scholarly journals Clinical Burden and Practice Patterns in Patients With Chronic Hypoparathyroidism in the United States (US): A Claims Data Analysis Using Diagnosis-Based Criteria

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A259-A259
Author(s):  
Dolly Sharma ◽  
Kathleen L Deering ◽  
Patrick Loustau ◽  
Michael D Culler ◽  
Soraya Allas ◽  
...  
Keyword(s):  
Vitamin D ◽  
Replacement Therapy ◽  
Index Date ◽  
Practice Patterns ◽  
The United States ◽  
Large Cohort ◽  
Claims Database ◽  
Prescription Claim ◽  
Chronic Hypoparathyroidism

Abstract Objectives: Significant knowledge gaps exist regarding the comorbidities, treatment and lab testing patterns of patients with chronic hypoparathyroidism (cHP). This study describes a large cohort of patients with cHP identified using a diagnosis-based criteria from a claims database. Methods: This retrospective cohort study was conducted using a large (130 million individuals) claims database (HealthVerity Closed Payer Claim Medical and Pharmacy databases: Private Source 20) from Oct 2014 to Dec 2019. Eligible patients had ≥2 diagnosis claims of HP (ICD9/10 codes: E20.0, E20.8, E20.9, 252.1) that were 6–15 months apart, a prescription claim for either active vitamin D, calcium, PTH or thyroid replacement therapy between the first qualifying HP claim and within 30 days of the second HP claim, and continuous enrollment for one year before the index date (the date of the first of two qualifying HP diagnosis claims) and ≥16 months after. Patients were followed up to two years after the index date. Patient characteristics, comorbidities, lab testing and treatment patterns were descriptively analyzed. Results: Out of 43,640 patients with a diagnosis claim for HP, 4,118 patients met the eligibility criteria. The mean age of the cohort was 56.5 years + 18.6 (SD), and 76.4% were females, similar to data from other large cohort studies. The most common comorbidities during the 1-year follow-up were hypertension (56.0%), hypocalcemia (38.7%), cancer (30.5%, of which 24% were thyroid cancers), diabetes (29.4%), chronic pulmonary disease (24.1%), cardiac arrhythmias (17.4%), CKD stage 3–5 (17.0%), osteoporosis (9.6%) and neuropsychiatric disorders, including depressive disorders (22.0%), anxiety (21.6%), and sleep-wake disorders (18.4%). During the 1-year follow up, commonly monitored lab tests included serum calcium (89.9%), eGFR/creatinine (85.7%), 25-hydroxy vitamin D (61.1%), and intact PTH (43.9%). Remarkably, serum phosphorous (36.3%), serum magnesium (35.4%), and 24h-urine calcium (10.5%) were much less often monitored. In addition, BMD was measured in 10.9% patients. Also during the 1-year follow-up, 67.1% of patients had a prescription claim for thyroid replacement therapy, 60.5% for calcitriol, 15.7% for ergocalciferol, and 3.4 % for PTH. Conclusion: Findings from this study highlight the high comorbidity burden in cHP patients which aligns with the monitoring patterns. Kidney function appears to be a key concern and may be important when considering therapeutic intervention. The comorbidities and practice patterns observed in this study are consistent with the results obtained using a surgery-based approach to identify cHP patients in the same claims database. Future studies will also examine the economic burden of cHP.

scholarly journals Clinical Burden and Practice Patterns in Patients With Chronic Hypoparathyroidism in the United States (US): A Claims Data Analysis Using Surgery-Based Criteria

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A259-A260
Author(s):  
Dolly Sharma ◽  
Kathleen L Deering ◽  
Patrick Loustau ◽  
Michael D Culler ◽  
Soraya Allas ◽  
...  
Keyword(s):  
Index Date ◽  
Practice Patterns ◽  
The United States ◽  
Eligibility Criteria ◽  
Clinical Burden ◽  
Ckd Stage ◽  
Comorbidity Burden ◽  
The Mean ◽  
Chronic Hypoparathyroidism

Abstract Objectives: Significant knowledge gaps exist regarding the clinical burden and practice patterns associated with chronic hypoparathyroidism (cHP). This study assessed the clinical burden and practice patterns in patients with cHP identified using surgery-based criteria. Methods: This retrospective cohort study was conducted using a large (130 million individuals) US claims database, the HealthVerity Closed Payer Claim Medical and Pharmacy database (Private Source 20) from Oct 2014 to Dec 2019. The patient eligibility criteria for the surgery-based method included the presence of a procedure claim of either parathyroidectomy, complete or partial thyroidectomy, or neck dissection, followed by a HP diagnosis claim (6–15 months apart) with a subsequent second HP diagnosis claim at any time point, and with continuous enrollment for 15 months before the index date (the date of the first qualifying HP diagnosis claim) and ≥6 months after. Patients were followed one year before the surgery and up to two years after the index date. Patient characteristics, comorbidities, laboratory testing and treatment patterns were descriptively analyzed. Results: A total of 1,406 patients met the eligibility criteria, among which 1,184 patients had complete data for 1-year follow-up. The mean age was 52.1 + 16.4 (SD) years, and 83.2% were females. The mean time between surgery and qualifying HP diagnosis claim was 8.7 + 2.3 (SD) months, and 115 patients (8.2%) had a HP diagnosis prior to surgery. During the 1-year follow-up, the most common comorbidities were cancer (54.2%, of which 49% were thyroid cancers), hypertension (49.7%), hypocalcemia (47.1%), chronic pulmonary disease (21.9%), diabetes (21.7%), cardiac arrhythmias (18.4%), CKD stage 3–5 (11.3%), osteoporosis (9.8%), and neuropsychiatric disorders, including anxiety (23.9%), depressive disorders (21.8%), and sleep-wake disorders (20.9%). Most cHP patients were monitored for lab values. These included serum calcium (93.2%), eGFR/creatinine (86.2%), 25-Hydroxy Vitamin D (66.5%), intact PTH (63.0%), serum magnesium (40.9%), serum phosphorous (38.4%), bone mineral density (9.8%), and 24h-urine calcium (8.4%) during the 1-year follow up. Also within the 1-year follow-up, 66.9% of patients had a prescription claim for thyroid replacement therapy, 51.6% for calcitriol, 13.3% for ergocalciferol, and 5.5 % for PTH. Conclusion: This cHP population, identified using surgery-based criteria, largely consists of patients with a recent diagnosis, and had a substantial comorbidity burden that aligned with the monitoring patterns. Already at this early stage of cHP, kidney function appears to be a key concern and may be important when considering therapeutic intervention. These data are consistent with our findings from a larger cHP population identified in the same database using a diagnosis-based approach.

Epidemiology and mortality of metastatic castration-resistant prostate cancer (mCRPC) in a managed care population in the United States.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e13592-e13592 ◽  
Author(s):  
Katrine Wallace ◽  
Adrienne Landsteiner ◽  
Scott Bunner ◽  
Nicole Engel-Nitz ◽  
Amy Luckenbaugh
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Index Date ◽  
The United States ◽  
Baseline Period ◽  
Mortality Data ◽  
Administrative Claims ◽  
Claims Database ◽  
Study Population

e13592 Background: To date, there has been a paucity of information in the literature describing the epidemiology of mCRPC within the prostate cancer population. We present a real-world data study describing characteristics and mortality of patients with mCRPC within an administrative claims database of an insured population within the United States. Methods: In an administrative claims database of ≈18,000,000 covered lives, adult male patients were included if they had ≥1 claim for prostate cancer (ICD-9: 185 or 233.4; ICD-10: C61 or D075), underwent pharmacologic or surgical castration, and had a code for metastatic disease during the identification period (January 1, 2008–March 31, 2018). The index date was the first metastatic claim; 6 months of continuous enrollment (CE) prior to (baseline period) and after (follow-up period) the index date was required. Patients with metastatic claims in the baseline period were excluded. Patients were followed until the earliest of: death (unless prior to the 6-month CE), end of study period, or disenrollment. A claims-based algorithm was employed to identify locally advanced and distant mCRPC patients in the prostate cancer study population. Mortality data were sourced from the Social Security Administration Medicare data, and a claims algorithm. Results: 343,089 patients were identified with a claim for prostate cancer; of those, 3690 mCRPC cases (1.1%) were identified using the claims-based algorithm and met the study inclusion criteria. Median age was 75 years. Insurance type included commercial plans (27%) and Medicare (73%). Castration type included pharmacologic (99%) and surgical (1%). First claims for metastases were most commonly in the bone (65%) or lymph nodes (15%), with 20% in other sites. The study population averaged a Charlson comorbidity index score of 3.05 at baseline, with 16% of patients receiving a score of ≥5. The most common baseline comorbidities were hypertension (67%), urinary disease (58%), dyslipidemia (52%), and cardiac disease (45%). Median follow-up time among the mCRPC group was 538 days, during which 1834 deaths occurred; 50% of the population experienced mortality during the study period. Conclusions: This study provides valuable insights into the epidemiology, clinical characteristics, prevalence rate, and mortality of patients with mCRPC. Given the high mortality proportion of this disease, the development of novel therapies to prolong life in patients with mCRPC is warranted.

scholarly journals Use of Sildenafil in Pulmonary Arterial Hypertension: Findings from a U.S. Healthcare Claims Database

10.36469/9871 ◽  
2014 ◽  
Vol 1 (3) ◽  
pp. 254-265 ◽  
Author(s):  
Ariel Berger ◽  
John Edelsberg ◽  
Simon Teal ◽  
Marko A. Mychaskiw ◽  
Gerry Oster
Keyword(s):  
United States ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Medication Possession Ratio ◽  
The United States ◽  
The European Union ◽  
Claims Database ◽  
Pharmacy Claims ◽  
Pulmonary Arterial

Background: Pulmonary arterial hypertension (PAH) is a disease characterized by dyspnea, fatigue, chest pain and syncope. As there is no known cure for PAH, the goal of treatment is to control symptoms and slow disease progression. Sildenafil, a phosphodiesterase-5 inhibitor, has been indicated to improve exercise capacity in PAH in both the United States and the European Union since 2005; since 2009, it also has been indicated in the United States to delay clinical worsening. Patterns of sildenafil use in PAH patients have not been reported. Objectives: To describe patterns of treatment with sildenafil among commercially insured patients in the United States with PAH. Methods: Using a large U.S. healthcare claims database, we identified all patients with evidence of PAH (International Classification of Disease, 9th Revision, Clinical Modification [ICD-9-CM] diagnosis codes 416.0, 416.8) and receipt of sildenafil between January 1, 2005 and September 30, 2008. The date of each patient’s earliest pharmacy claim for sildenafil was designated as his or her “index date”; patients with <6 months of data prior to this date were excluded. Post-index use of sildenafil was then examined in terms of the numbers of pharmacy claims and therapy-days, the medication possession ratio (MPR), and the incidence of therapy switching. Results: We identified a total of 855 PAH patients who began sildenafil therapy and met all other entry criteria. Mean (standard deviation [SD]) follow-up was 423.4 (313.0) days. Over this period, these patients averaged 7.1 (6.8) (median, 5) pharmacy dispensings for sildenafil, representing 273.4 (254.8) therapy-days (median, 180). Mean MPR was 71% (median, 83%). Fourteen percent of sildenafil patients switched to another agent during follow-up. Conclusions: In “real-world” clinical practice, many PAH patients beginning treatment with sildenafil remain on therapy for extended periods and are relatively compliant with treatment.

scholarly journals 1422. Real-World Study of the Effects of Inappropriate or Suboptimal Treatment on the Burden of Illness Among Patients with Uncomplicated Urinary Tract Infection and High-Risk Comorbid Conditions in the United States

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S794-S795
Author(s):  
Madison T Preib ◽  
Alen Marijam ◽  
Fanny S Mitrani-Gold ◽  
Daniel C Gibbons ◽  
Xiaoxi Sun ◽  
...  
Keyword(s):  
Urinary Tract ◽  
High Risk ◽  
Real World ◽  
Index Date ◽  
The United States ◽  
Uncomplicated Urinary Tract Infection ◽  
Comorbid Conditions ◽  
Tract Infections ◽  
High Risk Cohort

Abstract Background Urinary tract infections (UTIs) are associated with significant morbidity and economic burden. Nitrofurantoin (NFT) and fosfomycin are among the first-line treatments for uncomplicated UTI (uUTI) recommended by Infectious Diseases Society of America (IDSA) 2011 guidance. We used real-world data (RWD) to assess patterns of appropriate and optimal (AP&OP) and inappropriate or suboptimal (IA/SO) antibiotic (AB) prescribing (RX), and related healthcare resource use (HRU) and costs, in US uUTI patients with high-risk comorbid conditions. Methods This was a retrospective cohort study of RWD (IBM MarketScan, commercial/Medicare Supplemental claims January 1, 2014–December 31, 2017) in females ≥ 12 years of age with uUTI, who had an oral AB prescription ± 5 days of uUTI diagnosis (index date) and continuous health-plan enrollment ≥ 1 year pre-/post-index date. Patients were stratified into high-risk cohorts (Table 1) and by AB RX (AP&OP and IA/SO) during first uUTI episode (within 28 days of index). AP&OP RX followed IDSA guidance, IA RX did not; SO RX was considered a proxy for treatment failure (e.g., AB switch or a second UTI diagnosis [acute care setting] in index episode). Sample size was balanced via random match selection, AP&OP:IA/SO ratio 1:5 (age and region). uUTIrelated HRU and costs were compared between cohorts (at index episode and 1-year follow-up) via multivariable analysis. Table 1. High-risk cohorts identified in the study Results IA/SO AB RX was highest in the elderly cohort (94.3%, likely influenced by renal impairment/no NFT RX in this group) and > 90% in other cohorts; AP&OP AB RX was highest in the postmenopausal cohort (9.0%). IA/SO AB RX in all cohorts was associated with significantly higher uUTI-related HRU (outpatient visits and pharmacy claims) per index episode/during follow-up versus AP&OP AB RX (p ≤ 0.0237, Table 2). IA/SO AB RX in all cohorts was associated with significantly higher adjusted total costs per index episode/during follow-up versus AP&OP AB RX (p < 0.05; Table 3). Table 2. uUTI-related HRU* per patient according to high-risk cohort and stratified by AB RX Table 3. uUTI-related costs* per patient according to high-risk cohort and stratified by AB RX Conclusion Over 90% of females in each high-risk cohort identified had IA/SO AB RX (outside IDSA 2011 guidance for uUTI treatment), leading to high HRU and cost burden. This suggests an unmet need for uUTI symptom relief, new treatments, training, and improved RX practices in the US and, furthermore, a need for additional research in this area. Disclosures Madison T. Preib, MPH, STATinMED Research (Employee, Former employee of STATinMED Research, which received funding from GlaxoSmithKline plc. to conduct this study) Alen Marijam, MSc, GlaxoSmithKline plc. (Employee, Shareholder) Fanny S. Mitrani-Gold, MPH, GlaxoSmithKline plc. (Employee, Shareholder) Daniel C. Gibbons, PhD, GlaxoSmithKline plc. (Employee, Shareholder) Xiaoxi Sun, MA, STATinMED Research (Employee, Employee of STATinMED Research, which received funding from GlaxoSmithKline plc. to conduct this study) Christopher Adams, MPH, STATinMED Research (Employee, Employee of STATinMED Research, which received funding from GlaxoSmithKline plc. to conduct this study) Ashish V. Joshi, PhD, GlaxoSmithKline plc. (Employee, Shareholder)

The lines of loco-regional therapies received and the healthcare economic burden of patients newly diagnosed with hepatocellular carcinoma in the United States.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 286-286
Author(s):  
Brian Seal ◽  
Abdulla M. Abdulhalim ◽  
Melissa Lingohr-Smith ◽  
Jay Lin
Keyword(s):  
Radiation Therapy ◽  
Economic Burden ◽  
Healthcare Costs ◽  
Index Date ◽  
The United States ◽  
Newly Diagnosed ◽  
Ablative Therapy ◽  
Regional Therapy ◽  
The Us

286 Background: Hepatocelluar carcinoma (HCC) is one of the fastest growing causes of cancer-related deaths in the US. The objectives of this study were to examine the lines of loco-regional therapies received and the healthcare economic burden of patients newly diagnosed with HCC in the US. Methods: Patients (≥18 years of age) diagnosed with HCC who received ≥1 loco-regional therapy (index date) after diagnosis were identified from the MarketScan Commercial and Medicare Supplemental databases (July 1, 2013-May 31, 2018). Patients were required to have ≥6 months of continuous insurance enrollment before the index date and ≥1 month after (follow-up period). The follow-up period was censored when patients received any systemic therapy. During the follow-up periods, the number of patients who received radiation therapy, ablative therapy, and embolization procedures (transarterial embolization/chemoembolization [TAE] and radioembolization [TARE]) were examined. All-cause and HCC-related healthcare costs (total and patient out-of-pocket [OOP] payments per patient per month [PPPM]) were also measured. Results: Among the 2,101 patients newly diagnosed with HCC who received ≥1 loco-regional therapy, median age was 64 years and 75.0% were male; the mean follow-up duration was 11.5 months. During the follow-up periods, 28.1% (n = 590) received radiation therapy, 27.3% (n = 574) ablative therapy, and 77.3% (n = 1,623) embolization therapy (TAE: 68.7% [n = 1,443]; TARE: 20.7% [n = 434]); 30.9% of patients received multiple loco-regional therapies. During the follow-up periods, total all-cause healthcare costs were a mean of $20,316 (OOP: $378) PPPM, of which 70.7% ($14,359; OOP: $227 PPPM) were HCC-related. The breakdown of healthcare costs is shown in the table. Conclusions: According to the findings of this large-scale real-world analysis of patients newly diagnosed with HCC in the US, a vast majority received at least one embolization procedure. The monthly healthcare economic burden of patients with HCC treated with local-regional therapies is relatively high. [Table: see text]

Health care utilization and costs among HER2-negative, HR-positive, elderly women with metastatic breast cancer in the United States.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e11571-e11571 ◽  
Author(s):  
Manjiri Pawaskar ◽  
Sudeep Karve ◽  
Tapashi Dalvi ◽  
Keith L. Davis ◽  
Robert Deeter
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Index Date ◽  
Elderly Women ◽  
Metastatic Breast ◽  
The United States ◽  
Cost Burden ◽  
Hospital Outpatient ◽  
Physician Office

e11571 Background: Limited data exist on the cost burden of elderly women with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2) negative metastatic breast cancer (MBC). We therefore assessed this cost burden in a retrospective analysis of the Surveillance, Epidemiology and End Results-Medicare database (2000-2009). Methods: Women aged ≥65 years diagnosed with MBC or early-stage breast cancer who progressed to MBC with HER2 negative, HR positive status were selected. MBC diagnosis date or date of progression to MBC was the index date. The study included non-HMO patients who had continuous Medicare (Part A and B) enrollment for ≥12 months before index date to death or end of database (2009). All-cause and MBC-related (claims for MBC diagnoses or MBC-related treatments) healthcare utilization and costs were assessed descriptively and then annualized based on follow-up duration. Results: In total, 13,170 women met the inclusion criteria (mean [SD] age 76.7 [7.0] years, 88% white, 77% both ER and PR positive). Mean [SD] post-index follow-up duration was 38.5 [28.1] months. On average, patients had 2.5 hospitalizations (mean length-of-stay: 16 days) and 3 emergency department (ED) visits. Mean [SD] annual all-cause costs (in 2011 $) per patient were $34,264 [$33,429], half of which $16,397 [$18,284] were attributable to MBC. Hospitalizations, hospital outpatient visits, and physician office visits accounted for over three-quarters of total all-cause costs (mean [SD]: $13,804 [$22,589] $4,171 [$6,509], and $8,676 [$11,065], respectively) and 75% of MBC-related costs (mean [SD]: $4,449 [$9,436], $2,844 [$5,383], and $5,799 [$9,945], respectively). Within MBC-related costs, mean [SD] annual costs of chemotherapy, radiation, and hormone therapy were $1,442 [$4,095], $1,872 [$4,086], and $579 [$1,197], respectively. Conclusions: Our findings indicate that HR positive, HER2 negative elderly women with MBC have a substantial economic burden on the Medicare system with primary costs drivers being inpatient, hospital outpatient and physician office visit costs.

scholarly journals Cochlear Implant Practice Patterns: The U.S. Trends with Pediatric Patients

2018 ◽  
Vol 29 (08) ◽  
pp. 722-733 ◽  
Author(s):  
Carly Hemmingson ◽  
Jessica J. Messersmith
Keyword(s):  
Cochlear Implant ◽  
Online Survey ◽  
Practice Patterns ◽  
Pediatric Population ◽  
The United States ◽  
Practice Research ◽  
Clinical Practices ◽  
Cross Sectional Survey ◽  
Follow Up Care

AbstractMany factors affect an individual’s outcomes with a cochlear implant (CI); however, quality of device programming and consistency of follow-up appointments have been shown to be crucial contributors. As audiologists’ CI caseloads increase, time constraints on appointments also increase, thus fueling the need for efficient and effective programming strategies. Currently, there are no standardized guidelines describing what methods should be used during programming, nor are there standardized schedules that delineate what procedures should be performed at specific appointment intervals. Without standardized programming guidelines, clinical practices may be variable and may not align with best practice research; thus, outcomes with a CI, particularly for pediatrics, may not be reflective of the actual potential available.The purpose of this study was to identify the clinical practice patterns used by U.S. audiologists when programming and providing follow-up care to children who use CIs. This study aimed to determine the following: common programming approaches, provision intervals for these procedures, common validation assessments, typical follow-up care schedules, and source(s) of CI training. In addition, this study sought to evaluate if training and/or follow-up care differed between small and large CI centers.A cross-sectional survey design was used.Target population included practicing audiologists working with pediatric CI users throughout the United States. Participation was voluntary, thus random selection could not be used. A total of 167 participants opened and began the online survey and 113 successfully completed the survey instrument (23.99% return rate).Potential participants were identified using the “find a clinic” function on three CI manufacturers' websites. Potential participants were asked to complete an online survey seeking information about practices they employ in their clinical setting. Survey responses were analyzed for trends.Overall, a common follow-up schedule was determined, which included an average of 6.8 appointments within the first year. Minor differences in training and programming practices between small and large CI centers emerged; however, no statistically significant results were noted. Results did reveal trends in the use of certain clinical practices. This was particularly evident in the limited use of objective measures.Overall, the findings support other recent studies that suggest the development of CI guidelines that may standardize programming and follow-up practices of CI audiologists. This could prove valuable for the continual improvement of CI outcomes, particularly in the pediatric population.

Apheresis practice patterns in the United States of America: Analysis of a market claims database

2021 ◽  
Author(s):  
Nicole D. Zantek ◽  
Ryan J. Martinez ◽  
Andrew D. Johnson ◽  
Anthony J. Tholkes ◽  
Surbhi Shah
Keyword(s):  
United States ◽  
United States Of America ◽  
Practice Patterns ◽  
The United States ◽  
Claims Database

scholarly journals Treatment Patterns Among Patients with Immune Thrombocytopenia (ITP) in the United States: An Electronic Medical Record (EMR)-Based Analysis

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 43-43
Author(s):  
Amanda Wilson ◽  
Ahmed Daak ◽  
Jun Su
Keyword(s):  
Index Date ◽  
Unmet Need ◽  
The United States ◽  
Treatment Patterns ◽  
Lipid Lowering ◽  
Newly Diagnosed ◽  
Inclusion Criteria ◽  
Chronic Itp ◽  
Pain Medications

Introduction ITP is an autoimmune disorder characterized by platelet destruction and impaired production. Some patients with ITP are refractory or unresponsive to existing therapies, indicating significant unmet medical needs. An assessment of current real-world treatment patterns among patients with ITP should enhance understanding of the ITP disease population and current unmet need. Here we present real-world data describing the ITP population in the United States in terms of demographic and clinical characteristics and use of available ITP therapies. Methods This was a longitudinal, retrospective, observational cohort study utilizing data from the Optum® Clinformatics® claims database. Patients with newly diagnosed ITP were included; defined as patients with ≥1 inpatient claim or ≥2 outpatient claims within 90 days of ITP-related diagnosis codes (International Classification of Diseases [ICD], Ninth and Tenth Revision; ICD-9: 287.3x; ICD-10: D69.3x or D69.4x) between October 1, 2015 and March 31, 2020. The index date was the date these criteria were met. Patients were excluded if they had <12 months continuous coverage or any record of thrombopoietin receptor agonist (TPO-RA) use before the index date. All patients were required to have ≥1 prescription during follow-up. Primary ITP was defined as patients who met the inclusion criteria and also had no ICD codes for secondary ITP, and no causes of secondary ITP in an identified time period prior to the index date. Here we describe clinical characteristics and medication use among newly diagnosed patients with primary ITP and the proportion of patients who went on to develop persistent (90 days to <12 months) or chronic (≥12 months) ITP. Results There were 19,376 newly diagnosed patients who met inclusion criteria; 15,798 (82%) had primary ITP and 3,578 (18%) had secondary ITP. Among patients with primary ITP, median (min-max) duration of follow-up was 16 (0-55) months and 61% had ≥12 months of follow-up (median duration: 26 months). At baseline, mean (standard deviation [SD]) age was 67 (16) years and 53% of patients were male. Mean (SD) Charlson Comorbidity Index (CCI) was 0.94 (1.41) and 11% of patients fell into a CCI category ≥3. The most common comorbid conditions were hypertension (60%), cardiovascular disease (37%), diabetes (29%), and anemia (27%). The most commonly used concomitant medications were lipid-lowering medications (44%), pain medications (24%), corticosteroids (23%), and anticoagulants (11%). During follow-up, use of these medications increased (lipid-lowering medications [46%], pain medications [38%], corticosteroids [39%], and anticoagulants [15%]). The most commonly used ITP medications during follow-up were corticosteroids (33%), rituximab (3.3%), TPO-RA (2.8%), immunosuppressants (2.6%), intravenous immunoglobulin (2.5%), and immunomodulators (2.4%). There were 1935 (12%) deaths during follow-up, and 87 (0.6%) patients underwent a splenectomy. Of the patients with ≥12 months of follow-up (n=9610), 16% and 32% developed persistent ITP and chronic ITP, respectively. Among the patients with persistent/chronic ITP and ≥12 months of follow-up, 242 (5.3%) received TPO-RA during follow-up. Of these, 93% concomitantly received ≥1 additional ITP treatment-related medication (TRM), 73% of the patients who received TPO-RA and ≥1 other TRM received ≥2 additional ITP TRMs, and 68% of patients who received TPO-RA and ≥2 other TRMs received ≥3 additional ITP TRMs. Of the 242 patients with ≥12 months of follow-up and persistent/chronic ITP who received TPO-RA, 55 (23%) either received an additional TPO-RA therapy or received another newly initiated ITP-related medication ≥30 days after starting TPO-RA. Almost half of the patients with primary ITP developed persistent/chronic disease. However, only a small percentage of these patients in the Optum® Clinformatics® claims database with no history of TPO-RA use received TPO-RA during follow-up. The majority of patients treated with TPO-RA received ≥1 other ITP TRM during follow-up and nearly 1 in 4 persistent/chronic patients receiving TPO-RA required ≥1 additional TPO-RA or switched to another ITP medication. Conclusion Even with the availability of many ITP drug therapies, there is still a considerable current unmet need for effective treatments among patients with primary ITP. The authors acknowledge Rajeshwari Punekar for contributions to study design. Disclosures Wilson: Sanofi: Current Employment, Current equity holder in publicly-traded company. Daak:Sanofi: Current Employment. Su:Sanofi: Current Employment.

scholarly journals Follow up and complications of knee replacement surgery

2018 ◽  
Vol 5 (11) ◽  
pp. 4983
Author(s):  
Elaf Fakeih ◽  
Mohammed Basnawi ◽  
Waleed Alshardi ◽  
Shaher Albakheet ◽  
Marwan Mandura ◽  
...  
Keyword(s):  
Total Knee Replacement ◽  
Replacement Therapy ◽  
Search Engine ◽  
Knee Replacement ◽  
Cost Effective ◽  
The United States ◽  
Knee Replacement Surgery ◽  
Replacement Surgery ◽  
Total Knee

Total knee surgical replacement is considered to be an extremely cost-effective surgery in the field of orthopedics. It is estimated that over four million patients in the United States have undergone a total knee replacement, and more than half a million patients undergo this operation annually. In this review, we will discuss the risks of possible complications, methods for their prevention, and ideal follow up for patients who underwent total knee replacement surgery. We did a systematic search for prostatitis using PubMed search engine (http://www.ncbi.nlm.nih.gov/) and Google Scholar search engine (https://scholar.google.com). The terms used in the search were: total knee replacement, knee arthroplasty, complications, management and follow up. Despite having an overall favorable safety profile, total knee replacement therapy can have associated morbidities. Overall mortality following a total knee replacement therapy is extremely low and is about 0.08%. Possible complications include cardiovascular events like arrhythmias, heart failure, myocardial infarction, deep venous thrombosis, pulmonary embolisms, and fat embolisms. Other more common complications are prosthetic infection, which is the most common early complication, and aseptic loosening, which are the most common late complications.

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