Trends in Nasal Spray Prescribing Patterns by Otolaryngologists in the US Medicare Population

2021 ◽  
pp. 000348942110609
Author(s):  
Celeste Kim ◽  
Erica Tran ◽  
Ian Kim ◽  
Kevin Hur
Keyword(s):  
Fluticasone Propionate ◽  
Ipratropium Bromide ◽  
State Level ◽  
The United States ◽  
Prescribing Patterns ◽  
Kaiser Family Foundation ◽  
Nasal Sprays ◽  
Medicare Population ◽  
The Us ◽  
The Cost

Objectives: To quantify national and state-level prescribing and cost trends for the 3 most prescribed nasal sprays by otolaryngologists in the Medicare population. Methods: Through the Centers for Medicare and Medicaid Services (CMS) database and the Kaiser Family Foundation, we retrieved data on Medicare enrollment and on claims and costs of fluticasone propionate, azelastine HCl, and ipratropium bromide prescribed by otolaryngologists from January 1, 2013 to December 31, 2017. Results: From 2013 to 2017, CMS reimbursed $128.8 million for 5.2 million claims of fluticasone propionate, azelastine HCl, and ipratropium bromide prescribed by otolaryngologists. The national claim rate for fluticasone propionate increased 6.5% per year from 2013 to 2015 and then decreased 4.3% per year from 2015 to 2017 while azelastine HCl and ipratropium bromide consistently increased annually (19.0% and 12.2% respectively) from 2013 to 2017. The cost for fluticasone propionate decreased 33.0% a year from 2013 to 2015 and then increased 5.4% annually to $13.60 per claim in 2017. Azelastine HCl decreased 14.8% annually from $91.30 to $50.23 per claim and ipratropium bromide increased 5.2% annually to $34.78 in 2017. Variations in the claim rate and cost for all 3 nasal sprays were observed in some states. Conclusions: Otolaryngologists are prescribing azelastine HCl and ipratropium at an increasingly higher rate in the Medicare population, while the rate for fluticasone propionate has been decreasing nationally. Utilization and costs of nasal sprays also vary geographically across the United States.

scholarly journals Associations between Google Search Trends for Symptoms and COVID-19 Confirmed and Death Cases in the United States

2021 ◽  
Vol 18 (9) ◽  
pp. 4560
Author(s):  
Mostafa Abbas ◽  
Thomas B. Morland ◽  
Eric S. Hall ◽  
Yasser EL-Manzalawy
Keyword(s):  
Functional Data ◽  
Time Series Data ◽  
Principal Component ◽  
State Level ◽  
The United States ◽  
Functional Principal Component Analysis ◽  
Series Data ◽  
Dynamic Correlation ◽  
The Us ◽  
Google Search

We utilize functional data analysis techniques to investigate patterns of COVID-19 positivity and mortality in the US and their associations with Google search trends for COVID-19-related symptoms. Specifically, we represent state-level time series data for COVID-19 and Google search trends for symptoms as smoothed functional curves. Given these functional data, we explore the modes of variation in the data using functional principal component analysis (FPCA). We also apply functional clustering analysis to identify patterns of COVID-19 confirmed case and death trajectories across the US. Moreover, we quantify the associations between Google COVID-19 search trends for symptoms and COVID-19 confirmed case and death trajectories using dynamic correlation. Finally, we examine the dynamics of correlations for the top nine Google search trends of symptoms commonly associated with COVID-19 confirmed case and death trajectories. Our results reveal and characterize distinct patterns for COVID-19 spread and mortality across the US. The dynamics of these correlations suggest the feasibility of using Google queries to forecast COVID-19 cases and mortality for up to three weeks in advance. Our results and analysis framework set the stage for the development of predictive models for forecasting COVID-19 confirmed cases and deaths using historical data and Google search trends for nine symptoms associated with both outcomes.

scholarly journals The comparison of vaccine hesitancy of COVID-19 vaccination in China and the United States

2021 ◽  
Author(s):  
Taoran Liu ◽  
Zonglin He ◽  
Jian Huang ◽  
Ni Yan ◽  
Qian Chen ◽  
...  
Keyword(s):  
United States ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Discrete Choice ◽  
Choice Experiments ◽  
The United States ◽  
Discrete Choice Experiments ◽  
Vaccine Hesitancy ◽  
The Us ◽  
The Cost

AbstractObjectivesTo investigate the differences in vaccine hesitancy and preference of the currently available COVID-19 vaccines between two countries, viz. China and the United States (US).MethodA cross-national survey was conducted in both China and the US, and discrete choice experiments as well as Likert scales were utilized to assess vaccine preference and the underlying factors contributing to the vaccination acceptance. A propensity score matching (PSM) was performed to enable a direct comparison between the two countries.ResultsA total of 9,077 (5,375 and 3,702, respectively, from China and the US) respondents have completed the survey. After propensity score matching, over 82.0% respondents from China positively accept the COVID-19 vaccination, while 72.2% respondents form the US positively accept it. Specifically, only 31.9% of Chinese respondents were recommended by a doctor to have COVID-19 vaccination, while more than half of the US respondents were recommended by a doctor (50.2%), local health board (59.4%), or friends and families (64.8%). The discrete choice experiments revealed that respondents from the US attached the greatest importance to the efficacy of COVID-19 vaccines (44.41%), followed by the cost of vaccination (29.57%), whereas those from China held a different viewpoint that the cost of vaccination covers the largest proportion in their trade-off (30.66%), and efficacy ranked as the second most important attribute (26.34%). Also, respondents from China tend to concerned much more about the adverse effect of vaccination (19.68% vs 6.12%) and have lower perceived severity of being infected with COVID-19.ConclusionWhile the overall acceptance and hesitancy of COVID-19 vaccination in both countries are high, underpinned distinctions between countries are observed. Owing to the differences in COVID-19 incidence rates, cultural backgrounds, and the availability of specific COVID-19 vaccines in two countries, the vaccine rollout strategies should be nation-dependent.

scholarly journals On the ethics of doctors in capitalist countries

1981 ◽  
Vol 62 (5) ◽  
pp. 80-83
Author(s):  
S. Ya. Chikin
Keyword(s):  
United States ◽  
Surgical Intervention ◽  
The United States ◽  
For Profit ◽  
Us Congress ◽  
The Us ◽  
The Cost

In 1977, the US Congress published statistics on the operation of surgical clinics in many cities in the country. These materials cannot be read without a shudder. They once again proved that American doctors are no different from businessmen in their passion for profit. The report's conclusion was very sad. He testified that up to three million unjustified surgeries are performed annually in the United States. Naturally, they are not undertaken for the sake of the patient's health, but in order to present a more weighty bill to the patient, because the cost of the simplest surgical intervention is now estimated at at least $ 1000.

Abstract 18272: The Increasing Proportion of Acute Myocardial Infarction Represented by the Uninsured: a Growing Financial Burden in the United States

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Bethany Doran ◽  
Yu Guo ◽  
Jinfeng Xu ◽  
Sripal Bangalore
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Health Insurance ◽  
Financial Burden ◽  
Insurance Coverage ◽  
The United States ◽  
The Us ◽  
Hospital Stays ◽  
Nationally Representative ◽  
The Cost

Introduction: Under the provisions of the Affordable Care Act, insurance coverage will markedly increase with the Congressional Budgetary Office estimating the number of insured to increase by approximately 13 million in 2014 and 25 million in 2016. However, approximately 31 million non-elderly US citizens are expected to remain without health insurance in 2016. Acute myocardial infarction (AMI) remains a source of significant morbidity and mortality, as well as cost to society. No prior studies have examined temporal rates of uninsured among patients presenting with an AMI using a nationally representative database. Hypothesis: We tested the hypothesis that the proportion of uninsured individuals with AMI and cost of uninsured to society will vary by year. Methods: We used the Nationwide Inpatient Sample (NIS), which contains estimates from approximately 8 million hospital visits and information related to number of discharges, aggregate charges, and principal diagnoses of all patients discharged in the US. We calculated the percentage of acute myocardial infarction by insurance status, and the sum of all charges of hospital stays in the US adjusted for inflation. Results: The cost to society due to acute myocardial infarction in the uninsured increased substantially from 1997 to 2012, with total cost in 1997 of $852,596,272 and $3,446,893,954 in 2012 after adjustment for inflation. In addition, although rates of AMI decreased in the general population (from 268.6/100,000 individuals in 1997 to 193.8/100,000 individuals in 2012), the proportion of individuals with AMI who were uninsured increased (from 3.83% in 1997 to 7.37% in 2012). Conclusions: The proportion of those experiencing AMI who are uninsured is rising, as is cost to society. It remains to be seen what the effects of expanding health insurance will have on the rate of AMI as well as proportion of AMI represented by the uninsured.

scholarly journals International Religious Freedom Promotion and US Foreign Policy

Religions ◽  
2020 ◽  
Vol 11 (5) ◽  
pp. 260 ◽  
Author(s):  
Lee Marsden
Keyword(s):  
United States ◽  
Religious Freedom ◽  
State Level ◽  
The United States ◽  
Human Right ◽  
National Interests ◽  
Politics And Religion ◽  
The Us ◽  
The World ◽  
Political Background

The freedom to practice one’s religious belief is a fundamental human right and yet, for millions of people around the world, this right is denied. Yearly reports produced by the US State Department, United States Commission on International Religious Freedom, Open Doors International, Aid to the Church in Need and Release International reveal a disturbing picture of increased religious persecution across much of the world conducted at individual, community and state level conducted by secular, religious, terrorist and state actors. While religious actors both contribute to persecution of those of other faiths and beliefs and are involved in peace and reconciliation initiatives, the acceptance of the freedom to practice one’s faith, to disseminate that faith and to change one’s faith and belief is fundamental to considerations of the intersection of peace, politics and religion. In this article, I examine the political background of the United States’ promotion of international religious freedom, and current progress on advancing this under the Trump administration. International Religious Freedom (IRF) is contentious, and seen by many as the advancement of US national interests by other means. This article argues that through an examination of the accomplishments and various critiques of the IRF programme it is possible, and desirable, to discover what works, and where further progress needs to be made, in order to enable people around the world to enjoy freedom of thought, conscience and religion.

Recognizing barriers to entry of biosimilars in the United States market and highlighting the solutions

2020 ◽  
pp. 174113432097215
Author(s):  
Arpit Bana ◽  
Priti J Mehta
Keyword(s):  
Patent Protection ◽  
Reference Product ◽  
Market Competition ◽  
The United States ◽  
Living Cells ◽  
Barriers To Entry ◽  
The Us ◽  
The Government ◽  
The Cost ◽  
The U.S

Drugs that are procured from living cells and are used to treat acute and chronic diseases are called biologics, whereas biosimilars are the drugs which are highly similar but not identical to the original reference product. The main advantage of these drugs is that they are highly targeted with great therapeutic activity and can be used for multiple indications. Despite all the advantages biologics are still extremely costly. The main purpose of developing and introducing biosimilars was and is to increase market competition leading to a decrease in the cost of the biologics. However, until now the cost of the treatment has not decreased in the US market because there are many barriers to the entry of biosimilar in the US market which are discussed in this article. In this article, we argue that the barrier or hurdle in the US market entry of the biosimilars is not only limited to patent protection or exclusivity but other less discussed barriers are also there which are to be discussed. Due to these barriers till June 10, 2020, only 9 biosimilars are available commercially in the US market out of the 27 biosimilars approved for marketing by the U.S. Food and Drug Administration (FDA). We argue that the introduction of these biosimilars in the US market is essential for increasing market competition and thus decreasing the overall treatment cost for both the government and the payers. In this article, we are also providing perspective on the possible solutions to reduce these barriers and to encourage the entry of biosimilar in the US market.

scholarly journals Crisis Standards of Care Implementation at the State Level in the United States

2020 ◽  
Vol 35 (6) ◽  
pp. 599-603 ◽  
Author(s):  
Colton Margus ◽  
Ritu R. Sarin ◽  
Michael Molloy ◽  
Gregory R. Ciottone
Keyword(s):  
United States ◽  
Large Scale ◽  
State Level ◽  
The United States ◽  
The State ◽  
Pediatric Care ◽  
Standards Of Care ◽  
Institute Of Medicine ◽  
Full Spectrum ◽  
The Us

AbstractIntroduction:In 2009, the Institute of Medicine published guidelines for implementation of Crisis Standards of Care (CSC) at the state level in the United States (US). Based in part on the then concern for H1N1 pandemic, there was a recognized need for additional planning at the state level to maintain health system preparedness and conventional care standards when available resources become scarce. Despite the availability of this framework, in the years since and despite repeated large-scale domestic events, implementation remains mixed.Problem:Coronavirus disease 2019 (COVID-19) rejuvenates concern for how health systems can maintain quality care when faced with unrelenting burden. This study seeks to outline which states in the US have developed CSC and which areas of care have thus far been addressed.Methods:An online search was conducted for all 50 states in 2015 and again in 2020. For states without CSC plans online, state officials were contacted by email and phone. Public protocols were reviewed to assess for operational implementation capabilities, specifically highlighting guidance on ventilator use, burn management, sequential organ failure assessment (SOFA) score, pediatric standards, and reliance on influenza planning.Results:Thirty-six states in the US were actively developing (17) or had already developed (19) official CSC guidance. Fourteen states had no publicly acknowledged effort. Eleven of the 17 public plans had updated within five years, with a majority addressing ventilator usage (16/17), influenza planning (14/17), and pediatric care (15/17), but substantially fewer addressing care for burn patients (9/17).Conclusion:Many states lacked publicly available guidance on maintaining standards of care during disasters, and many states with specific care guidelines had not sufficiently addressed the full spectrum of hazard to which their health care systems remain vulnerable.

An economic analysis of axitinib and sorafenib for second-line treatment of cytokine-refractory patients with advanced renal cell carcinoma in the United States (US).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15601-e15601
Author(s):  
Ipek Özer-Stillman ◽  
Apoorva Ambavane ◽  
Paul Cislo
Keyword(s):  
Economic Analysis ◽  
The United States ◽  
Phase Iii ◽  
Administrative Claims ◽  
Line Treatment ◽  
Second Line ◽  
Cost Difference ◽  
Life Years ◽  
The Us ◽  
The Cost

e15601 Background: Cytokines are a first-line treatment option for a subset of advanced RCC patients in the US. After progression on cytokines, NCCN guidelines recommend targeted agents, such as axitinib and sorafenib. Subgroup analysis of post-cytokine patients in the phase III AXIS trial found that axitinib increased median progression free survival (PFS) compared with sorafenib (12.0 vs. 6.6 months, p<0.0001), while overall survival (OS) showed no difference (29.4 vs. 27.8 months, p=0.144). An economic analysis for this subgroup was conducted from a US healthcare payer perspective. Methods: A cohort partition model with monthly cycles was constructed to estimate direct medical costs and health outcomes, discounted at 3.0% per annum, over cohort lifetime. Patients were apportioned into 3 health states (progression-free, progressed and dead) based on OS and PFS Kaplan-Meier curves for the post-cytokine subgroup in the AXIS trial. Active treatment was applied until progression, followed by best supportive care (BSC) alone thereafter. The wholesale acquisition costs were based from RedBook. Adverse event (AE) management costs were obtained from published studies. AE rates and utility values were informed by the AXIS trial. Administrative claims data from MarketScan Database were analyzed to estimate costs for BSC and routine care of second-line advanced RCC patients. Results: The total per-patient lifetime costs were estimated to be $242,750 for axitinib and $168,880 for sorafenib and most of the cost difference (84%) was due to the higher total medication cost of axitinib. The cost difference was sensitive to dose intensity and length of treatment. The difference in quality-adjusted life-years (QALY) for axitinib versus sorafenib was minor (1.3 versus 1.2) and the incremental cost-effectiveness ratio (ICER) for axitinib compared with sorafenib was $683,209/QALY. Conclusions: For cytokine-refractory advanced RCC patients, axitinib resulted in an ICER > $650,000/QALY versus sorafenib due to high drug costs and lack of OS benefit, indicating that axitinib may not present good value for money as 2nd line treatment when compared to sorafenib in the US.

scholarly journals The cost of music

Popular Music ◽  
2020 ◽  
Vol 39 (1) ◽  
pp. 43-65 ◽  
Author(s):  
Matt Brennan ◽  
Kyle Devine
Keyword(s):  
Economic Cost ◽  
The United States ◽  
Environmental Cost ◽  
Recording Industry ◽  
Recorded Music ◽  
The Us ◽  
Human Costs ◽  
Audio Files ◽  
The One ◽  
The Cost

AbstractWhat is the cost of music in the so-called Anthropocene? We approach this question by focusing on the case of sound-recording formats. We consider the cost of recorded music through two overlapping lenses: economic cost, on the one hand, and environmental cost, on the other. The article begins by discussing how the price of records has changed from the late 19th to the 21st century and across the seven most economically significant playback formats: phonograph cylinder, gramophone disc, vinyl LP, cassette tape, compact disc, digital audio files on hard drive, and streaming from the cloud. Our case study territory is the United States, and we chart the gradual decline in the price of recorded music up to the present. We then examine the environmental and human costs of music by looking at what recordings are made out of, where those materials come from, and what happens to them when they are disposed of. Despite what rhetorics of digital dematerialisation tell us, we show that the labour conditions in the digital electronics and IT industries are as inhumane as ever, while the amount of greenhouse gases released by the US recording industry could actually be higher today than at the height of any previous format. We conclude by asking the obvious (but by no means straightforward) question: what are musicians and fans to do?

scholarly journals The Partisan Mask: Political Orientation, Collectivism, and Religiosity Predict Mask Use During COVID-19

2021 ◽  
Author(s):  
Hohjin Im ◽  
Peiyi Wang ◽  
Chuansheng Chen
Keyword(s):  
State Level ◽  
The United States ◽  
Political Orientation ◽  
Third Party ◽  
The Us ◽  
Political Conservatism ◽  
Strong Correlate ◽  
Using Data ◽  
The Individual ◽  
Socioeconomic And Demographic Factors

In the United States, the COVID-19 pandemic became an unconventional vehicle to advance partisan rhetoric and antagonism. Using data available at the individual- (Study 1; N = 4,220), county- (Study 2; n = 3,046), and state-level (n = 49), we found that partisanship and political orientation was a robust and strong correlate of mask use. Political conservatism and Republican partisanship were related to downplaying the severity of COVID-19 and perceiving masks as being ineffective that, in turn, were related to lower mask use. In contrast, we found that counties with majority Democrat partisanship reported greater mask use, controlling for various socioeconomic and demographic factors. Lastly, states with strong cultural collectivism reported greater mask use while those with strong religiosity reported the opposite. States with greater Democrat partisanship and strong cultural collectivism subsequently reported lower COVID-19 deaths, mediated by greater mask use and lower COVID-19 cases, in the five months following the second wave of COVID-19 in the US during the Summer of 2020. Nonetheless, more than the majority for Democrats (91.58%), Republicans (77.52%), and third-party members (82.48%) reported using masks. Implications for findings are discussed.

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