Retrospective Medical Data Research Articles

The medical treatment of depression, 1991–1996: productive inefficiency, expected outcome variations, and price indexes

We examine the price of treating episodes of acute phase major depression over the 1991–1996 time period. We combine data from a large retrospective medical claims data base (MarketScan, from the Medstat Group) with clinical literature and expert clinical opinion elicited from a two-stage Delphi procedure. This enables us to construct a variety of treatment price indexes that include variations over time in the proportion of the “off-frontier” production, as well as the corresponding variations in expected treatment outcomes. We find that in general the incremental cost of successfully treating an episode of acute phase major depression has generally fallen over the 1991–1996 time period. Based on hedonic regression equations that account for the effects of changing patient mix, we find reductions that range from about −1.66 to −2.13% per year.

PAM2: AN ECONOMIC EVALUATION OF OSTEOPOROSIS MEDICATION USE PATTERNS IN A MANAGED CARE ORGANIZATION: A TIME TO FRACTURE ANALYSIS

Osteoporosis affects approximately 24 million Americans and accounts for an estimated annual direct medical costs of over $13.8 billion. An economic analysis that evaluates the effectiveness of osteoporosis medications for prevention of bone fractures in a naturalistic setting has not been formally conducted. OBJECTIVES: To compare differences among four therapeutic alternatives [estrogen replacement therapy (ERT), raloxifene, nasal calcitonin, and alendronate] with respect to health care costs (pharmacy, medical, and total), and time to fracture. METHODS: Retrospective pharmacy and medical claims data from a large managed care organization were analyzed. Patients were included if they were diagnosed with osteoporosis and newly initiated on medication between 1/1/98–12/31/98. All patients were followed for exactly 1 year. Cost data was log-transformed to correct for skewness. ANCOVA was conducted to compare total health care costs; Cox Proportional Hazard Model was performed to compare the risk of fracture. Total health care costs was defined as all osteoporosis-related services covered. RESULTS: There were 12,757 female patients identified for the analysis and the average age was 70(S.D. = 10). A total of 1,721(13.5%) patients had a fracture after initiation of drug therapy. After adjusting for age, prior medication costs, prior fracture event, and comorbidities, adjusted means (95%CI) of log-transformed total health care costs was lowest for ERT 5.87(5.84–5.90), compared to raloxifene 6.32(6.19–6.46), alendronate 6.55(6.51–6.59) and calcitonin 7.20(6.61–7.80). Compared to calcitonin, the adjusted hazard ratios (95%CI) for a fracture were 0.174(0.078–0.39) for ERT, 0.175(0.078–0.39) for alendronate, and 0.160(0.068–0.377) for raloxifene. CONCLUSIONS: In this population, ERT was associated with statistically significant lower total health care costs compared to raloxifene, alendronate, and calcitonin. Raloxifene was associated with statistically significant lower total health care costs compared to calcitonin and alendronate. Furthermore, hazard ratios showed that patients taking ERT, raloxifene, or alendronate were approximately 83% less likely to experience fracture at any point in time compared to calcitonin.

Primary cutaneous melanoma in hidden sites is associated with thicker tumours — a study of 829 patients

The aim of this study was to determine if primary cutaneous melanomas in hidden anatomical sites were associated with thicker tumours. Retrospective medical data of 829 patients with melanomas diagnosed at our centre between January 1976 and July 1998 were recorded from our database. Three groups were defined according to the anatomical site of the primary melanoma: (1) visible areas (group 1: 493 patients); (2) visible areas only to the patients or to their partners in privacy (group 2: 281 patients); and (3) hidden areas (group 3: 55 patients). Univariate analysis indicated that patients with melanoma in hidden regions presented significantly thicker tumours (median for group 3: 2.25 versus 1.17 for group 1 and 1.42 for group 2). This group were also more commonly males (group 3: 58% men versus group 1: 38% and group 2: 51%), in a more advanced stage (metastatic disease at diagnosis in 16% of patients in group 3 versus 6% in groups 1 and 2) and at a more advanced age (median group 3: 66 years versus group 1: 59 years and group 2: 51 years), than patients in the other two groups. The association between tumour thickness and body site remained statistically significant after a multivariate analysis. As a delay in diagnosis may be responsible for the thicker size of melanoma in the hidden areas, preventive programmes should stress the importance of not forgetting these locations in self-examination and screening. Special attention should be given to educating elderly men.

Donepezil use in managed medicare: Effect on health care costs and utilization

Donepezil is one of the first effective and well-tolerated medications approved for the treatment of Alzheimer's disease (AD). This study examined the impact of donepezil on the costs of AD in a multisite managed care organization between January 1, 1996, and March 31, 1998. A pretreatment/posttreatment study was conducted using retrospective medical and prescription claims data for 70 individuals with AD and related dementias who were prescribed donepezil. The outcomes of interest were costs during the pretreatment and posttreatment phases, which were categorized as medical, prescription, and combined costs. Per diem costs were adjusted for differences in the duration of follow-up. We found that median per diem medical costs were $1.22 lower in the posttreatment phase than in the pretreatment phase ( P = 0.02). Moreover, posttreatment costs were reduced in 6 of 7 service settings, with median per diem savings of $0.77 in outpatient care ( P = 0.002) and $0.65 in office visits ( P < 0.001). In the posttreatment phase, the median per diem costs for prescriptions and all claims combined were higher by $2.59 ( P < 0.001) and $2.11 ( P = 0.04), respectively. Donepezil treatment was associated with a decrease in medical costs, particularly in the outpatient components of health care. However, overall costs were increased due to the higher costs of medication. Further pharmacoeconomic studies are needed to determine the exact impact of acetylcholinesterase-inhibitor therapy on the overall costs of care for individuals with dementia.

A review of cystic fibrosis children born to single mothers.

The purpose of this study was to examine the relationship between single parents and the health of their children with cystic fibrosis. Seventy-five children aged between 0.8 and 6.0 y were identified from our patient register; 20 of these children came from single parent families. Socioeconomic profiles were collated for each family. Retrospective medical data including, gene mutation analysis, were recorded from the hospital notes of all 75 patients. Maternal health was assessed by means of the General Health Questionnaire (28-item version). The results show that maternal age of < or = 19 y and lone parenthood were associated with higher morbidity in CF patients <6 y of age. Predicted values of the Shwachman score being lower by 4.1 and 4.3 points, respectively. A declining Shwachman score of 1.1 points/y was associated with increasing patient's age. In addition, analysis showed that the CF children of teenage mothers were 16 times more likely to have admission rates of > or = 1/y. Single mothers experienced more stress-related symptoms than those from the married group. We concluded that the young CF children of single or teenage mothers have a significantly worse clinical progress and consequently have a higher demand for hospital services. Clearly this population requires extra clinical vigilance and social support.

A review of cystic fibrosis children born to single mothers

The purpose of this study was to examine the relationship between single parents and the health of their children with cystic fibrosis. Seventy‐five children aged between 0.8 and 6.0 y were identified from our patient register; 20 of these children came from single parent families. Socioeconomic profiles were collated for each family. Retrospective medical data including, gene mutation analysis, were recorded from the hospital notes of all 75 patients. Maternal health was assessed by means of the General Health Questionnaire (28‐item version). The results show that maternal age of ≤19y and lone parenthood were associated with higher morbidity in CF patients &lt;6y of age. Predicted values of the Shwachman score being lower by 4.1 and 4.3 points, respectively. A declining Shwachman score of 1.1 points/y was associated with increasing patient's age. In addition, analysis showed that the CF children of teenage mothers were 16 times more likely to have admission rates of ≥1/y. Single mothers experienced more stress‐related symptoms than those from the married group. We concluded that the young CF children of single or teenage mothers have a significantly worse clinical progress and consequently have a higher demand for hospital services. Clearly this population requires extra clinical vigilance and social support.