Journal of medical economics
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To develop and apply a longitudinal model that adjusts for pre-treatment covariates to examine the trajectory of healthcare costs in duloxetine patients with major depressive disorder (MDD). ⋯ Longitudinal models, compared with conventional mean-based methods, provide better opportunities to assess changes in cost trajectory patterns around the time of changes in medical treatment. In insured patients with MDD started on duloxetine, healthcare costs increased before duloxetine initiation, perhaps signaling a clinical deterioration that led to a change in treatment strategy. Healthcare costs then decreased following duloxetine initiation.
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Randomized Controlled Trial
Cost effectiveness of transcatheter aortic valve replacement compared to medical management in inoperable patients with severe aortic stenosis: Canadian analysis based on the PARTNER Trial Cohort B findings.
The only effective treatment for severe aortic stenosis (AS) is valve replacement. However, many patients with co-existing conditions are ineligible for surgical valve replacement, historically leaving medical management (MM) as the only option which has a poor prognosis. Transcatheter Aortic Valve Replacement (TAVR) is a less invasive replacement method. The objective was to estimate cost-effectiveness of TAVR via transfemoral access vs MM in surgically inoperable patients with severe AS from the Canadian public healthcare system perspective. ⋯ Based on the results of this analysis, it can be concluded that TAVR is cost-effective compared to MM for the treatment of severe AS in surgically inoperable patients.
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The purpose of this study is to report on long-term treatment patterns in a back pain population and to consider whether these may be considered as reflective of under-treatment of pain or poor pain control. ⋯ Two features of this analysis stand out: (i) time since first diagnosis of pain for those currently experiencing severe or moderate back pain and (ii) the 'inertia' that appears to characterize long-term treatment decisions. Irrespective of current pain status, 70% or more of those experiencing current severe or moderate pain report no change from their initial treating physician or no change in prescription once referred to a pain specialist. This occurs over an extended time frame. Whether this should be interpreted as a failure in pain management is a moot point. The fact remains, however, that despite time since first diagnosis subjects not only currently experience severe or moderate pain but a substantial proportion may be expected to continue.
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To assess healthcare resource utilization and costs in a cohort of US managed care patients with systemic lupus erythematosus (SLE). ⋯ SLE is associated with high levels of healthcare utilization and costs in a managed care health plan. Inpatient hospital stays were the primary medical cost drivers, followed by physician office visits and outpatient hospital visits.
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To investigate adherence to dornase alfa therapy among commercially-insured patients with cystic fibrosis (CF) and to examine the impact of adherence on health and economic outcomes. ⋯ Adherence to dornase alfa was generally low, but varied by age and season. Adherence was not found to be significantly associated with respiratory exacerbations or total charges, but was associated with shorter hospital length of stay.