warfarin (n=11 771) or no oral anticoagulation therapy (n=18 226) in 2013 to 2014. Each patient was assigned to 1 of the 306 Dartmouth hospital-referral regions based on his/her zip code. We constructed logistic regressions to calculate the mean adjusted probability of initiating oral anticoagulation and the mean adjusted probability of initiating an NOAC among patients on oral anticoagulation in each hospital-referral region, after adjustment for demographic, clinical, and provider characteristics and type of insurance. Finally, we computed the correlation between 2 probabilities. Higher in the Midwest (0.54) and Northeast (0.54) and lowest in the South (0.47), the mean adjusted probability of initiating oral anticoagulation was 0.51, ranging from 0.32 to 0.72. The mean adjusted probability of being prescribed an NOAC among those on oral anticoagulation was 0.42 and was highest in the South (0.50) and lowest in the Midwest (0.36) and Northeast (0.39). In areas with the lower use of oral anticoagulation, patients on any oral anticoagulation therapy had a higher likelihood of being prescribed an NOAC (correlation coefficient, −0.16 P =0.006). Large geographic variation exists in oral anticoagulation use in atrial fibrillation. The use of oral anticoagulation is lower in the South, where the rates of stroke are unusually high. In the future, it will be important to analyze whether the high rates of stroke in the South can be partially attributed to the underuse of oral anticoagulation in this region.
Publisher: Springer Science and Business Media LLC
Date: 07-02-2012
Publisher: Springer Science and Business Media LLC
Date: 09-05-2018
DOI: 10.1007/S40256-018-0279-Y
Abstract: Several studies have compared the cost effectiveness of non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin using results from clinical trials evaluating NOACs. However, the time in therapeutic range (TTR) of warfarin groups ranged across clinical trials, and all were below the therapeutic goal of 70%. We compared the cost effectiveness of edoxaban 60 mg, apixaban 5 mg, dabigatran 150 mg, dabigatran 110 mg, rivaroxaban 20 mg, and well-managed warfarin with a TTR of 70% in preventing stroke among patients with atrial fibrillation at high risk of bleeding. For the six treatments, we used a Markov state-transition model to quantify lifetime costs in $US and effectiveness in quality-adjusted life-years (QALYs). We simulated relative risk ratios of clinical events with each NOAC versus warfarin with a TTR of 70% using published regression models that predict how the incidence of thrombotic or hemorrhagic events changes for each unit change in TTR. We re-ran our analysis for two other estimates of TTR: 65 and 75%. Treatment with edoxaban 60 mg cost $US127,520/QALY gained compared with warfarin with a TTR of 70% and cost $US41,860/QALY gained compared with warfarin with a TTR of 65%. However, warfarin with a TTR of 75% was more effective and less expensive than all NOACs. For three levels of TTR, apixaban 5 mg, dabigatran 150 mg, dabigatran 110 mg, and rivaroxaban 20 mg were dominated strategies. The comparative cost effectiveness of edoxaban and warfarin is highly sensitive to TTR. At the $US100,000/QALY willingness-to-pay threshold, our results suggest that warfarin is the most cost-effective treatment for patients who can achieve a TTR of 70%.
Publisher: Wiley
Date: 14-02-2018
Publisher: Springer Science and Business Media LLC
Date: 19-06-2021
DOI: 10.1186/S12939-021-01480-9
Abstract: This study aims to examine: (1) temporal trends in the percentage of cost-sharing and amount of out-of-pocket expenditure (OOPE) from 2011 to 2015 (2) factors associated with cost-sharing and OOPE and (3) the relationships between province-level economic development and cost-sharing and OOPE in China. A total of 10,316 adults aged ≥45 years from China followed-up from 2011 to 2015 were included in the analysis. We measured two main outcome variables: (1) patient cost sharing, measured by the percentage of OOPE as total healthcare expenditure, and (2) absolute amount of OOPE. Based on self-reported data, we did not find substantial differences in the percentage of cost sharing, but a significant increase in the absolute amount of OOPE among the middle-aged and older Chinese between 2011 and 2015. The percentage of cost-sharing was considerably higher for outpatient than inpatient care, and the majority paid more than 80% of the total cost for prescription drugs. Provinces with higher GDP per capita tend to have lower cost-sharing and a higher OOPE than their counterparts, but the relationship for OOPE became insignificant after adjusting for in idual factors. Reducing out-of-pocket expenditure and patient cost sharing is required to improve financial protection from illness, especially for those with those with chronic conditions and reside in less developed regions in China. Ongoing monitoring of financial protection using data from various sources is warranted.
Publisher: SAGE Publications
Date: 2017
Abstract: Objectives: The aim of the study was to examine the trend in incidence and prevalence of dementia, use and spending of antidementia and antipsychotic drugs among dementia patients. Methods: Using 2006-2012 Medicare claims data, we identified in iduals with diagnosis of dementia and collected their pharmacy claims in 2006-2012. We built regression models to test the trend in number of prescriptions and spending on antidementia, antipsychotic, and other drugs. Results: The prevalence of dementia did not change during our study period. Spending on antidementia and antipsychotic drugs creased to increase in 2011, following the patent expiration of Aricept, Zyprexa, and Seroquel and total pharmaceutical spending did not change in 2006-2012. Use of antidementia drugs increased during our study period however, the off-label use of antipsychotic drugs did not decrease. Discussion: Pharmaceutical spending associated with dementia may not be as concerning for Medicare as previously thought nevertheless, policies that discourage the nonevidence-based off-label use of drugs are warranted.
Publisher: Health Affairs (Project Hope)
Date: 2009
Publisher: Elsevier BV
Date: 05-2021
DOI: 10.1016/J.SOCSCIMED.2021.113886
Abstract: Physician adoption of new technologies is a key issue for population health and the sustainability of the healthcare system. This paper explores gender differences in general practitioners' (GPs) adoption of new oral anticoagulants. We combine detailed in idual data on physician and practice style characteristics from the Medicine in Australia: Balancing Employment and Life (MABEL) panel survey of Australian physicians with administrative prescribing data from the Australian Pharmaceutical Benefits Scheme (PBS) and the Medicare Benefits Schedule (MBS) for the period January 1, 2012 and December 31, 2015. After adjusting for various factors proposed in the literature as drivers of this gender gap, in addition to risk preferences and personality traits, we find a large statistical gender difference in the speed of adoption with men being faster than women in uptake. However, conditional on having prescribed for the first time, female and male GPs differ only slightly in the intensity of use of these new drugs. We show that the gender gap depends on the measure of uptake and discuss possible channels that could be driving the relatively large gender difference that remains in the speed of adoption.
Publisher: American Economic Association
Date: 05-2011
Abstract: Little is known about the relationship between variation in drug and non-drug medical treatment and how areas may substitute one type of care for the other. Using pharmacy and medical claims data for Medicare beneficiaries, we examine whether areas with more drug use have lower non-drug medical costs and how the quality of prescribing and primary care are associated with medical costs. We find that areas with higher drug spending do not have lower non-drug medical spending however, poorer-quality prescribing and primary care are associated with higher medical spending in general and inpatient spending in particular.
Publisher: American Medical Association (AMA)
Date: 22-06-2018
Start Date: 06-2021
End Date: 12-2025
Amount: $897,328.00
Funder: Australian Research Council
View Funded Activity