pharmacy claim
Recently Published Documents


TOTAL DOCUMENTS

4
(FIVE YEARS 1)

H-INDEX

2
(FIVE YEARS 1)

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 1133-1133 ◽  
Author(s):  
Imi Faghmous ◽  
Carlos Flores ◽  
Kati Sarouei ◽  
Tiffany Y. Chang ◽  
Anisha M. Patel ◽  
...  

Introduction Epidemiological studies in the literature provide conflicting conclusions regarding the risk of myocardial infarction (MI) in people diagnosed with congenital hemophilia A (HA). As a result, the question of protection from MI conferred by HA remains debated. Using insurance claims data, we conducted a study to explore this potential relationship. Methods Initially, a traditional pharmaco-epidemiological approach was conducted using the Truven MarketScan Commercial Database and/or Medicare Supplemental Database. A cohort of persons with HA (PwHA) was identified based on the following criteria: having had a confirmed diagnosis of congenital HA between Jan 1, 2000 and Sept 30, 2017; at least three claims for HA within 365 consecutive days; and continuous enrollment with insurance coverage for the 6 months after first diagnosis of HA. In addition, all individuals were required to be aged ≥18 years, male, and with no evidence of a diagnosis of von Willebrand disease (VWD), hemophilia B, acquired HA, or MI prior to their first HA diagnosis. Based on the results of the first analysis, a second, novel approach was undertaken, using a 2-step method incorporating machine learning and drug utilization for cohort identification. For this approach, the inclusion criteria for the study were further refined to include persons with at least one medical or pharmacy claim for factor VIII (FVIII) therapy, activated prothrombin complex concentrate, or activated factor VIIa therapy; or at least one medical or pharmacy claim for FVIII/VWD therapy; or at least one medical or pharmacy claim for desmopressin and at least one medically-attended visit with a diagnosis of HA in the same claim line; or at least one medically-attended visit with a HA diagnosis. The earliest date for fulfilling any of these inclusion criteria was deemed the individual's index date. Participants also had to have 183 days of continuous insurance enrollment prior to study entry in order to participate. Secondly, a HA classification algorithm, first developed and validated by Lyons et al (Value in Health 2018), was adapted and applied to the above refined cohort. A cohort of individuals with no evidence of HA in the study period was then randomly selected from the MarketScan database and frequency matched to the HA cohort by age, sex, insurance type, region, enrollment length, diabetes status, and hypertensive status at a 1:3 ratio, yielding a control cohort of 18,817 individuals. A Poisson regression model was then fitted to estimate the adjusted incidence rate ratio (IRR). The model was adjusted for all baseline covariates as well as HIV and hepatitis C status, with age as a time-varying covariate. Results Based on the chosen criteria, an initial cohort of 2148 PwHA was identified. The crude incidence rate of MI in this cohort was estimated to be 1.75 (95% confidence interval [CI] 1.43-2.11) per 100 person-years. Relative to the matched cohort of individuals with no evidence of HA (N=10,661), this yielded an IRR of 1.68. Such a high relative risk was investigated further by examining concomitant medications. This revealed evidence of misclassification bias with 16% of participants having been prescribed anticoagulants and a low frequency of hemophilia drug utilization. These results prompted the revision of methods underlying cohort identification to the machine learning/drug utilization approach. The revised cohort yielded a 98.5% specificity and 77.8% sensitivity for selection of PwHA, identifying 3154 individuals with a ≥90% probability of being true PwHA. Ten were excluded as they had a previous history of MI, leaving a final cohort of 3144 PwHA. The crude incidence rate of MI in this HA cohort was calculated to be 0.25 (95% CI 0.15-0.34) per 100 person-years and 0.22 (95% CI 0.18-0.27) in the non-HA population, yielding an unadjusted IRR of 1.13. The adjusted IRR was estimated to be 1.31 (95% CI 0.85-2.00, p=0.22), indicating no statistically significant difference in the risk of MI in the HA population versus a matched non-HA control. Conclusions No evidence of a different risk of MI in PwHA relative to non-HA counterparts was observed in this analysis. To our knowledge, this represents the largest real-world data study investigating MI in the HA population. While every effort was taken to mitigate for the effects of confounders and bias, the results should be interpreted in the context of the limitations of a secondary data use study. Disclosures Faghmous: F. Hoffmann-La Roche Ltd: Employment. Sarouei:Genentech, Inc.: Employment. Chang:Genentech, Inc.: Employment; Genentech/Roche: Equity Ownership. Patel:Genentech: Employment; Roche/Genentech: Equity Ownership. Sima:Roche/Genentech: Employment; Roche: Equity Ownership. Kuebler:Genentech, Inc.: Employment, Equity Ownership.


Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Gabriel S Tajeu ◽  
Shia T Kent ◽  
Daichi Shimbo ◽  
Marie Krousel-Wood ◽  
Ian M Kronish ◽  
...  

Introduction: Low antihypertensive medication adherence has been reported, leading to recommendations for interventions to improve adherence. We evaluated trends in low medication adherence and discontinuation among Medicare beneficiaries initiating antihypertensive medication from 2007 to 2012. Hypothesis: Low antihypertensive medication adherence has decreased over time. Methods: We analyzed data on beneficiaries with ≥ 2 diagnoses for hypertension (ICD-9, 401.xx) in the Medicare 5% random sample initiating antihypertensive medication. Initiation was defined by a pharmacy claim for antihypertensive medication with no claims within the previous 365 days. Beneficiaries were required to have full Medicare fee-for-service coverage (Parts A, B and D) for the 365 days prior to and following the date of initiation. Low adherence was defined as having a proportion of days covered <80% during the 365 day following initiation. Discontinuation was defined as having no days of supply or fills during the final 73 days in the year following initiation. Results: Between 2007-2012, 44,147 Medicare beneficiaries initiated antihypertensive medication. In the overall sample, low adherence decreased from 36.4% in 2007 to 31.7% in 2012 (p<0.001) (Table). After multivariable adjustment, the relative risk (RR) of low adherence for beneficiaries initiating treatment in 2012 compared with those initiating treatment in 2007 was 0.84 (95% CI 0.79-0.89). Throughout the study period, low adherence was more common in beneficiaries that were black (RR 1.41; 95% CI 1.35-1.48), Hispanic (RR 1.40; 95% CI 1.30-1.50), had low income (RR 1.19; 95% CI 1.08-1.32), depression (RR 1.06; 95% CI 1.01-1.12), or a serious fall injury following antihypertensive medication initiation (RR 1.34; 95% CI 1.23-1.47). Discontinuation did not decrease over time. Conclusion: Low adherence to antihypertensive medication among Medicare beneficiaries has decreased over time. Higher rates of low adherence remain for blacks compared with whites.


Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 79-79 ◽  
Author(s):  
Jane N. Ritho ◽  
Dionne Y. Mayhew ◽  
Abraham G. Hartzema ◽  
Huazhi Liu ◽  
Richard Lottenberg

Abstract Background: Efficacy of hydroxyurea (HU) was demonstrated in the Multicenter Study of Hydroxyurea in Sickle Cell Anemia (MSH) placebo-controlled randomized clinical trial with a reduction in average crisis rate (weighted mean difference −2.80; CI −4.74 to −0.86). HU was FDA-approved in 1998 for treatment of adults with sickle cell anemia experiencing recurrent painful episodes. An observational 9 year follow-up study of the MSH cohort demonstrated improved survival for patients taking HU. Purpose: To examine adoption and utilization of HU in SCD patients in a Medicaid population. Methods: A retrospective cohort study was conducted using Florida Medicaid eligibility, medical and pharmacy data for January 1, 2001 to December 31, 2005. The Medicaid database consists of medical and outpatient pharmacy utilization and reimbursement claims. SCD patients aged between 16 and 64 years with at least one inpatient or two outpatient SCD diagnosis claims (ICD-9-CM 282.6x), and meeting continuous eligibility criteria were included. HU adoption was determined by the presence of at least one HU pharmacy claim using National Drug Codes. Adherence to HU was calculated using the medication possession ratio (MPR) defined as the cumulative daily dose dispensed (excluding the last prescription refill and hospitalizations) divided by the time period between the first and last HU prescription (Rx) dispensed. Descriptive and bi-variate analyses were used to assess the relationship between patient characteristics, treatment and utilization of medical resources. Results: The mean age of the 2,301 SCD patients identified is 25 years ± 10.9(SD). Of those, the majority were female (64%) and younger than 25 years of age (60%). During the study eligibility period, 72% had at least one SCD-related emergency department visit, 88% at least one hospitalization and 53% at least one inpatient claim for SCD with pain crisis. During the study period, 33.4% of the patients had ≥ 3 hospitalizations for SCD with pain crisis in any 12 month period. Approximately one-third of patients had red blood cell transfusions (36%) but only 4.4% had a claim for iron-chelation. Of all SCD patients 26% used outpatient opioid medications with 65.4% receiving slow-release formulations. Nearly 17% of the cohort (n=384) had at least one pharmacy claim for HU. Compared to non-HU users, HU users were more likely to be males (OR 1.79; CI 1.44–2.23), aged ≥ 25 years (OR 1.35; CI 1.08–1.71), with a history of using slow-release opioid medications (OR 5.95; CI 4.65–7.59) or receiving red cell transfusions (OR 4.21; CI 3.35–5.31). Of those SCD patients eligible to receive HU according to the MSH criteria (≥ 3 hospitalizations a year for SCD crisis), only 38% received at least one HU Rx (OR 11.78, CI: 8.26–16.80). For those patients receiving at least two HU Rx, only 30.2% had a MPR of ≥ 0.60 (see Table). Conclusions: The prevalence of HU use in this Medicaid population is low. Our results suggest that only a small subset of SCD patients receive HU prescriptions consistently. Early therapy drop out and low adherence rates are common in patients prescribed HU. Interventions to promote physician adoption and prescribing of HU are needed, as are efforts to increase patient adherence. HU Possession Ratio Number of patients (%) 0 – < 0.2 69 (28.6) 0.2 – < 0.4 46 (19.1) 0.4 – < 0.6 53 (22.0) 0.6 – < 0.8 36 (14.9) > 0.8 37 (15.4) Total 241 (100)


1994 ◽  
Vol 28 (5) ◽  
pp. 659-664 ◽  
Author(s):  
Jon C. Clouse ◽  
Jane T. Osterhaus

OBJECTIVE: To compare healthcare use and associated costs in patients with migraine and patients without migraine headache. DESIGN: Retrospective review of a managed care organization's medical and pharmacy claims databases for claims filed between January 1, 1989 and June 30, 1990. PATIENTS: Patients between 18 and 64 years old with a 12-month minimum enrollment in the health plan, including enrollment for the prescription drug benefit. Migraine group (n=1336) inclusion required a medical claim with the diagnosis of migraine headache and a pharmacy claim for a medication potentially used for migraine treatment. Comparison group (n=1336) inclusion required at least one medical claim with no diagnosis of migraine; a pharmacy claim was not required. Comparison group patients were matched to migraine group patients by age, gender, enrollment status, and subscriber or dependent enrollment status. OUTCOME MEASURES: Total health services use, diagnosis-specific use of services, diagnostic procedures performed, comorbid conditions, medication use, and associated costs were tallied. RESULTS: Migraineurs generated nearly twice as many medical claims as comparison group patients, and nearly 2.5 times as many pharmacy claims. Number of claims generated and numbers of patients who generated claims within each of 19 diagnostic categories indicated greater comorbidity in the migraine group. Migraineurs used emergency services more than did patients in the comparison group. Total medical and pharmacy claims costs were $3.4 million for the migraine group and $2.1 million for the comparison group. The average amount paid per member-month of enrollment was significantly greater in the migraine group than in the comparison group. Comorbid conditions were responsible for a significant portion of costs in the migraine group. The migraine group incurred $83 537 for diagnostic procedures compared with $13 140 incurred by the comparison group.


Sign in / Sign up

Export Citation Format

Share Document