The Experts below are selected from a list of 171627 Experts worldwide ranked by ideXlab platform
Peggy Wagner - One of the best experts on this subject based on the ideXlab platform.
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antimigraine medication use and associated Health Care Costs in employed patients
Journal of Headache and Pain, 2012Co-Authors: Jun Wu, Mary D Hughes, Matthew F Hudson, Peggy WagnerAbstract:Migraine is under diagnosed and suboptimally treated in the majority of patients, and also associated with decreased productivity in employees. The objective of this retrospective study is to assess the antimigraine medication use and associated resource utilization in employed patients. Patients with primary diagnosis of migraine or receiving antimigraine prescription drugs were identified from an employer-sponsored Health insurance plan in 2010. Medical utilization and Health Care Costs were determined for the year of 2010. Generalized linear regression was applied to evaluate the association between Health Care Costs and the use of antimigraine medications by controlling covariates. Of 465 patients meeting the study criteria, nearly 30% that had migraine diagnosis were prescribed antimigraine medications, and 20% that had migraine diagnosis were not prescribed antimigraine medications. The remaining 50% were prescribed antimigraine medications but did not have migraine diagnosis. Patients with antimigraine medication prescriptions showed lower frequency of emergency department visits than those without antimigraine medication prescriptions. Regression models indicated an increase in migraine-related Health Care Costs by 86% but decreases in all-cause medical Costs and total Health Care Costs by 42 and 26%, respectively, in the antimigraine medication use group after adjusting for covariates. Employed patients experienced inadequate pharmacotherapy for migraine treatment. After controlling for covariates, antimigraine prescription drug use was associated with lower total medical utilization and Health Care Costs. Further studies should investigate patient self-reported Care and needs to manage headache and develop effective intervention to improve patient quality of life and productivity.
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antimigraine medication use and associated Health Care Costs in employed patients
Journal of Headache and Pain, 2012Co-Authors: Jun Wu, Mary D Hughes, Matthew F Hudson, Peggy WagnerAbstract:Migraine is under diagnosed and suboptimally treated in the majority of patients, and also associated with decreased productivity in employees. The objective of this retrospective study is to assess the antimigraine medication use and associated resource utilization in employed patients. Patients with primary diagnosis of migraine or receiving antimigraine prescription drugs were identified from an employer-sponsored Health insurance plan in 2010. Medical utilization and Health Care Costs were determined for the year of 2010. Generalized linear regression was applied to evaluate the association between Health Care Costs and the use of antimigraine medications by controlling covariates. Of 465 patients meeting the study criteria, nearly 30% that had migraine diagnosis were prescribed antimigraine medications, and 20% that had migraine diagnosis were not prescribed antimigraine medications. The remaining 50% were prescribed antimigraine medications but did not have migraine diagnosis. Patients with antimigraine medication prescriptions showed lower frequency of emergency department visits than those without antimigraine medication prescriptions. Regression models indicated an increase in migraine-related Health Care Costs by 86% but decreases in all-cause medical Costs and total Health Care Costs by 42 and 26%, respectively, in the antimigraine medication use group after adjusting for covariates. Employed patients experienced inadequate pharmacotherapy for migraine treatment. After controlling for covariates, antimigraine prescription drug use was associated with lower total medical utilization and Health Care Costs. Further studies should investigate patient self-reported Care and needs to manage headache and develop effective intervention to improve patient quality of life and productivity.
Hanshelmut Konig - One of the best experts on this subject based on the ideXlab platform.
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the impact of potentially inappropriate medication on the development of Health Care Costs and its moderation by the number of prescribed substances results of a retrospective matched cohort study
PLOS ONE, 2018Co-Authors: Dirk Heider, Herbert Matschinger, Andreas D Meid, Jurgenbernhard Adler, Christian Gunster, Renate Quinzler, Walter E. Haefeli, Hanshelmut KonigAbstract:Background In the growing population of the elderly, drug-related problems are considered an important Health Care safety issue. One aspect of this is the prescription of potentially inappropriate medication (PIM) which is considered to increase Health Care Costs. Objective Using data from the Health Economics of Potentially Inappropriate Medication (HEPIME) study, we aimed to analyze how the number of prescribed substances moderates the association of PIM use as defined by the German PRISCUS list and Health Care Costs applying a longitudinal perspective. Methods An initial number of 6,849,622 insurants aged 65+ of a large German Health insurance company were included in a retrospective matched cohort study. Based on longitudinal claims data from the four separate quarters of a 12-month pre-period, 3,860,842 individuals with no exposure to PIM in 2011 were matched to 508,212 exposed individuals. Exposure effects of PIM use on Health Care Costs and the number of prescribed substances were measured based on longitudinal claims data from the four separate quarters of the 12-month post-period. Results After successful balancing for the development of numerous matching variables during the four quarters of the pre-period, exposed individuals consumed 2.1 additional prescribed substances and had higher total Health Care Costs of 1,237 € when compared to non-exposed individuals in the 1st quarter of the post-period. Controlling for the number of prescribed substances, the difference in total Health Care Costs between both study groups was 401 €. The average effect of one additionally prescribed substance (other than PIM) on total Health Care Costs was increased by an amount of 137 € for those being exposed to a PIM. In quarters 2-4 of the post-period, the differences between both study groups tended to decrease sequentially. Conclusions PIM use has an increasing effect on the development of Health Care Costs. This cost-increasing effect of PIM use is moderated by the number of prescribed substances.
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effects of multiple chronic conditions on Health Care Costs an analysis based on an advanced tree based regression model
BMC Health Services Research, 2013Co-Authors: Hanshelmut Konig, Hanna Leicht, Horst Bickel, Angela Fuchs, Jochen Gensichen, Wolfgang Maier, Karola Mergenthal, Steffi G Riedelheller, Ingmar Schafer, Gerhard SchonAbstract:Background To analyze the impact of multimorbidity (MM) on Health Care Costs taking into account data heterogeneity.
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effects of multiple chronic conditions on Health Care Costs an analysis based on an advanced tree based regression model
BMC Health Services Research, 2013Co-Authors: Hanshelmut Konig, Hanna Leicht, Horst Bickel, Angela Fuchs, Jochen Gensichen, Wolfgang Maier, Karola Mergenthal, Steffi G Riedelheller, Ingmar Schafer, Gerhard SchonAbstract:To analyze the impact of multimorbidity (MM) on Health Care Costs taking into account data heterogeneity. Data come from a multicenter prospective cohort study of 1,050 randomly selected primary Care patients aged 65 to 85 years suffering from MM in Germany. MM was defined as co-occurrence of ≥3 conditions from a list of 29 chronic diseases. A conditional inference tree (CTREE) algorithm was used to detect the underlying structure and most influential variables on Costs of inpatient Care, outpatient Care, medications as well as formal and informal nursing Care. Irrespective of the number and combination of co-morbidities, a limited number of factors influential on Costs were detected. Parkinson’s disease (PD) and cardiac insufficiency (CI) were the most influential variables for total Costs. Compared to patients not suffering from any of the two conditions, PD increases predicted mean total Costs 3.5-fold to approximately € 11,000 per 6 months, and CI two-fold to approximately € 6,100. The high total Costs of PD are largely due to Costs of nursing Care. Costs of inpatient Care were significantly influenced by cerebral ischemia/chronic stroke, whereas medication Costs were associated with COPD, insomnia, PD and Diabetes. Except for Costs of nursing Care, socio-demographic variables did not significantly influence Costs. Irrespective of any combination and number of co-occurring diseases, PD and CI appear to be most influential on total Health Care Costs in elderly patients with MM, and only a limited number of factors significantly influenced cost. Current Controlled Trials ISRCTN89818205
John D Childs - One of the best experts on this subject based on the ideXlab platform.
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prevention of low back pain in the military cluster randomized trial effects of brief psychosocial education on total and low back pain related Health Care Costs
The Spine Journal, 2012Co-Authors: John D Childs, Deydre S Teyhen, Michael E Robinson, Steven Z GeorgeAbstract:BACKGROUND CONTEXT: Effective strategies for preventing low back pain (LBP) have remained elusive, despite annual direct Health Care Costs exceeding $85 billion dollars annually. In our recently completed Prevention of Low Back Pain in the Military (POLM) trial, a brief psychosocial education program (PSEP) that reduced fear and threat of LBP reduced the incidence of Health Care–seeking for LBP. PURPOSE: The purpose of this cost analysis was to determine if soldiers who received psychosocial education experienced lower Health Care Costs compared with soldiers who did not receive psychosocial education. STUDY DESIGN/SETTING: The POLM trial was a cluster randomized trial with four intervention arms and a 2-year follow-up. Consecutive subjects (n54,295) entering a 16-week training program at Fort Sam Houston, TX, to become a combat medic in the U.S. Army were considered for participation. METHODS: In addition to an assigned exercise program, soldiers were cluster randomized to receive or not receive a brief psychosocial education program delivered in a group setting. The Military Health System Management Analysis and Reporting Tool was used to extract total and LBP-related Health Care Costs associated with LBP incidence over a 2-year follow-up period. RESULTS: After adjusting for postrandomization differences between the groups, the median total LBP-related Health Care Costs for soldiers who received PSEP and incurred LBP-related Costs during the 2-year follow-up period were $26 per soldier lower than for those who did not receive PSEP ($60 vs. $86, respectively, p5.034). The adjusted median total Health Care Costs for soldiers who received PSEP and incurred at least some Health Care Costs during the 2-year follow-up period were estimated at $2 per soldier lower than for those who did not receive PSEP ($2,439 vs. $2,441,
Jonathan P Weiner - One of the best experts on this subject based on the ideXlab platform.
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exploring the use of machine learning for risk adjustment a comparison of standard and penalized linear regression models in predicting Health Care Costs in older adults
PLOS ONE, 2019Co-Authors: Hadi Kharrazi, Klaus W Lemke, Hsienyen Chang, David Bodycombe, Jonathan P WeinerAbstract:Background Payers and providers still primarily use ordinary least squares (OLS) to estimate expected economic and clinical outcomes for risk adjustment purposes. Penalized linear regression represents a practical and incremental step forward that provides transparency and interpretability within the familiar regression framework. This study conducted an in-depth comparison of prediction performance of standard and penalized linear regression in predicting future Health Care Costs in older adults. Methods and findings This retrospective cohort study included 81,106 MediCare Advantage patients with 5 years of continuous medical and pharmacy insurance from 2009 to 2013. Total Health Care Costs in 2013 were predicted with comorbidity indicators from 2009 to 2012. Using 2012 predictors only, OLS performed poorly (e.g., R2 = 16.3%) compared to penalized linear regression models (R2 ranging from 16.8 to 16.9%); using 2009–2012 predictors, the gap in prediction performance increased (R2:15.0% versus 18.0–18.2%). OLS with a reduced set of predictors selected by lasso showed improved performance (R2 = 16.6% with 2012 predictors, 17.4% with 2009–2012 predictors) relative to OLS without variable selection but still lagged behind the prediction performance of penalized regression. Lasso regression consistently generated prediction ratios closer to 1 across different levels of predicted risk compared to other models. Conclusions This study demonstrated the advantages of using transparent and easy-to-interpret penalized linear regression for predicting future Health Care Costs in older adults relative to standard linear regression. Penalized regression showed better performance than OLS in predicting Health Care Costs. Applying penalized regression to longitudinal data increased prediction accuracy. Lasso regression in particular showed superior prediction ratios across low and high levels of predicted risk. Health Care insurers, providers and policy makers may benefit from adopting penalized regression such as lasso regression for cost prediction to improve risk adjustment and population Health management and thus better address the underlying needs and risk of the populations they serve.
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Health Care Costs utilization and patterns of Care following lyme disease
PLOS ONE, 2015Co-Authors: Emily R Adrion, John N Aucott, Klaus W Lemke, Jonathan P WeinerAbstract:Background Lyme disease is the most frequently reported vector borne infection in the United States. The Centers for Disease Control have estimated that approximately 10% to 20% of individuals may experience Post-Treatment Lyme Disease Syndrome – a set of symptoms including fatigue, musculoskeletal pain, and neurocognitive complaints that persist after initial antibiotic treatment of Lyme disease. Little is known about the impact of Lyme disease or post-treatment Lyme disease symptoms (PTLDS) on Health Care Costs and utilization in the United States. Objectives 1) to examine the impact of Lyme disease on Health Care Costs and utilization, 2) to understand the relationship between Lyme disease and the probability of developing PTLDS, 3) to understand how PTLDS may impact Health Care Costs and utilization. Methods This study utilizes retrospective data on medical claims and member enrollment for persons aged 0-64 years who were enrolled in commercial Health insurance plans in the United States between 2006-2010. 52,795 individuals treated for Lyme disease were compared to 263,975 matched controls with no evidence of Lyme disease exposure. Results Lyme disease is associated with $2,968 higher total Health Care Costs (95% CI: 2,807-3,128, p<.001) and 87% more outpatient visits (95% CI: 86%-89%, p<.001) over a 12-month period, and is associated with 4.77 times greater odds of having any PTLDS-related diagnosis, as compared to controls (95% CI: 4.67-4.87, p<.001). Among those with Lyme disease, having one or more PTLDS-related diagnosis is associated with $3,798 higher total Health Care Costs (95% CI: 3,542-4,055, p<.001) and 66% more outpatient visits (95% CI: 64%-69%, p<.001) over a 12-month period, relative to those with no PTLDS-related diagnoses. Conclusions Lyme disease is associated with increased Costs above what would be expected for an easy to treat infection. The presence of PTLDS-related diagnoses after treatment is associated with significant Health Care Costs and utilization.
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impact of bariatric surgery on Health Care Costs of obese persons a 6 year follow up of surgical and comparison cohorts using Health plan data
JAMA Surgery, 2013Co-Authors: Jonathan P Weiner, Hsienyen Chang, Suzanne M Goodwin, Shari Bolen, Thomas M Richards, Roger A Johns, Soyal R Momin, Jeanne M ClarkAbstract:Importance Bariatric surgery is a well-documented treatment for obesity, but there are uncertainties about the degree to which such surgery is associated with Health Care cost reductions that are sustained over time. Objective To provide a comprehensive, multiyear analysis of Health Care Costs by type of procedure within a large cohort of privately insured persons who underwent bariatric surgery compared with a matched nonsurgical cohort. Design Longitudinal analysis of 2002-2008 claims data comparing a bariatric surgery cohort with a matched nonsurgical cohort. Setting Seven BlueCross BlueShield Health insurance plans with a total enrollment of more than 18 million persons. Participants A total of 29 820 plan members who underwent bariatric surgery between January 1, 2002, and December 31, 2008, and a 1:1 matched comparison group of persons not undergoing surgery but with diagnoses closely associated with obesity. Main Outcome Measures Standardized Costs (overall and by type of Care) and adjusted ratios of the surgical group's Costs relative to those of the comparison group. Results Total Costs were greater in the bariatric surgery group during the second and third years following surgery but were similar in the later years. However, the bariatric group's prescription and office visit Costs were lower and their inpatient Costs were higher. Those undergoing laparoscopic surgery had lower Costs in the first few years after surgery, but these differences did not persist. Conclusions and Relevance Bariatric surgery does not reduce overall Health Care Costs in the long term. Also, there is no evidence that any one type of surgery is more likely to reduce long-term Health Care Costs. To assess the value of bariatric surgery, future studies should focus on the potential benefit of improved Health and well-being of persons undergoing the procedure rather than on cost savings.
Kaj Sparle Christensen - One of the best experts on this subject based on the ideXlab platform.
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the outcome of Health anxiety in primary Care a two year follow up study on Health Care Costs and self rated Health
PLOS ONE, 2010Co-Authors: Per Fink, Eva Ornbol, Kaj Sparle ChristensenAbstract:Background Hypochondriasis is prevalent in primary Care, but the diagnosis is hampered by its stigmatizing label and lack of valid diagnostic criteria. Recently, new empirically established criteria for Health anxiety were introduced. Little is known about Health anxiety's impact on longitudinal outcome, and this study aimed to examine impact on self-rated Health and Health Care Costs.
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the outcome of Health anxiety in primary Care a two year follow up study on Health Care Costs and self rated Health
PLOS ONE, 2010Co-Authors: Per Fink, Eva Ornbol, Kaj Sparle ChristensenAbstract:BACKGROUND: Hypochondriasis is prevalent in primary Care, but the diagnosis is hampered by its stigmatizing label and lack of valid diagnostic criteria. Recently, new empirically established criteria for Health anxiety were introduced. Little is known about Health anxiety's impact on longitudinal outcome, and this study aimed to examine impact on self-rated Health and Health Care Costs. METHODOLOGY/PRINCIPAL FINDINGS: 1785 consecutive primary Care patients aged 18-65 consulting their family physicians (FPs) for a new illness were followed-up for two years. A stratified subsample of 701 patients was assessed by the Schedules for Clinical Assessment in Neuropsychiatry interview. Patients with mild (N = 21) and severe Health anxiety (N = 81) and Hypochondriasis according to the DSM-IV (N = 59) were compared with a comparison group of patients who had a well-defined medical condition according to their FPs and a low score on the screening questionnaire (N = 968). Self-rated Health was measured by questionnaire at index and at three, 12, and 24 months, and Health Care use was extracted from patient registers. Compared with the 968 patients with well-defined medical conditions, the 81 severe Health anxiety patients and the 59 DSM-IV Hypochondriasis patients continued during follow-up to manifest significantly more Health anxiety (Whiteley-7 scale). They also continued to have significantly worse self-rated functioning related to physical and mental Health (component scores of the SF-36). The severe Health anxiety patients used about 41-78% more Health Care per year in total, both during the 3 years preceding inclusion and during follow-up, whereas the DSM-IV Hypochondriasis patients did not have statistically significantly higher total use. A poor outcome of Health anxiety was not explained by comorbid depression, anxiety disorder or well-defined medical condition. Patients with mild Health anxiety did not have a worse outcome on physical Health and incurred significantly less Health Care Costs than the group of patients with a well-defined medical condition. CONCLUSIONS/SIGNIFICANCE: Severe Health anxiety was found to be a disturbing and persistent condition. It is costly for the Health Care system and must be taken seriously, i.e. diagnosed and treated. This study supports the validity of recently introduced new criteria for Health anxiety.
