scholarly journals The Prevalence and Forecast Prevalence of Overactive Bladder in the Medicare Population

2019 ◽  
Vol 12 ◽  
pp. 117956111984746 ◽  
Author(s):  
Gary Puckrein ◽  
David Walker ◽  
Liou Xu ◽  
Peter Congdon ◽  
Katherine Gooch
Keyword(s):  
Overactive Bladder ◽  
Urban Areas ◽  
Medicare Beneficiary ◽  
The United States ◽  
Population Projections ◽  
Drug Event ◽  
Fee For Service ◽  
Event File ◽  
Part D ◽  
Us Census

Objectives: To determine current and future prevalence of overactive bladder (OAB) among Medicare fee-for-service beneficiaries in the United States. Methods: Prevalence of OAB in US adults ⩾ 65 years was determined using the 2013 Medicare Beneficiary Part B Carrier Claims File, Part D Drug Event File, and Medicare Beneficiary Annual Summary File. Prevalence for 2027 was forecasted with US Census population projections. Regional projections were based on applying national OAB rates by age, sex, and race/ethnicity to zip code tabulation area beneficiary populations. Results: In the 2013 dataset, the prevalence of OAB was 7.2% (male: 7.7%; female: 6.7%). Across demographic categories, prevalence was the highest among those aged more than 74 years (9.3%), identifying as White (7.4%), and residing in urban areas (7.5%). By 2027, OAB is projected to increase by 48.1%. Discussion: OAB affects a substantial proportion of the US fee-for-service beneficiary population, with the prevalent population projected to rise substantially by 2027.

Biosimilar uptake of filgrastim and impact on spending in Medicare Part D from 2015 to 2019.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 67-67
Author(s):  
Syed Hussaini ◽  
Arjun Gupta ◽  
Kelly E. Anderson ◽  
Jeromie M. Ballreich ◽  
Lauren H. Nicholas ◽  
...  
Keyword(s):  
Cost Savings ◽  
Medicare Part D ◽  
The United States ◽  
Medicare Part ◽  
Drug Event ◽  
Cross Sectional ◽  
Part D ◽  
Medicare Part B ◽  
Significant Uptake ◽  
Biosimilar Filgrastim

67 Background: The introduction of a filgrastim biosimilar in 2014 was associated with substantial cost savings in Medicare Part B and Medicaid programs. However, Medicare Part D is unique since it is unable to directly negotiate prices with drug manufacturers. We sought to investigate the uptake of filgrastim biosimilars and impact on spending among Part D beneficiaries. Methods: We evaluated utilization trends for filgrastim (Neupogen), filgrastim-sndz (Zarxio), and tbo-filgrastim (Granix) using the 2015-2019 Medicare Part D Prescription Drug Event data. We conducted a retrospective cross-sectional review of annual spending, number of beneficiaries, number of claims, spending per beneficiary, and spending per dosage unit. We excluded filgrastim-aafi (Nivestym) due to recent approval and adjusted for inflation using 2019 dollars. Results: In 2019, total aggregate Part D spending on filgrastim products was $78 million. From 2015 to 2019, the biosimilar share of total aggregate spending increased from $1.8 million (2%) to $44 million (56%), with combined biosimilar spending (Zarxio and Granix) eclipsing originator Neupogen in 2018 (within 4 years of FDA approval of Zarxio). Total spending on Neupogen reduced 58% from 2015 to 2019. While biosimilar uptake progressively increased every year, total aggregate spending on all filgrastim forms reduced only 7% from 2015 to 2019 ($84 million to $78 million). For all 3 forms, from 2015 to 2019, trends in spending were: average spending per claim ($3193 to $2549, -20%), average spending per beneficiary ($5880 to $6722, +15%), and average spending per dosage unit of filgrastim ($583 vs $571, -2%). Detailed results in Table. Conclusions: We demonstrate that the significant uptake of biosimilar filgrastim products in Medicare Part D from 2015 to 2019 was associated with a small decrease in aggregate spending, essentially unchanged per unit spending, and increased spending per beneficiary on filgrastim products. Our findings contrast with experiences across Medicare Part B and Medicaid, that demonstrated significant cost savings with biosimilar filgrastim uptake. This may be due to inability of Medicare Part D to directly negotiate prices with manufacturers (in contrast to Medicare Part B and Medicaid), supporting ongoing Congressional policy being debated in the United States Senate (H.R. 3).[Table: see text]

scholarly journals Association between physician adoption of a new oral anti-diabetic medication and Medicare and Medicaid drug spending

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Ilinca D. Metes ◽  
Lingshu Xue ◽  
Chung-Chou H. Chang ◽  
Haiden A. Huskamp ◽  
Walid F. Gellad ◽  
...  
Keyword(s):  
Prescription Drug ◽  
The United States ◽  
County Level ◽  
Fee For Service ◽  
Drug Spending ◽  
Part D ◽  
Drug Classes ◽  
Level Data ◽  
Prescription Drug Spending ◽  
Physician Adoption

Abstract Background In the United States, there is well-documented regional variation in prescription drug spending. However, the specific role of physician adoption of brand name drugs on the variation in patient-level prescription drug spending is still being investigated across a multitude of drug classes. Our study aims to add to the literature by determining the association between physician adoption of a first-in-class anti-diabetic (AD) drug, sitagliptin, and AD drug spending in the Medicare and Medicaid populations in Pennsylvania. Methods We obtained physician-level data from QuintilesIMS Xponent™ database for Pennsylvania and constructed county-level measures of time to adoption and share of physicians adopting sitagliptin in its first year post-introduction. We additionally measured total AD drug spending for all Medicare fee-for-service and Part D enrollees (N = 125,264) and all Medicaid (N = 50,836) enrollees with type II diabetes in Pennsylvania for 2011. Finite mixture model regression, adjusting for patient socio-demographic/clinical characteristics, was used to examine the association between physician adoption of sitagliptin and AD drug spending. Results Physician adoption of sitagliptin varied from 44 to 99% across the state’s 67 counties. Average per capita AD spending was $1340 (SD $1764) in Medicare and $1291 (SD $1881) in Medicaid. A 10% increase in the share of physicians adopting sitagliptin in a county was associated with a 3.5% (95% CI: 2.0–4.9) and 5.3% (95% CI: 0.3–10.3) increase in drug spending for the Medicare and Medicaid populations, respectively. Conclusions In a medication market with many choices, county-level adoption of sitagliptin was positively associated with AD spending in Medicare and Medicaid, two programs with different approaches to formulary management.

scholarly journals Growing Income Inequality and Socioeconomic Segregation in the Chicago Region

2021 ◽  
pp. 349-369
Author(s):  
Janet L. Smith ◽  
Zafer Sonmez ◽  
Nicholas Zettel
Keyword(s):  
United States ◽  
New York ◽  
Los Angeles ◽  
Income Inequality ◽  
Urban Areas ◽  
Census Data ◽  
National Level ◽  
The United States ◽  
Ethnic Segregation ◽  
Us Census

AbstractIncome inequality in the United States has been growing since the 1980s and is particularly noticeable in large urban areas like the Chicago metro region. While not as high as New York or Los Angeles, the Gini Coefficient for the Chicago metro area (.48) was the same as the United States in 2015 but rising at a faster rate, suggesting it will surpass the US national level in 2020. This chapter examines the Chicago region’s growing income inequality since 1980 using US Census data collected in 1990, 2000, 2010, and 2015, focusing on where people live based on occupation as well as income. When mapped out, the data shows a city and region that is becoming more segregated by occupation and income as it becomes both richer and poorer. A result is a shrinking number of middle-class and mixed neighbourhoods. The resulting patterns of socioeconomic spatial segregation also align with patterns of racial/ethnic segregation attributed to historical housing development and market segmentation, as well as recent efforts to advance Chicago as a global city through tourism and real estate development.

Prevalence of nonmetastatic (M0) prostate cancer (PC) patients on continuous androgen deprivation therapy (ADT) in the United States.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 4659-4659
Author(s):  
Karynsa Cetin ◽  
Shuling Li ◽  
Anne Hudson Blaes ◽  
Scott Stryker ◽  
Alexander Liede ◽  
...  
Keyword(s):  
Insurance Coverage ◽  
Large Population ◽  
The United States ◽  
Continuous Exposure ◽  
Fee For Service ◽  
Male Population ◽  
Current Prevalence ◽  
The Us ◽  
Timing Of Initiation ◽  
Us Census

4659 Background: ADT is the cornerstone treatment of metastatic PC, but the nature and extent of its use in the M0 setting is less well-described. We sought to estimate the current prevalence of M0 PC patients actively receiving continuous ADT (≥6 months) in the US. Methods: Two point-prevalent cohorts on 12/31/2008 with continuous insurance coverage in 2008 were assembled: men aged 45-64 years (yrs) enrolled in commercial health plans (MarketScan) and men aged ≥67 yrs enrolled in fee-for-service (FFS) Medicare (Medicare 5% sample). Among those with evidence of PC and no evidence of metastases, we selected men who had continuous exposure to gonadotropin-releasing hormone agonists during at least the last 6 months of 2008 or received bilateral orchiectomy prior to 7/1/2008. The number of prevalent ADT users was extrapolated to the entire national commercially insured population aged 45-64 yrs and to the entire Medicare FFS population aged ≥65 yrs using person-level weights. Applying age-specific prevalence estimates to the US Census population on 12/31/2008, we estimated the number of prevalent ADT users in the total US male population aged ≥45 yrs. Results: An estimated 11,935 (95% confidence interval [CI]: 11,310-12,561) commercially insured men aged 45-64 yrs and 115,468 (95% CI: 112,304-118,633) Medicare FFS men aged ≥65 yrs were M0 PC patients actively receiving continuous ADT for ≥6 months on 12/31/2008. Extrapolated to the total US male population aged ≥45 yrs, this estimate was 188,916 (95% CI: 184,104-193,727). Age-specific prevalence (N [95% CI]) on 12/31/2008 is presented in the table. Conclusions: We projected nearly 190,000 US men with M0 PC were actively receiving continuous ADT for ≥6 months at the end of 2008, and the vast majority (91%) of these men were aged ≥65 yrs. Additional work will address timing of initiation, duration, and other aspects of ADT use in this large population of M0 PC patients. [Table: see text]

scholarly journals Rural-Urban Differences in Survival and Nursing Home Use Among Medicare Beneficiaries Diagnosed With Dementia

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 43-43
Author(s):  
Momotazur Rahman ◽  
Elizabeth White ◽  
Kali Thomas ◽  
Eric Jutkowitz
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Nursing Homes ◽  
Healthcare Utilization ◽  
Urban Areas ◽  
Health Assessment ◽  
The United States ◽  
Individual Characteristics ◽  
Fee For Service ◽  
Rural Residents

Abstract There is poor understanding as to how survival and healthcare utilization vary among older adults living with Alzheimer’s disease and related dementias (ADRD) in rural versus urban areas of the United States. This prospective cohort study used 2008-2015 Medicare claims linked with nursing home and home health assessment data to describe differences in survival and healthcare utilization in the six years following a new ADRD diagnosis between rural and urban populations. The sample consisted of 1,203,897 Medicare fee-for-service beneficiaries who were diagnosed with ADRD in 2008 or 2009. 77% (n=921,853) resided in metropolitan counties, 14% (n=162,857) in micropolitan counties, and 10% (n=119,187) in rural counties. Rural residents were on average about six months younger than metropolitan residents at diagnosis. Metropolitan residents survived a mean of 1211 days after diagnosis. Adjusting for individual characteristics, beneficiaries in rural and micropolitan counties survived 29.2 fewer days (95% CI -34.0,-24.4) and 31.9 fewer days (95% CI -36.1,-27.7) than metropolitan residents, respectively. Compared to metropolitan residents, rural residents spent 59.8 more days (95% CI 56.7, 63.0) in nursing homes. We found similar patterns in nursing home use for micropolitan vs. metropolitan residents, though the magnitude of the differences was smaller. Differences between groups became more pronounced the greater the time from diagnosis. These findings demonstrate that urban-dwelling older adults with ADRD are significantly more likely to remain in the community and less likely to use nursing homes than individuals in rural and micropolitan counties, particularly in later disease stages.

Home Dialysis Utilization among Racial and Ethnic Minorities in the United States at the National, Regional, and State Level

2017 ◽  
Vol 37 (1) ◽  
pp. 21-29 ◽  
Author(s):  
Eric L. Wallace ◽  
Janice Lea ◽  
Ninad S. Chaudhary ◽  
Russell Griffin ◽  
Eric Hammelman ◽  
...  
Keyword(s):  
United States ◽  
Peritoneal Dialysis ◽  
Medicare Beneficiary ◽  
State Level ◽  
The United States ◽  
Fee For Service ◽  
Underrepresented Minority ◽  
Home Dialysis ◽  
The Us ◽  
Dialysis Facility

BackgroundUnited States Renal Data System (USRDS) data from 2014 show that African Americans (AA) are underrepresented in the home dialysis population, with 6.4% versus 9.2% utilization in the general populace. This racial disparity may be inaccurately ascribed to the nation as a whole if regional and inter-state variability exists. This investigation sought to examine home dialysis utilization by minority Medicare beneficiary populations across the US nationally, regionally, and by individual state.MethodsThe 2012 Medicare 100% Outpatient Standard Analytic File was used to identify all Medicare fee-for-service (FFS) patients, with state of residence and race, receiving an outpatient dialysis facility bill type. Peritoneal dialysis (PD) and home hemodialysis (HHD) patients were identified using revenue and condition codes and were defined by having at least one claim during the year that met criteria for the category. Beneficiaries were counted once for each modality used that year. A home dialysis utilization ratio (UR) was calculated as the ratio of the proportion of a minority on PD or HHD within a geographic division to the proportion of Caucasians on PD or HHD within the same geographic division. A UR less than 1.00 indicated under-representation while a UR over 1.00 indicated over-representation. Utilization ratios were compared using a Poisson regression model.ResultsA total of 369,164 Medicare FFS dialysis patients were identified. Within the total cohort, AA were the most underrepresented minority on PD (UR 0.586; 95% confidence interval [CI]: 0.585 – 0.586; p < 0.0001), followed by Hispanics (UR 0.744; 95% CI 0.743 – 0.744; p < 0.0001). The underutilization of PD by AA and Hispanics could not be ascribed to any region of the US, as all regions of the US had UR < 1.00. Only Massachusetts had a UR > 1.00 for AA on PD. Peritoneal dialysis UR values for Asians and those self-identified as Other were 0.954; 95% CI 0.953 – 0.954 and 0.932; 95% CI 0.931 – 0.932, respectively. Nationally, all minorities utilized HHD less than Caucasians. However, more variability existed, with Asians utilizing more HHD than Caucasians in the Midwest.ConclusionsAlthough regional and interstate variability exists, there is near universal under-representation of AA and Hispanics in the home dialysis population, while Asians and Other demonstrate more interregional and interstate variability.

scholarly journals Autism Tsunami: the Impact of Rising Prevalence on the Societal Cost of Autism in the United States

2021 ◽  
Author(s):  
Mark Blaxill ◽  
Toby Rogers ◽  
Cynthia Nevison
Keyword(s):  
Forecast Model ◽  
The United States ◽  
Population Projections ◽  
Base Case ◽  
Prevention Strategies ◽  
Total Base ◽  
Cost Categories ◽  
The Cost ◽  
The Impact ◽  
First Time

AbstractThe cost of ASD in the U.S. is estimated using a forecast model that for the first time accounts for the true historical increase in ASD. Model inputs include ASD prevalence, census population projections, six cost categories, ten age brackets, inflation projections, and three future prevalence scenarios. Future ASD costs increase dramatically: total base-case costs of $223 (175–271) billion/year are estimated in 2020; $589 billion/year in 2030, $1.36 trillion/year in 2040, and $5.54 (4.29–6.78) trillion/year by 2060, with substantial potential savings through ASD prevention. Rising prevalence, the shift from child to adult-dominated costs, the transfer of costs from parents onto government, and the soaring total costs raise pressing policy questions and demand an urgent focus on prevention strategies.

scholarly journals Presentation, Management, and Outcomes across the Rural-Urban Continuum for Hepatocellular Carcinoma

2020 ◽  
Author(s):  
Kali Zhou ◽  
Trevor A Pickering ◽  
Christina S Gainey ◽  
Myles Cockburn ◽  
Mariana C Stern ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Rural Communities ◽  
Urban Areas ◽  
Tumor Stage ◽  
The United States ◽  
Population Based ◽  
Urban Residents ◽  
Place Of Residence ◽  
Incidence And Mortality ◽  
Receive Treatment

Abstract Background Hepatocellular carcinoma is one of few cancers with rising incidence and mortality in the United States. Little is known about disease presentation and outcomes across the rural-urban continuum. Methods Using the population-based SEER registry, we identified adults with incident hepatocellular carcinoma between 2000–2016. Urban, suburban and rural residence at time of cancer diagnosis were categorized by the Census Bureau’s percent of the population living in non-urban areas. We examined association between place of residence and overall survival. Secondary outcomes were late tumor stage and receipt of therapy. Results Of 83,368 cases, 75.8%, 20.4%, and 3.8% lived in urban, suburban, and rural communities, respectively. Median survival was 7 months (IQR 2–24). All stage and stage-specific survival differed by place of residence, except for distant stage. In adjusted models, rural and suburban residents had a respective 1.09-fold (95% CI = 1.04–1.14, p &lt; .001) and 1.08-fold (95% CI = 1.05–1.10, p &lt; .001) increased hazard of overall mortality as compared to urban residents. Furthermore, rural and suburban residents had 18% (OR = 1.18, 95% CI 1.10–1.27, p &lt; .001) and 5% (OR = 1.05, 95% CI = 1.02–1.09, p = .003) higher odds of diagnosis at late stage and were 12% (OR = 0.88, 95% CI = 0.80–0.94, p &lt; .001) and 8% (OR = 0.92, 95% CI = 0.88–0.95, p &lt; .001) less likely to receive treatment, respectively, compared to urban residents. Conclusions Residence in a suburban and rural community at time of diagnosis was independently associated with worse indicators across the cancer continuum for liver cancer. Further research is needed to elucidate the primary drivers of these rural-urban disparities.

scholarly journals SAT0172 UTILIZATION OF HYDROXYCHLOROQUINE AND CORTICOSTEROIDS AMONG LUPUS PATIENTS WITH INCIDENT END-STAGE RENAL DISEASE (ESRD) ONSET: A LONGITUDINAL STUDY USING USRDS REGISTRY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1027.2-1027
Author(s):  
A. R. Broder ◽  
W. Mowrey ◽  
A. Valle ◽  
B. Goilav ◽  
K. Yoshida ◽  
...  
Keyword(s):  
United States ◽  
Lupus Nephritis ◽  
Renal Disease ◽  
International Classification Of Diseases ◽  
The United States ◽  
Diagnostic Code ◽  
Prescribing Practices ◽  
Part D ◽  
Stage Renal Disease

Background:The development of ESRD due to lupus nephritis is one of the most common and serious complications of SLE. Mortality among SLE ESRD patients is 4-fold higher compared to lupus nephritis patients with preserved renal function1Mortality in SLE ESRD is also twice as high compared with non-SLE ESRD, even though SLE patients develop ESRD at a significantly younger age. In the absence of ESRD specific guidelines, medication utilization in SLE ESRD is unknown.Objectives:The objective of this study was to investigate the real-world current US-wide patterns of medication prescribing among lupus nephritis patients with new onset ESRD enrolled in the United States Renal Disease Systems (USRDS) registry. We specifically focused on HCQ and corticosteroids (CS) as the most used medications to treat SLE.Methods:Inclusion: USRDS patients 18 years and above with SLE as a primary cause of ESRD (International Classification of Diseases, 9thRevision (ICD9) diagnostic code 710.0, previously validated2). who developed ESRD between January 1st, 2006 and July 31, 2011 (to ensure at least 6 months of follow-up in the USRDS). Patients had to be enrolled in Medicare Part D (to capture pharmacy claims). The last follow-up date was defined as either the last date of continuous part D coverage or the end of the study period, Dec 31, 2013.Results:Of the 2579 patients included, 1708 (66%) were HCQ- at baseline, and 871 (34%) were HCQ+ at baseline. HCQ+ patients at baseline had a slightly lower duration of follow-up compared to HCQ- patients at baseline, median (IQR) of 2.32 (1.33, 3.97) years and 2.55 (1.44, 4.25) years, respectively, p= 0.02. During follow-up period, only 778 (30%) continued HCQ either intermittently or continuously to the last follow-up date, 1306 (51%) were never prescribed HCQ after baseline, and 495 (19%) discontinued HCQ before the last follow-up date. Of the 1801 patients who were either never prescribed or discontinued HCQ early after ESRD onset, 713 (40%) were prescribed CS to the end of the follow-up period: 55% were receiving a low dose <10mg/daily, and 43 were receiving moderate dose (10-20mg daily)Conclusion:HCQ may be underprescribed and CS may be overprescribed in SLE ESRD. Changing the current prescribing practices may improve outcomes in SLE ESRDReferences:[1]Yap DY et al., NDT 2012.[2]Broder A et al., AC&R 2016.Acknowledgments :The data reported here have been supplied by the United States Renal Data System (USRDS). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy or interpretation of the U.S. government.Funding: :NIH/NIAMS K23 AR068441 (A Broder), NIH/NIAMS R01 AR 057327 and K24 AR 066109 (KH Costenbader)Disclosure of Interests: :Anna R. Broder: None declared, Wenzhu Mowrey: None declared, Anna Valle: None declared, Beatrice Goilav: None declared, Kazuki Yoshida: None declared, Karen Costenbader Grant/research support from: Merck, Consultant of: Astra-Zeneca

Identification of Potential Freight Parking Locations in Urban Areas

2021 ◽  
pp. 036119812110130
Author(s):  
Glenn Vorhes ◽  
Ernest Perry ◽  
Soyoung Ahn
Keyword(s):  
United States ◽  
Information System ◽  
Satellite Imagery ◽  
Urban Areas ◽  
The United States ◽  
Truck Drivers ◽  
Short List ◽  
Automated Processes ◽  
Parking Facilities ◽  
Urban Sites

Truck parking is a crucial element of the United States’ transportation system as it provides truckers with safe places to rest and stage for deliveries. Demand for truck parking spaces exceeds supply and shortages are especially common in and around urban areas. Freight operations are negatively affected as truck drivers are unable to park in logistically ideal locations. Drivers may resort to unsafe practices such as parking on ramps or in abandoned lots. This report seeks to examine the potential parking availability of vacant urban parcels by establishing a methodology to identify parcels and examining whether the identified parcels are suitable for truck parking. Previous research has demonstrated that affordable, accessible parcels are available to accommodate truck parking. When used in conjunction with other policies, adaptation of urban sites could help reduce the severity of truck parking shortages. Geographic information system parcel and roadway data were obtained for one urban area in each of the 10 Mid America Association of Transportation Officials region states. Area and proximity filters were applied followed by spectral analysis of satellite imagery to identify candidate parcels for truck parking facilities within urban areas. The automated processes created a ranked short list of potential parcels from which those best suited for truck parking could be efficiently identified for inspection by satellite imagery. This process resulted in a manageable number of parcels to be evaluated further by local knowledge metrics such as availability and cost, existing infrastructure and municipal connections, and safety.

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