scholarly journals Healthcare utilization and cost of cancer-related care prior to allogeneic hematopoietic cell transplantation for hematologic malignancies in the US: a retrospective real-world analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Machaon Bonafede ◽  
Elias Anaissie ◽  
Kristin Evans ◽  
Robbin Itzler
Keyword(s):  
Healthcare Utilization ◽  
Resource Utilization ◽  
Hematopoietic Cell Transplantation ◽  
Hematologic Malignancy ◽  
Hematologic Malignancies ◽  
Supplemental Insurance ◽  
Time Period ◽  
The Us ◽  
Insured Patients ◽  
The Cost

Abstract Background Hematopoietic cell transplantation (HCT) is a potentially curative therapy as well as a costly procedure. Published studies have examined the cost of HCT in the US and the complications that follow but little is known about the cancer-related healthcare costs and resource utilization prior to the procedure and none of the studies have examined the variability in cost based on the type of hematologic malignancy involved. The aim of this study was to estimate mean cancer-related costs and resources incurred before the HCT is performed from the time the hematologic malignancy first develops. Methods The IBM® MarketScan® Research Databases were used to identify adult patients ≥18 years of age with commercial or Medicare supplemental insurance who had undergone allogeneic HCT for hematologic malignancies from January 1, 2008 to December 31, 2017. Healthcare utilization and costs were assessed during the 6 months prior to diagnosis (pre-diagnostic period) and the follow-up period from diagnosis just prior to the HCT (pre-HCT period). Multivariable regression models were constructed to estimate total all-cause costs and cancer-related costs as well as healthcare utilization by type in each time period. Results A total of 2663 commercially insured patients and 266 with Medicare supplemental insurance were included in the study population. The mean-adjusted incremental cancer-related costs for commercially insured patients was $399,011 in the overall observation period including the pre-diagnostic and pre-HCT periods combined, 9% of which was incurred in the pre-diagnostic period. The corresponding mean-adjusted incremental cancer-related costs for Medicare supplemental patients was $195,575 for the same time period but the patterns of healthcare utilization were similar to the commercially insured population. Inpatient care accounted for approximately one-half the cost in both patient populations. By type of hematologic malignancy, costs were lowest for myeloproliferative disorders ($211,561) and highest for acute lymphocytic leukemia ($462,072) in the commercially insured population. Conclusion This study demonstrates that overall patients with hematologic malignancies requiring HCT have considerable cancer-related healthcare resource utilization and costs leading up to HCT compared to the period of time prior to developing cancer.

Phase 1 Study of Carfilzomib for the Prevention of Relapse and Graft-Versus-Host Disease in Allogeneic Hematopoietic Cell Transplantation for High-Risk Hematologic Malignancies

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1907-1907 ◽  
Author(s):  
Attaphol Pawarode ◽  
Steven Goldstein ◽  
Daniel R. Couriel ◽  
Thomas Braun ◽  
John M. Magenau ◽  
...  
Keyword(s):  
High Risk ◽  
Graft Versus Host Disease ◽  
Hematopoietic Cell Transplantation ◽  
Hematologic Malignancy ◽  
Phase 1 ◽  
Hematologic Malignancies ◽  
Hematopoietic Cell ◽  
Unrelated Donor ◽  
Host Disease ◽  
Graft Versus Host

Abstract Allogeneic hematopoietic cell transplant (HCT) remains the primary curative option for patients (pts) with poor-risk hematologic malignancies, but graft-versus-host disease (GVHD) and relapse remain major obstacles. Of note, GVHD therapy with systemic steroid and more potent immunosuppression abrogates graft-versus-tumor effect and further increases relapse. The NF-κB signaling pathway has a pivotal role in maintaining malignant cell survival and in mediating inflammatory and immune response by promoting activated T and dendritic cell function and survival. Inhibition of proteasome function results in down-regulation of the NF-κB signaling pathway, thus selective apoptosis of malignant cells, in which this pathway is up-regulated, and of allo-reactive T and dendritic cells. The reversible proteasome inhibitor bortezomib may abrogate GVHD and relapse based on pre-clinical studies and a phase 1/2 clinical trial when added to high-risk mismatched unrelated donor HCTs for pts with hematologic malignancies. (Koreth J, et al. J Clin Oncol 2012;30(26):3202-8.) Carfilzomib is a second-generation irreversible immunoproteasome inhibitor, with potentially increased efficacy and specificity to the immune and hematologic malignancy cells. It has a less off-target toxicity profile, especially myelosuppression, neuropathy and diarrhea. We are exploring the addition of carfilzomib to fludarabine-based conditioning regimens and GVHD prophylaxis with tacrolimus and methotrexate. Primary Objective: To identify the maximal tolerated dose (MTD) of carfilzomib when administered on day +1, +2, +6, +7. Methods: The phase 1 design is standard 3+3. Eligible conditioning regimens include fludarabine/busulfan and fludarabine/melphalan. Tacrolimus is started on day -3 and tapered off by day +180 if ≥grade II acute GVHD do not occur. Methotrexate 5 mg/m2 is given IV on day +1, +3, +6, +11. Carfilzomib is administered IV on days +1, +2 at 20 mg/m2/day fixed dose and on day +6, +7 at 4 dose levels: 20, 27, 36, 45 mg/m2/day. Premedication with 4 mg dexamethasone IV is administered prior to each dose of carfilzomib 20 and 27 mg/m2 and with 8 mg prior to each dose of 36 and 45 mg/m2, respectively. Carfilzomib is given after IV methotrexate on day +1 and +6. Subcutaneous filgrastim 5 μg/kg/day is started on day +1 until engraftment. Dose-limiting toxicities (DLTs) are defined as any ≥grade 3 non-hematologic National Cancer Institute Common Terminology Criteria for Adverse Events version 4 toxicities which occur within 28 days of carfilzomib treatment (day +35) and are directly attributed to carfilzomib. Results: Since October 2014, 10 pts (Male: Female, 5:5) have been enrolled. Nine pts received all planned 4 doses and 1 female received 3 doses only before being removed due to unrelated infectious adverse events. Among 9 evaluable pts, the median age was 55 (range, 29-61) years; all donors were 8/8 matched (7 sibling, 2 unrelated). Stem cell sources were peripheral blood in 8 and bone marrow in 1 unrelated donor. Primary diseases included FLT3-ITD+ acute myeloid leukemia in 2, acute bi-phenotypic leukemia in 1, BCR/ABL+ acute lymphoblastic leukemia in 1, myelodysplastic syndrome in 2, lymphoma in 2, and multiple myeloma in 1. All pts received the myeloablative reduced-toxicity fludarabine and busulfan x 4 (FluBu4), with busulfan kinetics targeting the concentration at steady state at 600-900 ng/mL. One pt with diffuse large B cell lymphoma received rituximab-FluBu4. All 9 pts engrafted neutrophil and platelet at a median time of 10 (range, 10-15) and 12 (9-14) days, respectively. A pt of dose level 2 (20/27 mg/m2) who received a bone marrow stem cell dose of 1.3 x 106 CD34+ cells/kg unexpectedly engrafted as early as day +15. Expected common toxicities related to the FluBu4 treatment was oral mucositis. Median CD33+ and CD3+ donor chimerisms were 100% and 88% at day 30, respectively, and were 100% and 91% at day 100, respectively. As of 8/4/15, no DLTs occurred in the 8 pts who had passed day +35, with the median transplant day of day +172 (range, 65-292). The 9th pt of dose level 3 (20/36 mg/m2) is day +14 and has engrafted. Conclusion: Adding the irreversible immunoproteasome inhibitor carfilzomib to fludarabine-based conditioning HCT appears safe and feasible. Dose escalation to level 4 (20/45 mg/m2) is ongoing and the results will be updated at the meeting. Disclosures Pawarode: Onyx Pharmaceuticals: Research Funding. Off Label Use: Carfilzomib is an irreversible proteasome inhibitor and is FDA approved for treament of relapsed refractory multiple myeloma. It is here being investigated for its immunomodulatory and anti-tumor properties in the prevention of graft-versus-host disease (GVHD) and disease relapse when incorporated into fludarabine based conditioning and GVHD prophylaxis regimens for allogeneic hematopoietic cell transplantation in patients with high-risk hematologic malignancy.. Levine:Novartis: Consultancy.

Transition of Intensive Chemotherapy for Acute Lymphoblastic Leukemia (ALL) to the Outpatient Setting: Analysis of Safety and Cost Savings

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5604-5604 ◽  
Author(s):  
Timothy E. Kubal ◽  
Christopher Rodriguez Salamanca ◽  
Julio C Chavez ◽  
Bijal D. Shah ◽  
Rami S. Komrokji ◽  
...  
Keyword(s):  
Board Of Directors ◽  
Research Funding ◽  
Hematologic Malignancy ◽  
Lymphoblastic Leukemia ◽  
Hemorrhagic Cystitis ◽  
Outpatient Setting ◽  
Cost Of Care ◽  
Advisory Committees ◽  
Time Period ◽  
The Cost

Abstract Background: ALL is an aggressive hematologic malignancy traditionally treated with intensive inpatient-based chemotherapy, which can require prolonged hospitalizations both for the delivery of chemotherapy and subsequent side effects including infectious complications and cytopenias. In addition, chemotherapeutic CNS prophylaxis further intensifies the regimen and the logistical challenges associated with its delivery. While inpatient delivery of chemotherapy may mitigate some of the logistical and clinical challenges, as healthcare moves towards a value oriented approach, delivery of these services in an outpatient setting that could lower the cost of care may offer significant value to the patient and institution. We report on our institutional experience of shifting the commonly used Hyper-CVAD regimen ("Arm-A") into the outpatient setting. Methods: Hyper-CVAD consists of an "A" Arm (Cyclophosphamide, Vincristine, Doxorubicin, Dexamethasone) and a "B" Arm (Methotrexate and Cytarabine). From 5/2014-6/2015, 24 patients received Hyper-CVAD Arm-A for ALL (18 patients) or high-grade lymphoma (6 patients) in the outpatient setting. Median age was 35.7 years (range of 20-67). A total of 50 cycles of HyperCVAD Arm-A were delivered to these 24 patients: an average of 2.1 cycles per patient. The majority of patients (n=21, 88%) received the first cycle of Hyper-CVAD as inpatient. Doses and schedule of chemotherapy as follows: Cyclophosphamide 300mg/m2/dose IV over 3 hours Q12 hours x 6 on days 1-3, Vincristine 2mg IV over 10 minutes x 1 on day 4, Doxorubicin 50mg/m2 IV over 15 minutes x1 on day 4, Dexamethasone 40mg PO daily on days 1-4 and 11-14. Modifications to the regimen to facilitate outpatient administration included the delivery of cyclophosphamide over 1 hour in the morning and evening doses (reduced from three hours) with evening cyclophosphamide delivered approximately 10 hours after morning dosing. Additionally, on days 1-3, each patient received mesna via a 24 hour ambulatory pump with pump change each day during morning chemotherapy sessions. Daily urinalyses were performed. Cost of regimen delivery was estimated through work with our financial analysis group and includes expected gross charges for chemotherapy and any hospitalization associated with the delivery of chemotherapy. Results: None of the 24 patients died during the period of outpatient administration of Hyper-CVAD. In addition, there were no occurrences of hemorrhagic cystitis. While there were predictable complications, including infections that required hospitalization, these occurred after completion of chemotherapy, during the period of neutropenia. Only 1 patient (4%) required admission for chemotherapy mid-cycle due to concerns for compliance with outpatient therapy. Overall, we estimated that 200 hospital days were saved over the examined time period. Administration of a cycle of Hyper-CVAD, Arm-A in the outpatient setting was accompanied by an approximate 13% reduction in gross charges ($2541). Thus, over the course of this 13 month time period, administration of outpatient Arm-A of HyperCVAD was accompanied by an estimated reduction in the cost of care of $127,050 amongst 24 patients. Conclusion: Outpatient administration of Arm A of Hyper-CVAD was feasible, safe and well tolerated, while significantly reducing the overall cost of care associated with its delivery. Future efforts and larger studies to transition traditional inpatient chemotherapy regimens to the outpatient setting appear warranted. Disclosures Shah: Acetylon: Membership on an entity's Board of Directors or advisory committees; Pharmacyclics: Speakers Bureau; Spectrum: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Celgene: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; PLexus Communications: Honoraria; Bayer: Honoraria; Rosetta Genomics: Research Funding; Seattle Genetics: Research Funding. Komrokji:Novartis: Research Funding, Speakers Bureau; Pharmacylics: Speakers Bureau; Incyte: Consultancy; Celgene: Consultancy, Research Funding. Lancet:Amgen: Consultancy; Kalo-Bios: Consultancy; Seattle Genetics: Consultancy; Celgene: Consultancy, Research Funding; Boehringer-Ingelheim: Consultancy; Pfizer: Research Funding.

The Cost of Relapse in Schizophrenia and Schizoaffective Disorder

2009 ◽  
Vol 17 (4) ◽  
pp. 265-272 ◽  
Author(s):  
Paul Fitzgerald ◽  
Anthony de Castella ◽  
Dinesh Arya ◽  
W. Robert Simons ◽  
Andrew Eggleston ◽  
...  
Keyword(s):  
Resource Utilization ◽  
Schizoaffective Disorder ◽  
Service Use ◽  
Hospital Costs ◽  
Healthcare Resource Utilization ◽  
Index Admission ◽  
Retrospective Audit ◽  
Time Period ◽  
The Cost

Objective: The aim of this study was to quantify the costs and resource utilization associated with a relapse of schizophrenia or schizoaffective disorder. Methods: The study comprised a retrospective audit of data from 200 patients diagnosed with schizophrenia or schizoaffective disorder who were admitted to hospital for a relapse of their disorder in two mental health services in Australia between 1 June 2001 and 31 May 2002. Resource use and costing data were collected for 12 months before and 12 months after the hospitalization. Results: There was an increase in contacts per month and associated outpatient costs after the index admission which persisted for the full 12 month data collection period (total of AUD $637). There was also a total increase in hospital costs but this did not persist beyond the first 2 months of the follow-up period and is likely explained by the index admission. Conclusions: Increased healthcare resource utilization and costs results from relapse in patients with schizophrenia or schizoaffective disorder. An increase in service use and costs persist for a considerable time period after an episode of relapse.

scholarly journals A Decolonising Doctor?

M/C Journal ◽  
1999 ◽  
Vol 2 (2) ◽  
Author(s):  
Nick Caldwell
Keyword(s):  
Science Fiction ◽  
Popular Fiction ◽  
Good Deal ◽  
Cultural Value ◽  
Doctor Who ◽  
Doctor Visits ◽  
Space Race ◽  
Time Period ◽  
The Us ◽  
The Cost

Narratives of invasion have been stock in trade for science fiction in film and on TV for many years now. It's not hard to see how this began; at least at the conceptual level, visual SF tends not to be greatly innovative, drawing much of its iconography and subject matter from written SF produced in the 30s and 40s -- and in that time period, invasion and imperialism was something of a hot topic. But invasion narratives in visual SF are still extremely popular and prevalent even today (witness the X-Files' overarching storyline), which suggests the reasons may be not so much a matter of any lack of innovation and more an issue of some wider cultural value. To address some of the implications of this I want to turn to the British TV series, Doctor Who, which, in its twenty-five year run, explored practically every possible variation of the invasion narrative. One of the aspects of the show that both its native viewers and its "colonial" (I use the term here very loosely, and to describe fans and viewers in Australia, the US and NZ) fans seem to find especially valuable and interesting is what they invariably term its "Britishness". This Britishness manifests itself particularly in the persona of the lead character, the Doctor, an alien time-traveller who nevertheless is typically garbed in Edwardian jackets and is fond of cricket, tea, and jellybabies (though not all at the same time). Time and time again, the Doctor must save the Earth (and occasionally other planets, and sometimes the Universe) from hordes of monstrous foes. Well, when I say "Earth", I mostly mean England. In the greater London area. This is clearly demonstrated in an early story from 1964, featuring the Doctor's oldest foes, the Daleks, who have come to Earth in the 21st century to enslave humanity and mine the planet's core. The Daleks are depicted gliding unstoppably through an eerily deserted London, exterminating any stray humans they encounter. Nothing is shown of any other city or country on the planet -- we are therefore encouraged to view London as the paradigmatic representation of Earth. The image recurs through the course of the series: on every planet the Doctor visits, the inhabitants speak impeccable BBC English. The harsh budgetary restrictions and unforgiving production schedule undeniably shaped this seemingly complete insularity. And indeed the pluralistic humanism that informed the show's best episodes mitigated its insular tendencies a good deal. I think it is possible to see it as symptomatic of a wider cultural force -- the burden of Empire. It is almost inescapable that Britain's status as a fading colonial power becomes inscribed in its popular fiction texts -- and particularly SF offered avenues for the recuperation of this status through technology, for instance. Both Doctor Who and its near-contemporary, Quartermass, offered visions of Britain leading the space race with manned flights to Mars and the outer solar system. The Doctor's main foes, such as the Daleks, the Cybermen and the Sontarans, for instance, were frequently depicted in the course of the series as taking humans as slaves for labour work and experimentation. In one particular case, the slaves were all portrayed by white South African actors! Certainly a very tangled set of ideological interrelations operating out of this unease at the cost of colonialism. Ultimately, however, the vision of the Doctor, a capable British eccentric saving oppressed peoples from tyrannical governments and marauding invaders, must surely be another gesture towards the kind of cultural and moral recuperation that I've alluded to. Citation reference for this article MLA style: Nick Caldwell. "A Decolonising Doctor? British SF Invasion Narratives." M/C: A Journal of Media and Culture 2.2 (1999). [your date of access] <http://www.uq.edu.au/mc/9903/who.php>. Chicago style: Nick Caldwell, "A Decolonising Doctor? British SF Invasion Narratives," M/C: A Journal of Media and Culture 2, no. 2 (1999), <http://www.uq.edu.au/mc/9903/who.php> ([your date of access]). APA style: Nick Caldwell. (1999) A decolonising doctor? British SF invasion narratives. M/C: A Journal of Media and Culture 2(2). <http://www.uq.edu.au/mc/9903/who.php> ([your date of access]).

scholarly journals Prophylactic Treatment in People with Severe Hemophilia B in the US: An Analysis of Real-World Healthcare System Costs and Clinical Outcomes

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2118-2118
Author(s):  
Declan Noone ◽  
Gabriel Pedra ◽  
Sohaib Asghar ◽  
Jamie O'Hara ◽  
Eileen K Sawyer ◽  
...  
Keyword(s):  
Healthcare System ◽  
Resource Utilization ◽  
Real World ◽  
Annual Cost ◽  
Healthcare Resource Utilization ◽  
Hemophilia B ◽  
Severe Hemophilia ◽  
The Us ◽  
The Usa ◽  
The Cost

Introduction The treatment paradigm for people with severe hemophilia B in the US typically involves prophylaxis with factor IX (FIX) replacement therapy, the primary aim of which is to provide sufficient FIX levels to reduce the frequency of bleeding events. The clinical benefits of FIX prophylaxis are well understood, however the cost of FIX products as well as costs associated with healthcare resource utilization present a significant burden to the healthcare system. Substantive costs may also accrue in patients who continue to bleed while on prophylaxis, due to the impact on both short and long-term joint-related outcomes. In the absence of existing data in the US, the 'Cost of Hemophilia Across the USA: a Socioeconomic Survey' (CHESS US) study was conducted to establish a population-based estimate of the real-world US healthcare system burden associated with severe hemophilia. Using data drawn from the CHESS US study, this analysis examines the real-world healthcare system costs and clinical outcomes of people with severe hemophilia B on FIX prophylaxis. Methods CHESS US, a retrospective, cross-sectional dataset of adults with severe hemophilia in the USA, gathered information on patient cost via a patient record form. Data on the following parameters are included in this analysis: FIX consumption, annualized bleeding rate (ABR), the presence of one or more chronically damaged joints ("problem joint"), as well as costs associated with annual (prophylactic) factor consumption and hospitalizations (i.e., number of admissions, number of day cases, total inpatient days, and total intensive care unit [ICU] days). All variables report retrospective data of the 12 months prior to enrolment in the study. Results are presented as mean (± standard deviation) or N (%). Results In total, 132 of 576 patients profiled in the CHESS US study had severe hemophilia B. Among them, 77 patients were on FIX prophylaxis, of whom 44 patients reported FIX dosing regimen and were included in the current analyses. Among them, 20 patients were treated with conventional FIX and 24 patients with extended half-life (EHL) FIX products. The cohort has a mean age of 27.64 (± 11.05) and mean weight (kg) of 75.71 (± 13.41). In the last 12 months, the mean number of international units (IU) prescribed for FIX prophylaxis across the full cohort was 257,216 IU (± 213,591), with an associated annual cost of $610,966 (± $495,869). Among patients treated with conventional FIX, mean prescribed FIX was 287,141 IU (± 264,906) at an annual cost of $397,491 (± $359,788), while patients treated with EHL FIX reported a mean prescribed FIX of 232,278 IU (± 160,914) at an annual cost of $788,861 (± $529,258). The cohort reported a mean ABR of 1.73 (± 1.39); 8 (18%) were reported to have a target joint meeting the International Society on Thrombosis and Haemostasis (ISTH) definition; and 11% were reported to have had at least one chronically damaged joint (i.e., problem joint). Healthcare resource utilization associated with bleed events were reported as follows: hospital admissions days [0.18 (± 0.62)]; inpatient days [0.34 (± 1.22)]; and ICU days [0.23 (± 0.86)]. The direct medical cost to the healthcare system was $2,885 (± $7,857; excluding FIX cost) and $614,886 (± $498,839; including FIX cost). Discussion Data from the CHESS US study showed substantial costs and resource utilization among patients with severe hemophilia B receiving FIX prophylaxis, of which the cost of FIX replacement therapy constituted most of the total cost to healthcare system. Although the ABR observed in the analysis population was low, bleed-related hospitalizations comprised a significant non-drug cost to the healthcare system. A proportion of patients also still experienced joint arthropathy. Such substantial clinical and economic burden highlights that unmet needs remain in patients with severe hemophilia B on FIX prophylaxis in the US. Disclosures Noone: HCD Economics: Employment. Pedra:HCD Economics: Employment. Asghar:HCD Economics: Employment. O'Hara:HCD Economics: Employment, Equity Ownership. Sawyer:uniQure Inc.: Employment. Li:uniQure Inc.: Employment.

scholarly journals Stable Rates of Obstructive Hypertrophic Cardiomyopathy in a Contemporary Era

2022 ◽  
Vol 8 ◽  
Author(s):  
Michael Butzner ◽  
Douglas L. Leslie ◽  
Yendelela Cuffee ◽  
Christopher S. Hollenbeak ◽  
Christopher Sciamanna ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Diagnosis Code ◽  
Time Period ◽  
The Us ◽  
Obstructive Hypertrophic Cardiomyopathy ◽  
International Statistical Classification ◽  
Males And Females ◽  
Insured Patients ◽  
Genetic Heart Disease

Hypertrophic cardiomyopathy is the most common genetic heart disease in the US, with an estimated prevalence of 1 in 500. However, the extent to which obstructive hypertrophic cardiomyopathy is clinically recognized is not well-established. Therefore, the objective of this study was to estimate the annual prevalence of clinically diagnosed oHCM in the US from 2016 to 2018. Data from the MarketScan® database were queried from years 2016 to 2018 to identify patients with ≥1 claim of oHCM (International Statistical Classification of Disease and Related Health Problems diagnosis code: I42.1). Prevalence rates for oHCM were calculated and stratified by sex and age. In 2016, 4,612 unique patients had clinical diagnosis of oHCM, resulting in an estimated oHCM prevalence of 1.65 per 10,000. The prevalence of oHCM in males and females was 2.07 and 1.26, respectively. Prevalence of oHCM was highest in patients 55–64 years of age (4.82). Prevalence of oHCM generally increased with age, from 0.36 per 10,000 in those under 18 to 4.82 per 10,000 in those 55–65. Trends in prevalence of oHCM over time, including by sex and age group, remained similar and consistent in 2017 and 2018. The prevalence of oHCM was stable over the 3-year time period, including higher rates of oHCM in males and patients aged 55–64 years. These results suggest that the majority of privately insured patients with oHCM are undiagnosed in the US and reinforce the need for policies and research to improve the clinical identification of oHCM patients in the US.

scholarly journals Socioeconomic Factors and Survival of Multiple Myeloma Patients

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 590
Author(s):  
Kamal Chamoun ◽  
Amin Firoozmand ◽  
Paolo Caimi ◽  
Pingfu Fu ◽  
Shufen Cao ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Socioeconomic Factors ◽  
Hematopoietic Cell Transplantation ◽  
Financial Burden ◽  
Private Insurance ◽  
Median Income ◽  
The Us ◽  
Medicare Patients ◽  
Insured Patients ◽  
Privately Insured

Background: Outcome of Multiple Myeloma (MM) patients has improved as the result of the introduction of novel medications and use of autologous hematopoietic cell transplantation. However, this improvement comes at the expense of increased financial burden. It is largely unknown if socioeconomic factors influence MM survival. Methods: We used the National Cancer Database, a database that houses data on 70% of cancer patients in the US, to evaluate the effect of socioeconomic factors on the survival of 117,926 MM patients diagnosed between 2005 and 2014. Results: Patients aged ≥65 years who were privately insured lived longer than patients with Medicare (42 months vs. 31 months, respectively, p < 0.0001). Treatment in academic institutions led to better survival (HR: 1.49, 95% CI: 1.39, 1.59). Younger age, fewer comorbidities, treatment in academic centers, and living in a higher median income area were significantly associated with improved survival. After adjusting for confounders, survival of Medicare patients was similar to those with private insurance. However, the hazard of death remained higher for patients with Medicaid (HR: 1.59, 95% CI: 1.36, 1.87) or without insurance (HR: 1.62, 95% CI: 1.32, 1.99), compared to privately insured patients. Conclusion: Economic factors and treatment facility type play an important role in the survival of MM patients.

The cost-utility of the rivastigmine transdermal patch in the management of patients with moderate Alzheimer's disease in the US

2009 ◽  
Vol 36 (S 02) ◽  
Author(s):  
A Brennan ◽  
B Nagy ◽  
A Brandtmüller ◽  
SK Thomas ◽  
M Gallagher ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cost Utility ◽  
Transdermal Patch ◽  
The Us ◽  
The Cost

World Economy: Prospects and Barriers for Recovery

2012 ◽  
pp. 61-83 ◽  
Author(s):  
M. Ershov
Keyword(s):  
World Economy ◽  
Western World ◽  
Short Time Period ◽  
Market Segments ◽  
Junk Bonds ◽  
The Past ◽  
Time Period ◽  
The Us ◽  
Global Liquidity ◽  
Short Time

According to the latest forecasts, it will take 10 years for the world economy to get back to “decent shape”. Some more critical estimates suggest that the whole western world will have a “colossal mess” within the next 5–10 years. Regulators of some major countries significantly and over a short time‑period changed their forecasts for the worse which means that uncertainty in the outlook for the future persists. Indeed, the intensive anti‑crisis measures have reduced the severity of the past problems, however the problems themselves have not disappeared. Moreover, some of them have become more intense — the eurocrisis, excessive debts, global liquidity glut against the backdrop of its deficit in some of market segments. As was the case prior to the crisis, derivatives and high‑risk operations with “junk” bonds grow; budget problems — “fiscal cliff” in the US — and other problems worsen. All of the above forces the regulators to take unprecedented (in their scope and nature) steps. Will they be able to tackle the problems which emerge?

Sign in / Sign up

Export Citation Format

Share Document