Dr. Gordon Sun of PHAR, along with researchers from the University of Michigan and VA Center for Clinical Management Research compared postoperative technical, quality-of-life, and cost outcomes following either robotic or open thyroidectomy for thyroid nodules and cancer. They  examined relevant controlled trials, comparative effectiveness studies, and cohort studies for eligible publications to calculate the pooled relative risk for key postoperative complications, mean differences for operative time, and standardized mean differences for length of stay using random effects models.  They found that the robotic approaches may introduce the risk of new complications and require longer operative times. The study can be read here.

Despite the availability of numerous antiepileptic drugs, some epilepsies remain resistant to treatment. We compared utilization and costs in patients with uncontrolled epilepsy to those with stable epilepsy using commercial insurance claims data.  We found patients with uncontrolled epilepsy use more services and incur higher costs compared with those with stable epilepsy. Epilepsy-related costs accounted for <50% of the total costs, suggesting that comorbid conditions and/or under identification of utilization may substantially contribute to costs. This study was published in Epilepsy & Behavior and can be read here.

Given the small magnitude of benefit with adjuvant therapy in stage II colon cancer, chemotherapy is often selected for patients based on their physicians’ subjective assessment of clinical factors. To help guide oncologists’ adjuvant treatment recommendations for standard risk patients where other existing markers are not informative, the 12-gene colon cancer Oncotype DX® Recurrence Score® Assay was developed. The investigators at PHAR in collaboration with Genomic Health studied the effects of the assays by conducting physician surveys. U.S. medical oncologists who ordered the assay for ≥3 stage II colon cancer patients were asked to complete a web-based survey regarding their most recent such patient. They found that the use of the Oncotype DX assay is associated with an overall change of nearly one in three treatment recommendations for stage II colon cancer patients, and that it may lead to more appropriate use of adjuvant treatment. The study can be read here.

There are no clinical guidelines on best practices for the use of bronchoscopy and esophagoscopy in diagnosing head and neck cancer.  Dr. Gordon Sun of PHAR partnered with investigators from the University of Michigan and the University of Pennsylvania to examine variation in the use of bronchoscopy and esophagoscopy across hospitals in Michigan through a retrospective cohort study of the Michigan State Ambulatory Surgery Database.  The authors found that patients with head and neck cancer who are undergoing diagnostic laryngoscopy are much more likely to undergo concurrent bronchoscopy and esophagoscopy at low- and medium-volume hospitals than at high-volume hospitals.  The publication can be viewed here.

Experts from Eisai presented findings of a PHAR/Eisai study on chemotherapy-induced nausea and vomiting (CINV) medication at the MASCC/ISOO International Symposium on Supportive Care in Cancer, held in Berlin, Germany. The investigators compared the cost and occurrence of CINV between patients who were only prescribed palonosetron and patients who were prescribed the generic alternative in combination with other oral medication. The study found that patients treated with palonosetron alone had a significantly lower risk of CINV, and lower CINV-related charges, than patients treated with generic alternatives. The poster can be viewed here

photoResearchers at PHAR, in conjunction with experts from Novartis Pharmaceuticals Corporation, presented the results of several studies on Cushing’s disease at the Endocrine Society’s 95th Annual Meeting on June 19th, 2013. Cushing’s disease, a pituitary disorder, is poorly studied because of its rarity. The PHAR research team reported on the incidence, treatment patterns, and annual economic burden associated with the disease–topics on which very little was previously known. The three posters presented at ENDO can be viewed by clicking the links below:

Incidence of Cushing’s Disease in the United States

Real-World Treatment Patterns in Cushing’s Disease Patients in Two Large US Nationwide Databases: Application of a Novel, Graphical Methodology

Annual Economic Burden Associated with Cushing’s Disease in the United States

The PHAR researchers presented three posters at the 18th Annual International Meeting of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) in New Orleans, LA. A summary and link to each poster can be found below:

  • A Markov cohort model assessed the clinical and economic trade-offs of two products (EVG/cobi/FTC/TDF and EFV/FTC/TDF) in first-line antiretroviral therapy in US adults and found that EVG/cobi/FTC/TDF was not cost effective in the base case compared with EFV/FTC/TDF for first-line HIV treatment. The poster can be viewed here.
  • A comparison of healthcare costs and utilization between epilepsy patients treated with Long-Acting and Short-Acting  antiepileptic drug (AED) monotherapy found that LA AED users incur a lower economic burden than SA AED. The poster can be viewed here.
  • An evaluation of commercially-insured patients with Cushing’s disease, a rare disorder resulting from excessive exposure to glucocorticoids, found a substantial economic burden in these patients with up to $35,000 incurred annually in overall healthcare costs, of which $31,995 are for medical costs. The poster can be viewed here.

According to Andrew M. Kaunitz, MD, Editor in chief of Journal Watch, Women’s Health, a study by PHAR researchers demonstrates that “except in women with mutations that raise risk for ovarian cancer, bilateral oophorectomy should not be performed at hysterectomy for benign indications.” Dr. Kaunitz is  is Professor and Associate Chair of the Department of Obstetrics and Gynecology at the University of Florida College of Medicine–Jacksonville.

Patients with cystic fibrosis (CF), a common life-shortening inherited disorder, often don’t take all their medications. It has been proposed that better adherence could improve these patients’ health more than any specific medical treatment. Investigators at PHAR, LLC, in collaboration with Genentech, Inc. conducted a retrospective cohort analysis and confirmed that there was generally low adherence to dornase alfa, a key drug for CF. The study also found that better adherence was associated with shorter hospital stays. This publication can be viewed by visiting the Journal of Medical Economics website.

A recent study demonstrates that bilateral oophorectomy decreases the risk of ovarian cancer but increases the risk of death from other causes. Researchers from PHAR,LLC; the John Wayne Cancer Institute; USC; Stanford; Brigham and Women’s Hospital/ Harvard; and the University of Auckland conducted a prospective cohort study following over 30,000 Nurses’ Health Study participants for 28 years to investigate long-term health outcomes in women who had either bilateral oophorectomy or ovarian conservation at hysterectomy. Bilateral oophorectomy was associated with increased mortality in women younger than 50 years who never used estrogen therapy, and at no age was oophorectomy associated with increased survival. The full article is now available online ahead-of-print in Obstetrics & Gynecology An accompanying editorial comments, “Dr. Parker and colleagues have made a significant contribution to our understanding of the effect of estrogen deprivation on women’s health, and they elegantly outline the dramatic increases in mortality.” The editorial is also available online.