Health Insurance Claims Database Research Articles

Epidemiology of Scabies in Korea (2010~2021): An Updated Report

Background: Scabies is a neglected disease that significantly affects the daily lives of patients and their cohabitants. Objective: To investigate the current epidemiological data regarding scabies in Korea. Methods: This was a nationwide population-based observational study using data from the National Health Insurance claims database (reference period: 2010~2021). The primary outcome measure was the annual incidence of scabies. Subgroup analyses were performed disaggregated by sex, age, and region of residence. Results: A total of 517,296 scabies cases were identified, with a male-to-female ratio of 0.83. The annual age-standardized incidence rates steadily decreased from 2010 (97.6 per 100,000 person-years [PY]) to 2021 (43.4 per 100,000 PY), with an average annual percent change of -5.0%. A steep decrease was observed in 2015 (-12.9%), 2020 (-12.7%), and 2021 (-22.8%). An aging trend in patients with scabies was observed, with patients aged ≥50 years accounting for 36.5% and 63.8% of patients in 2010 and 2021, respectively. The ≥80 years age group showed the highest age-specific incidence rate. Although all age groups showed a reduction in annual incidence, the extent of the reduction was relatively greater in patients aged <50 years. The number of patients with scabies was the highest in Gyeonggi, Seoul, and Busan, while the regional incidence rates were highest in Gwangju, Jeonbuk, Jeonnam, Daejeon, and Jeju. Conclusion: During the last 12 years, there has been a gradual decrease in the overall prevalence of scabies. However, the incidence remains relatively higher among the elderly population.

Burden of narcolepsy in Japan: A health claims database study evaluating direct medical costs and comorbidities

ObjectiveThis study aimed to determine the burden of narcolepsy in terms of direct medical costs and comorbidities and compare it with the respective burden of schizophrenia, epilepsy, and ulcerative colitis as controls. MethodsPatients diagnosed with narcolepsy (at least once based on the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, code G47.4) between April 2017 and March 2022 were identified on the health insurance claims database compiled by JMDC Inc. Patients with schizophrenia (F20), epilepsy (G40), and ulcerative colitis (K51) were matched as controls. Direct medical costs (including inpatient, outpatient, and medication costs) and comorbidities were analyzed. ResultsWe identified 4,594 patients with narcolepsy (≥18 years), 18,376 with schizophrenia, 18,376 with epilepsy, and 4,594 with ulcerative colitis. The total annual direct medical cost per person with narcolepsy was 349,188 JPY. The cost for narcolepsy was less than that for schizophrenia, epilepsy, and ulcerative colitis. Several comorbidities, such as sleep apnea, attention deficit hyperactivity disorder (ADHD), and obesity were more prevalent in the narcolepsy group. ConclusionsThe total direct cost for narcolepsy was approximately three times higher than the national medical expense for people aged 15–44 years (122,000 JPY in 2020), but lower than the total cost for all control diseases. The patients with narcolepsy were also likely to have comorbidities that affected their burden. These findings can contribute to future discussions on medical expense assistance programs for patients with narcolepsy.

Epidemiology of cruciate ligament surgery in Japan: A repeated cross-sectional study from 2014 to 2021.

Understanding the incidence and trends of cruciate ligament (CL) surgeries in Japan is crucial for providing effective healthcare services. This study aimed to use open data available from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) to analyze changes in CL surgeries over time and the characteristics of the Japanese population by sex and age. We retrospectively identified CL surgeries of the knee joint registered from April 2014 to March 2022 using the NDB open data. Data on sex, age, and practice were extracted to determine the number of cases per 100,000 population. Trends in the annual incidence of CL surgeries were evaluated using Poisson regression analysis. A total of 142,931 CL surgeries were performed from 2014 to 2021, with arthroscopic ligament reconstruction accounting for 98% of cases. The number of surgeries significantly increased from 16,975 in 2014 to 19,735 in 2019 (P<0.001). CL surgeries were most common in the 15-19 and 20-29 years age groups, with variations between males and females. The incidence of CL surgery in Japan has increased, with characteristics varying by sex and age, including middle-aged and older patients. Further investigation of general patterns in CL surgery in Japan would be valuable.

Comparison of the incidence of severe outcomes in outpatients with COVID-19 or seasonal influenza without risk factors: Retrospective analysis of a health insurance claims-database

BackgroundTo evaluate disease severity for coronavirus disease of 2019 (COVID-19), seasonal influenza (FLU) is often used as a control group for comparison. However, evidence regarding outpatients without risk factors for severe disease is insufficient to consider future treatment policies for these patients. ObjectivesTo compare the risk of severe disease in patients without risk factors for severe disease who are diagnosed with COVID-19 or FLU. Study designThis was a retrospective study analyzing a health insurance claims database (data collection: COVID-19, January 2020 through August 2022; FLU, October 2017 through September 2019). Outcome measures were incidences of severe events of hospitalization, respiratory and heart rate monitoring, oxygen therapy, ventilator use, and intensive care unit admission (within 28 days from diagnosis), and death (within the following month). ResultsData from 575,293 patients were included in the COVID-19 group and from 1,095,698 patients in the FLU group, without risk factors. Adjusted odds ratios for all study outcomes were significantly higher for patients with COVID-19 than with FLU (>3 times greater odds ratio for all severe events). For the population aged ≥18 years, there was also a significantly higher risk for all severe events with COVID-19 versus FLU. The incidence of severe events with COVID-19 among the population aged <18 years was greatly reduced (versus ≥18 years), and risk for severe events was not significantly different with COVID-19 versus FLU. ConclusionsThese findings suggest that the medical need for specific treatment for patients with COVID-19 may be as high as for FLU.

Annual trends of ophthalmic surgeries in Japan’s super-aged society, 2014–2020: a national claims database study

This study aimed to analyze the trends and factors influencing the number of ophthalmic surgeries in Japan using the open data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan published by the Ministry of Health, Labour and Welfare. We calculated the number of cataract, glaucoma, and vitreoretinal surgeries, categorized by sex, age, and surgical type, for the fiscal years (FY) 2014 to 2020. The number of cataract surgeries remained stable at approximately 1.45 million cases from FY 2014 to 2018, increased to nearly 1.6 million cases in FY 2019, and decreased to 1.45 million cases in FY 2020. Among glaucoma surgeries, surgical treatments were increased 1.8 times over 7 years, from 33,000 to 60,000 cases. Laser treatment remained steady at around 55,000 cases from FY 2014 to 2017 and then increased to approximately 60,000 cases. The number of vitreoretinal surgeries was increased 1.2 times from FY 2014 to 2019, from 120,000 to 140,000, and decreased to 130,000 by FY 2020. Trends in ophthalmic surgeries over the past 7 years may be influenced by population aging, minimally invasive surgery, and the coronavirus disease pandemic. These findings have implications on surgical decision-making and resource allocation.

Insights from the trends of omalizumab and mepolizumab utilization in patients with asthma: A population-based cohort study using the National Database in Japan

BackgroundBiologics are increasingly being used in patients with severe uncontrolled asthma. However, the trends in their use for treating severe asthma in Japan remain unclear. MethodsThe number of patients with asthma prescribed omalizumab or mepolizumab between April 2017 and March 2018 was estimated according to sex, age, and geographical region using data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. ResultsOverall, 5,014, 3,449 and 7,977 patients were prescribed omalizumab, mepolizumab, or either combination, respectively. The total number of patients prescribed biologics displayed a bimodal distribution with peaks in their early teens and seventies. Biologics were most commonly used by male and female patients in their seventies. Prescription was 1.24 times higher in males than in females up to the teenage years, whereas it was 1.95 times higher in females than in males from their twenties onwards. Omalizumab was prescribed 1.45 times more frequently than mepolizumab, especially in pediatric patients, and was prescribed 1.96 times more often to female patients than to male patients. Regional differences were observed in the proportion of patients prescribed biologics. Correlation analysis suggested a weak relationship (r = 0.3226, p = 0.0270) between the proportion of patients prescribed biologics and board-certified allergists according to the geographic region. ConclusionsIn Japan, biologics are prescribed more often to older patients with severe asthma compared to those in other countries. Thus, eliminating the regional disparities in asthma treatment by specialists is necessary to provide appropriate medical care to patients with severe asthma.

Lifestyle factors associated with a rapid decline in the estimated glomerular filtration rate over two years in older adults with type 2 diabetes–Evidence from a large national database in Japan

Background The present study investigated lifestyle risk factors from metabolic syndrome-related lifestyles for a rapid decline in the estimated glomerular filtration rate (eGFR) among adults aged 40–74 years with treated and untreated type 2 diabetes. Methods and results This study analyzed data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan, encompassing the period from fiscal year (FY) 2017 to FY2020. We established FY2018 as our baseline year. The subjects of this study were adults aged 40–74 in FY2018(baseline) who had type 2 diabetes and underwent specific health checkups in FY2020. We excluded adults with a medical record of kidney dialysis between FY2017 and FY2018, records of suspected type 1 diabetes between FY2017 and FY2020, or a baseline eGFR &gt;85 mL/min/1.73 m2 or missing eGFR data as of FY2020. Eventually we analyzed 573,860 individuals. The outcome variable was a rapid decline in eGFR (≥30%) during the follow-up. Exposure lifestyle factors included skipping breakfast, late-night dinners, regular smoking, a high alcohol intake, non-refreshing sleep, and a lack of habitual exercise. Logistic regression models were stratified by age (40–59 and 60–74 years) and baseline eGFR levels (60–85, 30–59, and &lt;30 mL/min/1.73 m2). Covariates included sex, a history of heart disease, a history of stroke, a history of renal failure, anemia, low-density lipoprotein, systolic blood pressure, hemoglobin A1C, body mass index, antidiabetic medications, antihypertension drugs, lipid-lowering drugs, the oral adsorbent Kremezin, non-steroidal anti-inflammatory drugs, and drugs for the treatment of renal anemia. A rapid decline in eGFR was detected in approximately 1.3% of participants (7,683 cases). In the baseline eGFR &gt;30 subgroups (60–85 or 30–59 mL/min/1.73 m2), skipping breakfast and regular smoking were associated with a rapid decline in eGFR in both age groups, while a lack of habitual exercise and late-night dinners in the 60–74 age group and non-refreshing sleep in the 40–59 age group were identified as risk factors. Additionally, skipping breakfast was a risk factor for a rapid decline in eGFR in the 60–74 age group regardless of baseline eGFR levels. In the baseline eGFR &lt;30 mL/min/1.73 m2 subgroup, skipping breakfast and non-refreshed sleep were risk factors for a rapid decline in eGFR. Conclusions We found specific lifestyle risk factors were associated with a rapid eGFR decline among people with type 2 diabetes from a nationwide database in Japan. The associations varied by baseline eGFR level, age, and sex. Lifestyle modifications may effectively prevent the aggravation of diabetic kidney disease.

Relationship between antihypertensive drug use and number of people with high blood pressure in FY 2018: a descriptive epidemiological study based on the National Database of Health Insurance Claims and Specific Health Checkups of Japan open data

BackgroundIn most countries barring Japan, antihypertensive drug use has been reported using the defined daily doses/1000 inhabitants/day (DID). Although DID has been shown to allow for the assessment of the number of patients treated with a particular drug, the relationship between DID and the number of patients with hypertension has not been clarified. This study aimed to clarify the relationship between antihypertensive drug use and the number of people with high blood pressure based on the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) open data.MethodsDID was calculated by extracting the use of oral antihypertensive drugs from outpatient prescriptions in the NDB Open Data in FY 2018. The number of people with high blood pressure was calculated using the number of enrollees in each sex–age group for systolic and diastolic blood pressure in the 40–74 years age group. The correlation between the DID of antihypertensive drugs and the number of people with high blood pressure by sex and age class was evaluated using Spearman’s rank correlation coefficient.ResultsThe use of antihypertensive drugs increased with age in both men and women. Furthermore, in both sexes, dihydropyridine derivatives, calcium antagonists, and angiotensin II receptor blockers were the main drugs used from the age of 20 years onward. In addition, a very strong positive correlation was found between the number of people with high systolic blood pressure and DID in both sexes (men: r = 1, P < 0.05; women: r = 1, P < 0.05). In contrast, there was no significant correlation between the number of people with high diastolic blood pressure and DID in both sexes (men: r = − 0.214, P > 0.05; women: r = 0.393, P > 0.05).ConclusionsTo our knowledge, this study is the first to investigate the use of oral antihypertensive drugs in outpatient settings in Japan. In addition, the DID of antihypertensive drugs can be used as an alternative indicator of the number of people with high systolic blood pressure.

Antiresorptive Drugs and the Risk of Femoral Shaft Fracture in Men and Women With Osteoporosis: A Cohort Study Using the National Database of Health Insurance Claims of Japan.

This cohort study aimed to estimate incidence rates of femoral shaft fracture in patients who were treated with antiresorptive drugs. We used data from the National Database of Health Insurance Claims of Japan from April 2009 and October 2016. All patients with new use of an antiresorptive drug, prescription-free period of ≥3 months, and no prior femoral fractures were included. Femoral shaft fractures were identified using a validated definition based on International Classification of Diseases, 10th revision (ICD-10) codes. Incidence rate ratios were estimated using Poisson regression, with adjustment for sex, age, and the Charlson Comorbidity Index. We identified 7,958,655 patients (women: 88.4%; age ≥75 years: 51.2%). Femoral shaft fractures were identified in 22,604 patients. Incidence rates per 100,000 person-years were 74.8 for women, 30.1 for men, 30.1 for patients aged ≤64 years, 47.7 for patients aged 65-74 years, and 99.0 for patients aged ≥75 years. Adjusted incidence rate ratios in patients taking versus not taking each type of antiresorptive drug were 1.00 (95% confidence interval [CI], 0.98-1.03) for bisphosphonates, 0.46 (95% CI, 0.44-0.48) for selective estrogen receptor modulators, 0.24 (95% CI, 0.18-0.32) for estrogens, 0.75 (95% CI, 0.71-0.79) for calcitonins, and 0.93 (95% CI, 0.84-1.03) for denosumab. The adjusted incidence rate ratio for alendronate was 1.18 (95% CI, 1.14-1.22). The incidence rates of femoral shaft fracture varied across patients treated with different antiresorptive drugs. Further research on a specific antiresorptive drug can increase understanding of the risk of femoral shaft fracture.

EPH112 Prevalence, Incidence, and Patient Characteristics of Valvular Heart Disease Using the National Database of Health Insurance Claims in Japan

EPH112 Prevalence, Incidence, and Patient Characteristics of Valvular Heart Disease Using the National Database of Health Insurance Claims in Japan

Carotid artery stenting has a lower risk of severe acute kidney injury than percutaneous coronary intervention: Based on Korean national health insurance claims database

Carotid artery stenting has a lower risk of severe acute kidney injury than percutaneous coronary intervention: Based on Korean national health insurance claims database

Prevalence and Incidence of Strabismus by Age Group in Japan: A Nationwide Population-Based Cohort Study

To investigate the prevalence and incidence of strabismus in the Japanese population by age group and to estimate the subtype proportions. A nationwide population-based cohort study. This study investigated the number of cases with previous and new diagnoses of strabismus by age group between 2009 and 2020 using the National Database of Health Insurance Claims and Specific Health Checkups of Japan, which includes almost all (≥95%) medical claims data. We calculated the strabismus prevalence and 1-year incidence in 2019 and analyzed the proportion of each strabismus subtype. The strabismus prevalence was 2.154% (2 709 207/125 708 000; 95% CI, 2.152%-2.157%). It showed a bimodal distribution, with a high proportion in school and old ages (especially ≥75 years). Exotropia, esotropia, and cyclovertical strabismus proportions were 67.3%, 26.0%, and 6.7%, respectively. Cyclovertical strabismus was uncommon in patients aged ≤18 years (1.4%) and more common (10.2%) in those aged >18 years. The strabismus incidence in 2019 was 321 per 100 000 person-years (403 093/125 708 000; 95% CI, 320-322). The annual incidence proportion of cyclovertical strabismus as opposed to whole strabismus subtypes in patients aged >18 years (13.1%) was higher than that in those aged ≤18 years (1.4%). This is the first nationwide population-based cohort study to demonstrate strabismus's overall prevalence and incidence. The high prevalence of cyclovertical strabismus in adults compared with children may suggest that cyclovertical strabismus is a primarily age-related strabismus. The high prevalence of exotropia may indicate a genetic difference between Japanese and other ethnicities.

Economic Burden Associated with ASCT in Patients with Relapsed/Refractory Diffuse Large B-Cell Lymphoma: A Nationwide Health Insurance Claims Database Study in Japan during 2012-2022

Introduction: Autologous stem-cell transplantation (ASCT) is a standard of care for transplant-eligible patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL). ASCT-related costs and cost drivers remain unknown in Japan, thus restricting economic evaluation comparisons of newer innovative therapies with ASCT. Japan has universal health insurance coverage with a copayment system, which provides a nationwide snapshot of the current treatment landscape in Japan through health insurance database analysis. To capture continuous follow-up data of DLBCL patients who received stem-cell transplantation (SCT) in Japan, we conducted this study using a Japanese health insurance association (HIA) claims database. Methods: This is a retrospective observational study of patients with DLBCL who received SCT using the Medical Data Vision, Co. Ltd. (MDV; Tokyo, Japan) HIA claims database. The MDV HIA database contains inpatient, outpatient, and pharmacy claims from 149 health insurance societies in Japan. The database comprises approximately 7.84 million unique patient identifiers and covers about 3.0% of the Japanese population (as of August 2022). Patients who received treatment during the identification period from October 2012 to February 2022, inclusive, were selected using the DLBCL ICD-10 codes C83.3, C83.8, C85.1, and C85.2. Patients were required to have data for at least 6 months before and after the index date, which is the date of the first recorded ASCT procedure. The total cost included the costs of SCT-related lab tests, stem cell harvests, conditioning regimens during the lookback period, and all costs during the follow-up period including SCT-related hospitalization. Structural Equation Modelling (SEM) is ongoing to estimate the relationships of observed and latent variables having direct and indirect effects on pre-assumed causal relationships. Results: A total of 108 patients (3.8%) among all DLBCL patients who received SCT met the eligibility criteria, and all were ASCT patients. Of those patients, 41.67% were female and 97.22% were aged between 18 to 65 years old with a median age of 55. Subsequent therapy after the index date was received by 13.89% of the 108 patients, of which 2 (1.85%) patients received CAR-T cell therapy. Among the 108 ASCT patients, the median (Q1-Q3) length of SCT-related hospitalization was 34 days (28.50-42.00 days). During SCT-related hospitalization, CT scan was the most common test (22, 50.93%) among all ASCT patients, followed by MRI (12, 11.11%) and PET (3, 2.78%); and no patients were admitted to the ICU or emergency room during SCT-related hospitalization. There was 1 (0.93%) patient who received radiation therapy during SCT-related hospitalization. The median (Q1, Q3) of the total cost for ASCT patients during the lookback and follow-up period (index date inclusive) was $78,718.63 ($57,175.90, $141,108.38). Conclusions: This is the first study to examine the total cost and healthcare resource use of ASCT among patients with DLBCL in the Japan nationwide setting with a follow-up period of up to 24 months. While it is not directly comparable to our study, the median of the total cost for ASCT with a 6-month follow-up period in the US, as reported by Cui et al. (2022), was more than $86,408. The data presented in this study will be a benchmark when considering new innovative therapies for patients with DLBCL. Identifying the cost drivers of ASCT-related costs for DLBCL patients may provide insights for optimizing clinical practice for patients with DLBCL undergoing ASCT and for delivering better care for patients.

Health Care Resource Use, Comorbidities, and Costs of Hemophilia A Patients in France: A Nationwide Claims Database Analysis

Background and objectives Hemophilia A is an inherited bleeding disorder characterized by a deficiency in blood clotting factor VIII (FVIII). Its severity varies based on the degree of FVIII deficiency, with the most severe cases experiencing frequent spontaneous hemorrhages (FVIII levels &amp;lt; 1 IU/dL). Treatment options include on-demand administration following a hemorrhage or prophylaxis to prevent bleeding. The most frequent complication is the production of inhibitory antibodies against the coagulation factors, leading to more aggressive and expensive treatments. The aim of this study was to describe Hemophilia A patients according to severity in France in 2021, including sociodemographic characteristics and comorbidities, current treatments, healthcare resource use and related costs. Methods This study used the French health-insurance claims database (SNDS) containing pseudonymized individual data for over 66 million people. Hemophilia A patients are fully covered in France and might be identified by the ICD-10 code D66. Patients alive on January 1st, 2021, were selected after exclusion of those presenting with Willebrand disease and other rare bleeding disorders. Comorbidities were identified through validated algorithms. An age and gender matched control group without Hemophilia A was randomly selected in the general population: for each HA patient a subject of the same age, gender and region of residence was randomly selected among the overall population of French citizens (excluding HA patients). Sub-group analyses were performed according to the treatment pattern (on demand / in prophylaxis) and the presence of inhibitors (defined with the treatment: emicizumab before October 2019, high dose of factor VIII or bypassing agents). Direct costs were estimated in a societal perspective. Results 5,507 patients with Hemophilia A were identified. Mean age was 36 years and 97.3% were males. Compared to controls, hemophilia patients had significantly (p&amp;lt;0.05) more frequently an HIV infection, hepatitis B or C, and a hepatic disease (Figure 1). There were no significant differences for chronic cardiopathy, coronary artery disease, chronic heart failure and arrhythmia. Respectively 4,056 (73.7%), 36 (0.7%), 1,243 (22.6%) and 172 (3.1%) patients were treated on demand without and with inhibitors and in prophylaxis without and with inhibitors. Compared to controls, patients with hemophilia A had more frequent consultations with general practitioners and hospital specialists, visits to emergency unit, with nurses and physiotherapists (Table 1). They also were more frequently treated with analgesics and corticosteroids but less frequently with non-steroid anti-inflammatory drugs. The proportion of hemophilia A patients hospitalized was higher than controls, overall and also for bleeding episodes and for orthopedic surgery. The mean annual direct medical costs (drugs, consultations, hospitalizations, ...) varied strongly according to treatment modalities and presence of inhibitors: €11,471 for patients treated on demand without inhibitors (versus €1,806 for their matched controls)€76,332 for patients treated on demand with inhibitors (versus €2,288 for their matched controls)€247,937 for patients treated in prophylaxis without inhibitors (versus €1,159 for their matched controls)€349,616 for patients treated in prophylaxis with inhibitors (versus €1,342 for their matched controls). The majority of the costs was related to antihemophilic drugs: 64%, 60%, 94% and 93% respectively in the 4 treatment groups. Conclusion: These results highlight the burden of hemophilia A in terms of comorbidities, healthcare consumptions and cost. The cost of Hemophilia A varied greatly with disease severity and presence of inhibitors and was mostly due to the antihemophilic drugs.

Health Care Resource Use, Comorbidities, and Costs of Hemophilia B Patients in France: A Nationwide Claims Database Analysis

Background and objectives Hemophilia B is an inherited bleeding disorder characterized by a deficiency in blood clotting factor IX (FIX). Its severity varies based on the degree of FIX deficiency, with the most severe cases experiencing frequent spontaneous hemorrhages (FIX levels &amp;lt; 1 IU/dL). Treatment options include on-demand administration following a hemorrhage or prophylaxis to prevent bleeding. A complication is the production of inhibitory antibodies against the coagulation factors in some patients, leading to more aggressive and expensive treatments. The aim of this study was to describe Hemophilia B patients according to severity in France in 2021, including sociodemographic characteristics and comorbidities, current treatments, healthcare resource use and related costs. Methods This study used the French health-insurance claims database (SNDS) containing pseudonymized individual data for over 66 million people. Hemophilia B patients are fully covered in France and might be identified by the ICD-10 code D67. Patients alive on January 1st, 2021, were selected after exclusion of those presenting with Willebrand disease and other rare bleeding disorders. Comorbidities were identified through validated algorithms. An age and gender matched control group without Hemophilia B was randomly selected in the general population: for each HB patient a subject of the same age,gender and region of residence was randomly selected among the overall population of French citizens (excluding HB patients). Sub-group analyses were performed according to the treatment pattern (on demand / in prophylaxis) and the presence of inhibitors (defined with the treatment: high dose of factor IX or bypassing agents). Direct costs were estimated in a societal perspective. Results 1,311 patients with Hemophilia B were identified. Mean age was 36 years and 83.5% were males. Compared to controls, hemophilia patients had significantly (p&amp;lt;0.05) more frequently an HIV infection, hepatitis B or C, and a chronic cardiopathy (Figure 1). There were no significant differences for coronary artery diseases, chronic heart failure, arrhythmia, and hepatic diseases. Respectively 996 (76.0%) and 303 (23.1%) patients were treated on demand and in prophylaxis both without inhibitors. Less than 10 patients were treated either on demand with inhibitors or in prophylaxis with inhibitors. Compared to controls, patients with hemophilia B had more frequent consultations with general practitioners and hospital specialists, visits to emergency unit, with nurses and physiotherapists (Table 1). They also were more frequently treated with analgesics and corticosteroids but less frequently with non-steroid anti-inflammatory drugs. The proportion of hemophilia B patients hospitalized was higher than controls, overall and also for bleeding and for orthopedic surgery. The mean annual direct medical costs (drugs, consultations, hospitalizations, ...) varied strongly according to treatment modalities: €6,506 for patients treated on demand without inhibitors (versus €1,795 for their matched controls)€162,635 for patients treated in prophylaxis without inhibitors (versus €1,071 for their matched controls). The majority of the costs was related to antihemophilic drugs: 33% and 92% respectively for these 2 treatment groups. Conclusion: These results highlight the burden of hemophilia B in terms of comorbidities, healthcare consumptions and cost. The cost of Hemophilia B varied greatly with disease severity and was mostly due to the antihemophilic drugs

Volatile Anesthetic Use Versus Total Intravenous Anesthesia for Patients Undergoing Heart Valve Surgery: A Nationwide Population-Based Study.

Many studies have suggested that volatile anesthetic use may improve postoperative outcomes after cardiac surgery compared to total intravenous anesthesia (TIVA) owing to its potential cardioprotective effect. However, the results were inconclusive, and few studies have included patients undergoing heart valve surgery. This nationwide population-based study included all adult patients who underwent heart valve surgery between 2010 and 2019 in Korea based on data from a health insurance claim database. Patients were divided based on the use of volatile anesthetics: the volatile anesthetics or TIVA groups. After stabilized inverse probability of treatment weighting (IPTW), the association between the use of volatile anesthetics and the risk of cumulative 1-year all-cause mortality (the primary outcome) and cumulative long-term (beyond 1 year) mortality were assessed using Cox regression analysis. Of the 30,755 patients included in this study, the overall incidence of 1-year mortality was 8.5%. After stabilized IPTW, the risk of cumulative 1-year mortality did not differ in the volatile anesthetics group compared to the TIVA group (hazard ratio, 0.98; 95% confidence interval, 0.90-1.07; P = .602), nor did the risk of cumulative long-term mortality (hazard ratio, 0.98; 95% confidence interval, 0.93-1.04; P = .579) at a median (interquartile range) follow-up duration of 4.8 (2.6-7.6) years. Compared with TIVA, volatile anesthetic use was not associated with reduced postoperative mortality risk in patients undergoing heart valve surgery. Our findings indicate that the use of volatile anesthetics does not have a significant impact on mortality after heart valve surgery. Therefore, the choice of anesthesia type can be based on the anesthesiologists' or institutional preference and experience.

Clinical outcomes, medical costs, and medication usage patterns of different somatic symptom disorders and functional somatic syndromes: a population-based study in Taiwan.

Somatic symptom disorders (SSD) and functional somatic syndromes (FSS) are often regarded as similar diagnostic constructs; however, whether they exhibit similar clinical outcomes, medical costs, and medication usage patterns has not been examined in nationwide data. Therefore, this study focused on analyzing SSD and four types of FSS (fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, functional dyspepsia). This population-based matched cohort study utilized Taiwan's National Health Insurance (NHI) claims database to investigate the impact of SSD/FSS. The study included 2 615 477 newly diagnosed patients with SSD/FSS and matched comparisons from the NHI beneficiary registry. Healthcare utilization, mortality, medical expenditure, and medication usage were assessed as outcome measures. Statistical analysis involved Cox regression models for hazard ratios, generalized linear models for comparing differences, and adjustment for covariates. All SSD/FSS showed significantly higher adjusted hazard ratios for psychiatric hospitalization and all-cause hospitalization compared to the control group. All SSD/FSS exhibited significantly higher adjusted hazard ratios for suicide, and SSD was particularly high. All-cause mortality was significantly higher in all SSD/FSS. Medical costs were significantly higher for all SSD/FSS compared to controls. The usage duration of all psychiatric medications and analgesics was significantly higher in SSD/FSS compared to the control group. All SSD/FSS shared similar clinical outcomes and medical costs. The high hazard ratio for suicide in SSD deserves clinical attention.

Development and validation of a predictive model for persistent opioid use in new opioid analgesic users via a nationwide claims database.

Chronic opioid use is associated with problematic opioid use, such as opioid abuse. It is important to develop a prediction model for safe opioid use. In this study, we aimed to develop and validate a risk score model for chronic opioid use in opioid-naïve, noncancer patients, using data from a nationwide database. Data from the National Health Insurance Claims Database in the Republic of Korea from 2016 to 2018 were used, and adult, noncancer patients who were started on non-injectable opioid analgesics (NIOAs) were included. The risk score model was developed using the β coefficient of each variable in the multivariable logistic regression analysis. Overall, 676,676 noncancer patients were started on NIOAs, of which 65,877 (9.7%) were prescribed NIOAs chronically. Age, baseline healthcare utilization, comorbidities, co-medications, and pattern of first NIOA prescription were identified as risk factors for chronic opioid use. The c-static for the performance of our risk score model was 0.754 (95% confidence interval, 0.750-0.758). To our knowledge, this is the first tool that can predict chronic opioid use in the Korean population. The model can help physicians examine the risk of chronic opioid use by patients who are started on NIOA.

Impact of diverting stoma on long-term survival in patients with rectal cancer: A nationwide study based on health insurance claims data

BackgroundA diverting stoma is often created to prevent anastomotic leakage when a low anterior resection (LAR) is performed for rectal cancer. However, it remains unclear how a diverting stoma impacts the prognosis. MethodsWe identified patients with rectal cancer in the National Database of Health Insurance Claims and Specific Health Checkups of Japan who underwent LAR in 2014 and received adjuvant chemotherapy within 12 months of surgery. Overall survival was compared according to the presence or absence of a diverting stoma. Only patients with a stoma were selected to compare overall survival according to the timing of stoma closure. ResultsPatients with a diverting stoma had a significantly better prognosis than those without a diverting stoma (hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.63–0.99, P ​= ​0.039). Compared with patients with early closure, the prognosis of patients with late closure was significantly better (HR 0.56, 95% CI 0.33–0.95, P ​= ​0.031) and that of patients without stoma closure was significantly poorer (HR 2.21, 95% CI 1.34–3.64, P ​= ​0.002). ConclusionAmong patients with rectal cancer who underwent LAR followed by adjuvant chemotherapy, those who had a diverting stoma had better prognosis than those who did not. Patients with a diverting stoma who underwent late closure had the best prognosis.

Longitudinal analysis of long-term outcomes of colorectal cancer after laparotomy and laparoscopic surgery: The Shizuoka study.

Long-term cancer prognosis after initial surgical procedures is an unlikely endpoint for clinical trials. Medical claim databases may aid in addressing this issue regardless of limited information on disease and patient background. However, the long-term prognosis (especially regarding long-term care needs) following surgical procedures remains unclear. This study aimed to assess whether long-term outcomes, such as the exacerbation of long-term care needs and mortality, differ with surgical methods. Using a longitudinal study with linkage between medical claim and long-term care database, patients with primary colorectal cancer who underwent initial colonoscopies were identified through anonymized data in Japan (Shizuoka Kokuho Database, 2012-2018). Odds ratios (ORs) for long-term outcomes (long-term care needs and all-cause mortality during a 6.5-year follow-up period) were analyzed using logistic regression to compare laparoscopy and endoscopic surgery to laparotomy. Overall, 3,744 primary colorectal cancer cases (822 laparotomies, 705 laparoscopies, and 2,217 endoscopic surgeries) were included. Compared to the laparotomy group, the crude OR for exacerbation of long-term care needs in the laparoscopic surgery group was 0.376 (95% confidence interval, 0.227, 0.624), while the OR for all-cause mortality was 0.22 (0.329, 0.532). This is the first study to analyze long-term prognosis after surgery for patients with colorectal cancer to combine medical and long-term needs data. As the national health insurance claim database rarely includes information on cancer stage and comorbidities, better prognosis on endoscopic surgery may need careful interpretation. Therefore, laparoscopy has superior outcomes in terms of long-term care needs and mortality compared to those of laparotomy.