HSR19-096: The Impact of New Oncology Drugs on Disability and Health Care Spending: An Assessment of Real-World Evidence

Background: It is sometimes suggested that newly-approved cancer treatments have only marginal effectiveness, which raises questions concerning their cost-vs-benefit ratio. Such concerns appear at odds with the lower cancer-related hospitalization rate and improved survival. However, such cost-effectiveness analyses rely on population-based averages obtained from the analysis of clinical trial data. By failing to analyze data from longitudinal datasets, such assessments are unable to account for real-world patient conditions and treatment patterns in evaluating clinical and cost-effectiveness. Longitudinally surveyed clinical data has the potential to objectively reveal any association between patient outcomes and new cancer treatment utilization. Methods: We investigated the effect of being prescribed a higher proportion of new oncology drugs on quality of life, medical services use, and productivity measures as reported by the Medical Expenditure Panel Survey (MEPS, 1996–2015). General linear models with Taylor series variance estimation were applied. New oncology drugs were defined as cancer treatments marketed after the year 2000. Included subjects (N=16,677) had a solid or hematologic malignancy diagnosis (CCCodex 11–47) and available prescription data. Individual age and employment status were accounted for as covariates. All analyses were performed using SAS version 9.4 (Cary, NC). Results: Unadjusted regression data show that individuals using newer oncology treatments missed on average 2.5 (±0.3 SE) fewer days of work or school per year as compared to patients using older drugs (43% improved productivity, P<.0001). The effect persisted even after adjusting for the magnitude of the effect (P<.0001). Accounting for age, the use of newer drugs was, on average, associated with ∼35% fewer missed work or school days. Cancer patients using newer treatments had 0.06 (±0.01 SE) fewer hospital admissions/year compared to patients using older treatments (P<.0001) and spent less time in the emergency room (P<.0411) with ∼45% fewer hospitalizations. Patients using newer medicines also had fewer health-related visits (P<.0001). Conclusion: Analysis of longitudinal real-world evidence gives a more comprehensive and reliable view of the clinical and economic impact of new oncology treatments. Our data suggests significant reductions in lost work/school days, hospitalizations, and use of medical services in general.

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1607-P: Real-World Evidence of the Impact of Obesity on Residual Teeth in the Japanese Population

Diabetes ◽

10.2337/db20-1607-p ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 1607-P

Author(s):

MAYU HAYASHI ◽

KATSUTARO MORINO ◽

KAYO HARADA ◽

MIKI ISHIKAWA ◽

ITSUKO MIYAZAWA ◽

...

Keyword(s):

Real World ◽

Japanese Population ◽

Real World Evidence ◽

The Impact

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The impact of anti-CGRP monoclonal antibodies in resistant migraine patients: a real-world evidence observational study

Journal of Neurology ◽

10.1007/s00415-021-10523-8 ◽

2021 ◽

Author(s):

Marta Torres-Ferrús ◽

Victor J. Gallardo ◽

Alicia Alpuente ◽

Edoardo Caronna ◽

Eulalia Gine-Cipres ◽

...

Keyword(s):

Monoclonal Antibodies ◽

Observational Study ◽

Real World ◽

Real World Evidence ◽

The Impact

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Cost-effectiveness analysis of dabigatran versus rivaroxaban for stroke prevention in patients with non-valvular atrial fibrillation using real-world evidence in elderly US Medicare beneficiaries

Current Medical Research and Opinion ◽

10.1080/03007995.2017.1375470 ◽

2017 ◽

Vol 34 (1) ◽

pp. 55-63 ◽

Cited By ~ 3

Author(s):

Siyang Peng ◽

Kristen A. Deger ◽

Anastasia Ustyugova ◽

Pranav Gandhi ◽

Nan Qiao ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cost Effectiveness ◽

Real World ◽

Stroke Prevention ◽

Cost Effectiveness Analysis ◽

Medicare Beneficiaries ◽

Effectiveness Analysis ◽

Real World Evidence

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Real-world evidence on sodium-glucose cotransporter-2 inhibitor use and risk of Fournier’s gangrene

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2019-000985 ◽

2020 ◽

Vol 8 (1) ◽

pp. e000985 ◽

Cited By ~ 3

Author(s):

Jeff Yufeng Yang ◽

Tiansheng Wang ◽

Virginia Pate ◽

John B Buse ◽

Til Stürmer

Keyword(s):

Real World ◽

Fournier’S Gangrene ◽

Sensitivity Analyses ◽

Standardized Mortality Ratio ◽

Fournier's Gangrene ◽

Diagnosis Codes ◽

Sodium Glucose Cotransporter ◽

Real World Evidence ◽

Increased Risk ◽

The Impact

BackgroundSodium-glucose cotransporter-2 inhibitors (SGLT2i) have been associated with increased occurrence of Fournier’s gangrene (FG), a rare but serious form of necrotizing fasciitis, leading to a warning from the Food and Drug Administration. Real-world evidence on FG is needed to validate this warning.MethodsWe used data from IBM MarketScan (2013–2017) to compare the incidence of FG among adult patients who initiated either SGLT2i, a dipeptidyl peptidase-4 inhibitor (DPP4i), or any non-SGLT2i antihyperglycemic medication. FG was defined using inpatient International Classification of Diseases, Ninth Edition and Tenth Edition diagnosis codes 608.83 and N49.3, respectively, combined with procedure codes for debridement, surgery, or systemic antibiotics. We estimated crude incidence rates (IRs) using Poisson regression, and crude and adjusted HRs (aHR) and 95% CIs using standardized mortality ratio-weighted Cox proportional hazards models. Sensitivity analyses examined the impact of alternative outcome definitions.ResultsWe identified 211 671 initiators of SGLT2i (n=93 197) and DPP4i (n=118 474), and 305 329 initiators of SGLT2i (n=32 868) and non-SGLT2i (n=272 461). Crude FG IR ranged from 3.2 to 3.8 cases per 100 000 person-years during a median follow-up of 0.51–0.58 years. Compared with DPP4i, SGLT2i initiation was not associated with increased risk of FG for any outcome definition, with aHR estimates ranging from 0.25 (0.04–1.74) to 1.14 (0.86–1.51). In the non-SGLT2i comparison, we observed an increased risk of FG for SGLT2i initiators when using FG diagnosis codes alone, using all diagnosis settings (aHR 1.80; 0.53–6.11) and inpatient diagnoses only (aHR 4.58; 0.99–21.21).ConclusionsNo evidence of increased risk of FG associated with SGLT2i was observed compared with DPP4i, arguably the most relevant clinical comparison. However, uncertainty remains based on potentially higher risk in the broader comparison with all non-SGLT2i antihyperglycemic agents and the rarity of FG.Trial registration numberEUPAS Register Number 30018.

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A randomised controlled trial exploring the impact of a dedicated Health and Social Care Professionals team in the Emergency Department on the quality, safety, clinical and cost-effectiveness of care for older adults: Study Protocol

10.21203/rs.2.12207/v2 ◽

2019 ◽

Author(s):

Marica Cassarino ◽

Katie Robinson ◽

Íde O’Shaughnessy ◽

Eimear Smalle ◽

Stephen White ◽

...

Keyword(s):

Older Adults ◽

Cost Effectiveness ◽

Randomised Controlled Trial ◽

Hospital Admissions ◽

Controlled Trial ◽

Health And Social Care ◽

Effectiveness Of Care ◽

Randomised Controlled ◽

The Impact

Abstract Background : Older people are frequent Emergency Department (ED) users who present with complex issues that are linked to poorer health outcomes post-index visit, often have increased ED length of stay and tend to have raised healthcare costs. Encouraging evidence suggests that ED teams involving health and social care professionals (HSCPs) can contribute to enhanced patient flow and improved patient experience by improving care decision-making and thus promoting timely and effective care. However, the evidence supporting the impact of HSCPs teams assessing and intervening with older adults in the ED is limited and identifies important methodological limitations, highlighting the need for more robust and comprehensive investigations of this model of care. This study aims to evaluate the impact of a dedicated ED-based HSCP team on the quality, safety, clinical and cost-effectiveness of care of older adults when compared to usual care. Methods : The study is a single-site randomised controlled trial whereby patients aged ≥65 years who present to the ED of a large Irish hospital will be randomised to the experimental group (ED-based HSCP assessment and intervention) or the control group (usual ED care). The recruitment target is 320 participants. The HSCP team will provide a comprehensive functional assessment as well as interventions to promote a safe discharge for the patient. The primary outcome is ED length of stay (from arrival to discharge). Secondary outcomes include: rates of hospital admissions from the ED, ED re-visits, unplanned hospital admissions and healthcare utilisation at 30-days, four and six-month follow-up; patient functional status and quality of life (at baseline and follow-up); patient satisfaction; costs-effectiveness in terms of costs associated with ED-based HSCP compared to usual care; and perceptions on implementation by ED staff members. Discussion : This is the first randomised controlled trial testing the impact of HSCPs working in teams in the ED on the quality, safety, clinical and cost-effectiveness of care for older patients. The findings of the study will provide important information on the effectiveness of this model of care for future implementation. Trial registration : ClinicalTrials.gov, NCT03739515; registered on 12 th November 2018. Protocol version 1. URL: https://clinicaltrials.gov/ct2/show/NCT03739515

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