scholarly journals Medical Costs of Stroke Care Between Women With and Without Dysmenorrhea: A Population-Based Comparison

2021 ◽  
Vol 9 ◽  
Author(s):  
Ya-Wen Lin ◽  
Fung-Chang Sung ◽  
Ming-Hung Lin ◽  
Chih-Hsin Muo ◽  
Yu-Kuei Teng ◽  
...  
Keyword(s):  
Medical Cost ◽  
Stroke Care ◽  
Medical Costs ◽  
Population Based ◽  
Hospitalization Rate ◽  
Cost Of Care ◽  
Research Database ◽  
Stroke Subtype ◽  
Stroke Subtypes ◽  
Medical Care Costs

Objective: This study investigated the medical care costs of stroke type between age-matched cohorts with and without dysmenorrhea using the National Health Insurance Research Database (NHIRD).Methods: We collected all 66,048 women with dysmenorrhea and 66,048 women without dysmenorrhea whose age (15-44-year-old) and index year (from 1997 to 2013) were matched for comparison. We assessed the incidence and compared the risk of stroke and stroke subtype in two cohorts. The proportional distributions of stroke subtypes by age between the two cohorts were compared among the women with stroke, and their hospitalization rate was also estimated. In addition, medical cost, length of stay, and the medical cost within 30 days after stroke were compared between the two cohorts.Results: The stroke risk in dysmenorrhea was greater than comparisons (HR = 1.26, 95% CI = 1.11–1.42). Proportionally, hemorrhagic stroke (HS) significantly decreased with age in both cohorts, whereas ischemic stroke (IS) significantly increased with age when both cohorts were combined. The dysmenorrhea cohort had a higher portion of transient cerebral ischemia (TIA) stroke than comparisons (31.3 vs. 24.2%, p = 0.01) and a lower risk of hospitalization for IS (OR = 0.48, 95% CI = 0.21–0.69). Among the four-stroke subtypes, the cost of care for TIA was the least (US$157 ± 254). The average cost for stroke care was not significantly different between women with and without dysmenorrhea.Conclusion: The hospitalization rate and medical costs of TIA are lower than other types. All women should prevent and treat TIA as soon as possible to avoid recurrence or progression to major stroke events and reduce medical costs, regardless of whether they have dysmenorrhea.

scholarly journals Population-based Comparison Study on the Costs of Stroke Care for Women with Dysmenorrhea

2021 ◽  
Author(s):  
Ya-Wen Lin ◽  
Fung-Chang Sung ◽  
Ming-Hung Lin ◽  
Chih-Hsin Mou ◽  
Yu-Kuei Teng ◽  
...  
Keyword(s):  
Hemorrhagic Stroke ◽  
Stroke Care ◽  
Population Based ◽  
Research Database ◽  
Comparison Study ◽  
Stroke Subtype ◽  
Outpatient Visits ◽  
Increased Risk ◽  
Insurance Claims Data

Abstract Background No study has investigated costs of stroke care for women with dysmenorrhea and stroke. This study compared types of stroke and costs of stroke care between women with and without dysmenorrhea, using the National Health Insurance Research Database of Taiwan. Methods From the insurance claims data, we identified women aged 15–44 to establish study cohorts with and without dysmenorrhea, frequency matched by age, with same sample size of 66048. Incidence of stroke and costs by stroke subtype were compared between the two cohorts at the end of follow-up. Results The incidence of stroke was 1.3-fold greater in the dysmenorrhea cohort than in comparisons. Proportionally, hemorrhagic stroke (HS) decreased with age, whereas ischemic stroke (IS) increased with age in both cohorts. Compared to comparisons, dysmenorrhea women had lower proportions of both HS (16.6% vs. 21.3%) and IS (19.8 vs. 20.1%), whereas dysmenorrhea women had higher proportion of transient cerebral ischemia (TIA) (31.3 vs. 24.2%). The average HS care and IS care cost ratios were 4.1 (3254/789, USD) for dysmenorrhea women, and 3.3-fold (3870/1171, USD) for comparisons. Hospitalization rate was lower in the dysmenorrhea than in comparisons (18.0 vs. 23.4%). Dysmenorrhea was associated with an increased risk of HS hospitalized (adjusted odds ratio (aOR) = 1.26, 95% confidence interval (CI) 0.71–2.23), but a lowered risk for IS (aOR = 0.48, 95% CI 0.21–0.69). Average costs for inpatient care, intensive care units, emergency and outpatient visits for dysmenorrheal women were all less than that for comparisons, but not significant. Conclusion The overall incidence of stroke was higher in dysmenorrheal women than in comparisons due to a higher proportion of TIA, but not HS and IS. However, costs for stroke care were slightly lower for dysmenorrhea women than for comparisons.

Medical cost of care by line of treatment (LoT) in Medicare Fee-for-Service (FFS) beneficiaries with KRAS-mutated metastatic non-small cell lung cancer (mNSCLC).

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 63-63
Author(s):  
Tara Matsuda ◽  
Aurelien Jamotte ◽  
Ann Xi ◽  
Barton Jones ◽  
Allison Petrilla ◽  
...  
Keyword(s):  
Medical Cost ◽  
Medical Management ◽  
Treatment Options ◽  
Medical Costs ◽  
Cost Of Care ◽  
Cancer Drug ◽  
Fee For Service ◽  
Kras Mutations ◽  
Real World Evidence ◽  
Anti Cancer

63 Background: While no targeted therapy is currently approved for patients with KRAS-mutated mNSCLC, new therapies are being developed for patients with KRAS p.G12C-mutated NSCLC. However, real-world evidence on cost of care in managing this population is currently lacking. This study addresses this gap by describing costs of mNSCLC patients with KRAS mutations, stratified by LoT and relative to exposure to a PD(L)1 inhibitor [PD(L)1i]. Methods: Medicare FFS claims (100% sample, Parts A/B) and the PROGNOS NSCLC Explorer dataset were linked to identify patients with mNSCLC, a positive KRAS biomarker test result, and anti-cancer treatment from July 2014 - June 2018. Patients were followed from date of metastasis and stratified by LoT and prior and current exposure to PD(L)1i. Mean total medical costs included all Medicare-covered Parts A/B costs. On treatment medical costs during each LoT were reported per patient per month (PPPM) and were categorized as anti-cancer drug costs or medical management costs (excluding anti-cancer drugs). Results: 438 beneficiaries met inclusion criteria: median age 75 years, 54% female, 91% white, 116 with G12C mutations. 1L patients receiving PD(L)1i had higher total medical costs ($14,331) than those not receiving PD(L)1i ($10,055). Total medical cost of care was similar between patients on 1L ($12,178) and 2L/3L ($12,042). Although total cost of care was similar among 2L/3L patients, irrespective of PD(L)1i exposure status, the medical management costs in patients who progressed after a PD(L)1i or had never received a PD(L)1i were almost twice the medical management costs of the PD(L)1i treated patients. Conclusions: This study demonstrates a high economic burden exists among Medicare patients with KRAS-mutated mNSCLC who have progressed after 1L therapy and for whom there are no targeted treatment options available. [Table: see text]

scholarly journals Continuity of Care Is Associated with Medical Costs and Inpatient Days in Children with Cerebral Palsy

2020 ◽  
Vol 17 (8) ◽  
pp. 2913
Author(s):  
Kuang-Tsu Yang ◽  
Chun-Hao Yin ◽  
Yao-Min Hung ◽  
Shih-Ju Huang ◽  
Ching-Chih Lee ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Continuity Of Care ◽  
Length Of Hospital Stay ◽  
Medical Costs ◽  
Population Based ◽  
Research Database ◽  
Younger Age ◽  
Children With Cerebral Palsy ◽  
Catastrophic Illness ◽  
One Year

Background: Children with cerebral palsy (CP) place a considerable burden on medical costs and add to an increased number of inpatient days in Taiwan. Continuity of care (COC) has not been investigated in this population thus far. Materials and Methods: We designed a retrospective population-based cohort study using Taiwan’s National Health Insurance Research Database. Patients aged 0 to 18 years with CP catastrophic illness certificates were enrolled. We investigated the association of COC index (COCI) with medical costs and inpatient days. We also investigated the possible clinical characteristics affecting the outcome. Results: Over five years, children with CP with low COCI levels had higher medical costs and more inpatient days than did those with high COCI levels. Younger age at CP diagnosis, more inpatient visits one year before obtaining a catastrophic illness certificate, pneumonia, and nasogastric tube use increased medical expenses and length of hospital stay. Conclusions: Improving COC reduces medical costs and the number of inpatient days in children with CP. Certain characteristics also influence these outcomes.

Abstract 139: Trends in Ischemic Stroke Subtype Over a 17-Year Period

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Stacie L Demel ◽  
Jane C Khoury ◽  
Charles J Moomaw ◽  
Kathleen Alwell ◽  
Brett M Kissela ◽  
...  
Keyword(s):  
Population Based ◽  
Incidence Rates ◽  
Large Vessel ◽  
Cardiac Monitoring ◽  
Stroke Subtype ◽  
Stroke Incidence ◽  
Stroke Subtypes ◽  
Ischemic Stroke Subtype ◽  
Age Adjusted Rates ◽  
Over Time

Introduction: Overall US stroke incidence rates have declined. Prior analysis of the Cincinnati region has demonstrated more thorough diagnostic workups coinciding with decreased proportion of cryptogenic and increased proportion of cardioembolic strokes over time in those patients presenting to the ED. We now examine trends in population-based incidence rates of stroke subtypes. Methods: Within the Greater Cincinnati/Northern Kentucky catchment area of 1.3 million, all strokes were ascertained between July 1993 and June 1994 and in 1999, 2005 and 2010. Incidence rates per 100,000, age-, race- and sex-adjusted to the 2000 US population, and associated 95% confidence intervals were calculated. Changes in stroke-subtype proportions over time were examined using a general linear model. Results: There were a total of 6859 incident ischemic strokes (1709 in 1993/94, 1778 in 1999, 1681 in 2005, and 1691 in 2010; age ≥20 years), of which 1290 (18.8%) were black and 3846 (56.1%) female. The Table shows subtype-adjusted incident rates by study period. Incidence rates of both small- and large-vessel etiology showed no significant change over time. Incidence rates of both cardioembolic and other known etiology increased significantly over time, whereas incidence rates of unknown subtype decreased significantly. Conclusions: In our large, biracial population-based cohort, while overall stroke incidence rates have been stable or declining over the last 17 years, trends for individual stroke subtypes have varied. Consistent with our prior analyses, more strokes have been attributed to cardioembolic etiology, whereas strokes attributable to small-vessel and large-vessel etiology have remained stable. The increase in cardioembolic strokes may be due to age and/or prolonged cardiac monitoring. Future analysis of age-adjusted rates for atrial fibrillation over time is warranted.

scholarly journals Vegetarian Diets and Medical Expenditure in Taiwan—A Matched Cohort Study

Nutrients ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 2688 ◽  
Author(s):  
Chin-Lon Lin ◽  
Jen-Hung Wang ◽  
Chia-Chen Chang ◽  
Tina H.T. Chiu ◽  
Ming-Nan Lin
Keyword(s):  
Sex Education ◽  
Medical Cost ◽  
Alcohol Drinking ◽  
Population Based ◽  
Medical Expenditure ◽  
Care Utilization ◽  
Sex Characteristics ◽  
Research Database ◽  
Vegetarian Diets ◽  
Global Burden Of Diseases

Vegetarian diets and lifestyle have been shown to reduce the risk of many chronic non-communicable diseases, which now accounts for the major global burden of diseases. We aimed to determine the contribution of vegetarian diets and lifestyle to the actual direct medical cost in a population-based study. Through linkage to the National Health Insurance Research Database of Taiwan, we compared the health care utilization and medical expenditure of 2166 vegetarians and 4332 age-sex-matched omnivores recruited from the Buddhist Tzu Chi Foundation. Diet and lifestyle questionnaires were self-administered and prospectively collected. We used the general linear model to estimate the 5-year average medical expenditure in vegetarians versus omnivores while adjusting for age, sex, education, exercise habits, smoking, and alcohol drinking. Medical expenses related to non-diet associated lifestyle factors (smoking, alcohol drinking, active community volunteering, and religious emotional support) were estimated through a comparison with the published population medical cost data standardized to match the age and sex characteristics of the cohort. Tzu Chi vegetarians had significantly lower outpatient visits. This translated into 13% lower outpatient (p = 0.007) and 15% lower total medical expenditures (p = 0.008) when compared with the Tzu Chi omnivores, who had an additional 10% lower medical expenditure when compared with the general population. No difference in dental visits and expenses were found between diet groups. Vegetarian diets are associated with significantly lower medical care expenditure and could be an effective strategy to alleviate the medical–economic burden in selected populations.

scholarly journals Traditional Chinese Medicine Reduces Hospitalization Risk of Osteoarthritis Patients: A 13- Year Population-based Cohort Study

2021 ◽  
Author(s):  
Yanping Zhao ◽  
Shuya Wang ◽  
James Cheng-Chung Wei ◽  
Yu Hsun Wang ◽  
Zhiyi Zhang
Keyword(s):  
Logistic Regression ◽  
Cohort Study ◽  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Population Based ◽  
Hospitalization Rate ◽  
Study Patient ◽  
Research Database ◽  
Medical Expense

Abstract Introduction：Osteoarthritis (OA) is a chronic musculoskeletal disorder of the movable joints. TCM has been widely used as complementary therapy for OA in Chinese. Traditional Chinese medicine (TCM) including Duhuojishi decoction, Shujing Huoxue decoction, Angelica Niantong decoction, Guilu Erxian glue et al are widely used in the clinical of osteoarthritis treatment. However there are very few large-scale studies about long-term effect of TCM on OA treatment. This study determined the long-term effects of TCM on reducing OA patients hospitalization risk.Material and methods: This study was a population-based retrospective cohort study. Patient data were collected from the claim-based Taiwan National Health Insurance Research Database from 2000 to 2012. We enrolled 67737 TCM treated cohort and 67737 non-TCM comparison of newly diagnosed OA patients. Propensity score matching was done on age, sex and possible confounders to ensure baseline comparability. Outcomes were medical utility, including hospitalization rate, emergency visits and direct medical expense. Logistic regression was conducted to compare the differences o between TCM and non-TCM groups. Subgroup analyses were also performed by age, gender, income and urbanization.Results: TCM group had an overall higher medical expense than non-TCM group. Although Logistic regression analysis results showed that there was no difference of emergency rate in TCM group and non-TCM group, TCM treatment reduced hospitalization rate of OA significantly.Conclusions: The usage of TCM was associated with a reduced risk of hospitalization of OA patients. TCM might play a complementary role in OA treatment.

scholarly journals Risk of Cardiovascular Events and Medical Cost of Dapagliflozin and Dipeptidyl Peptidase-4 Inhibitors

2021 ◽  
Vol 12 ◽  
Author(s):  
Jong-Mi Seong ◽  
Jong Joo Kim ◽  
Hae Jin Kim ◽  
Hyun Soon Sohn
Keyword(s):  
Cohort Study ◽  
Medical Cost ◽  
Medical Costs ◽  
Dipeptidyl Peptidase ◽  
Population Based ◽  
Decision Analytic Model ◽  
Dipeptidyl Peptidase 4 ◽  
Direct Medical Costs ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Insurance Claims Data

This study compared dapagliflozin, a sodium-glucose co-transporter 2 inhibitor, and dipeptidyl peptidase-4 inhibitors (DPP-4i) with regard to cardiovascular (CV) event incidence and direct medical costs during type 2 diabetes treatment. A retrospective cohort study was conducted using national health insurance claims data from September 1, 2014, to June 30, 2018, of patients in Korea. Patients who were prescribed dapagliflozin and DPP-4i for the first time were included. The primary outcome was the incidence of a composite of major adverse CV events (MACEs)—nonfatal myocardial infarction, nonfatal stroke, or in-hospital CV death. Proportional hazard models after propensity score weighting were used to determine hazard ratios (HRs) and 95% confidence intervals (CIs) for MACE in the dapagliflozin and DPP-4i groups. A decision analytic model was used to compare direct medical costs between the two treatment groups from a healthcare provider’s perspective. Of the 260,336 patients in the cohort, 23,147 and 237,189 received dapagliflozin and DPP-4i, respectively. During the follow-up, 184 patients receiving dapagliflozin and 3,674 receiving DPP-4i (incidence, 6.47 and 11.33 events/1,000 person-years, respectively) had MACE. The adjusted HR of MACE for dapagliflozin compared with that for DPP-4i was 0.69 (95% CI 0.57–0.83). The corresponding HRs were consistent among patients with and without underlying CV disease. The estimated direct medical cost appeared to be lower by $68,452 in the dapagliflozin group than that in the DPP-4i group for 3 years, in 1,000 hypothetical patients. In this population-based cohort study, the use of dapagliflozin instead of DPP-4i was associated with a reduced risk of MACE, which subsequently reduced direct medical costs. These data provide valuable information to patients, practitioners, and authorities regarding the risk of CV events associated with dapagliflozin versus DPP-4i use in clinical practice.

scholarly journals The Effect of Surrounding Greenness on Type 2 Diabetes Mellitus: A Nationwide Population-Based Cohort in Taiwan

2020 ◽  
Vol 18 (1) ◽  
pp. 267
Author(s):  
Hui-Ju Tsai ◽  
Chia-Ying Li ◽  
Wen-Chi Pan ◽  
Tsung-Chieh Yao ◽  
Huey-Jen Su ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Vegetation Index ◽  
Normalized Difference Vegetation Index ◽  
Population Based ◽  
Research Database ◽  
Individual Level ◽  
The Relationship

This study determines whether surrounding greenness is associated with the incidence of type 2 diabetes Mellitus (T2DM) in Taiwan. A retrospective cohort study determines the relationship between surrounding greenness and the incidence of T2DM during the study period of 2001–2012 using data from the National Health Insurance Research Database. The satellite-derived normalized difference vegetation index (NDVI) from the global MODIS database in the NASA Earth Observing System is used to assess greenness. Cox proportional hazard models are used to determine the relationship between exposure to surrounding greenness and the incidence of T2DM, with adjustment for potential confounders. A total of 429,504 subjects, including 40,479 subjects who developed T2DM, were identified during the study period. There is an inverse relationship between exposure to surrounding greenness and the incidence of T2DM after adjustment for individual-level covariates, comorbidities, and the region-level covariates (adjusted HR = 0.81, 95% CI: 0.79–0.82). For the general population of Taiwan, greater exposure to surrounding greenness is associated with a lower incidence of T2DM.

scholarly journals Intravenous Immunoglobulin Treatment in Kawasaki Disease Decreases the Incidence of Myopia

2021 ◽  
Vol 10 (7) ◽  
pp. 1381
Author(s):  
Hun-Ju Yu ◽  
Meng-Ni Chuang ◽  
Chiao-Lun Chu ◽  
Pei-Lin Wu ◽  
Shu-Chen Ho ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Intravenous Immunoglobulin ◽  
Systemic Vasculitis ◽  
Age Distribution ◽  
Population Based ◽  
Research Database ◽  
Ocular Manifestations ◽  
Missing Data Treatment ◽  
The Difference ◽  
Age Range

Kawasaki disease (KD) is a systemic vasculitis that primarily affects children under the age of 5 years old. The most significant complication is coronary artery lesions, but several ocular manifestations have also been reported. Recently, one study revealed an increasing incidence of myopia among KD patients. Therefore, the aim of this study was to assess the difference in myopic incidence between Kawasaki disease (KD) patients treated with aspirin and intravenous immunoglobulin (IVIG). Materials and methods: We carried out a nationwide retrospective cohort study by analyzing the data of KD patients (ICD-9-CM code 4461) from Taiwan’s National Health Insurance Research Database (NHIRD) during the period of 1996–2013. Results: A total of 14,102 diagnosed KD were found in Taiwan during the study period. After excluded missing data, treatment strategy and age distribution, a total of 1446 KD patients were enrolled for analysis including 53 of which received aspirin (without IVIG) and 1393 of which were treated with IVIG. Patients who had myopia, astigmatism, glaucoma, cataract, etc. prior to their KD diagnosis were excluded. The age range was 0 to 6 years old. According to the cumulative curves, our results demonstrated that the myopic incidence in the IVIG group was significantly lower than the aspirin group (hazard ratio: 0.59, 95% confidence intervals: 0.36~0.96, p = 0.02). Treatment with IVIG for KD patients may have benefit for myopia control. Conclusion: Compared to aspirin, IVIG may decrease the myopic risk in KD patients. However, it needs further investigation including clinical vision survey of myopia due to the limitations of this population-based study.

scholarly journals Risk of herpes zoster in psoriasis patients receiving systemic therapies: a nationwide population-based cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sze-Wen Ting ◽  
Sze-Ya Ting ◽  
Yu-Sheng Lin ◽  
Ming-Shyan Lin ◽  
George Kuo
Keyword(s):  
Cohort Study ◽  
Herpes Zoster ◽  
Population Based ◽  
Research Database ◽  
Newly Diagnosed ◽  
Increased Risk ◽  
Taiwan National Health Insurance ◽  
Reduced Risk ◽  
Systemic Therapies

AbstractThe incidence of herpes zoster in psoriasis patients is higher than in the general population. However, the association between herpes zoster risk and different systemic therapies, especially biologic agents, remains controversial. This study investigated the association between herpes zoster risk and several systemic antipsoriasis therapies. This prospective open cohort study was conducted using retrospectively collected data from the Taiwan National Health Insurance Research Database. We included 92,374 patients with newly diagnosed psoriasis between January 1, 2001, and December 31, 2013. The exposure of interest was the “on-treatment” effect of systemic antipsoriasis therapies documented by each person-quarter. The outcome was the occurrence of newly diagnosed herpes zoster. During a mean follow-up of 6.8 years, 4834 (5.2%) patients were diagnosed with herpes zoster after the index date. Among the systemic antipsoriasis therapies, etanercept (hazard ratio [HR] 4.78, 95% confidence interval [CI] 1.51–15.17), adalimumab (HR 5.52, 95% CI 1.72–17.71), and methotrexate plus azathioprine (HR 4.17, 95% CI 1.78–9.82) were significantly associated with an increased risk of herpes zoster. By contrast, phototherapy (HR 0.76, 95% CI 0.60–0.96) and acitretin (HR 0.39, 95% CI 0.24–0.64) were associated with a reduced risk of herpes zoster. Overall, this study identified an association of both etanercept and adalimumab with an increased risk of herpes zoster among psoriasis patients. Acitretin and phototherapy were associated with a reduced risk.

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