Publications

On August 16, the Journal of Oncology Practice (JOP) published a joint guidance statement from ASCO and the American Academy of Hospice and Palliative Medicine (AAHPM) regarding high-quality palliative care as delivered as part of routine cancer care. PHAR supported the development of this important guidance by moderating a meeting of experts using the RAND/UCLA modified Delphi panel process. With this method, over 900 potential palliative care services were rated by more than 20 participants on multiple dimensions. Those services which were both highly ranked and which had a high level of agreement were included in the final guidance. Read the full study here.

Carcinoid syndrome describes the hormonal effects of carcinoid tumors, including the secretion of serotonin into the systemic circulation causing episodic diarrhea. Despite the frequent occurrence of this symptom, the healthcare costs and utilization associated with non-infectious diarrhea has not been elucidated. The researchers at PHAR and Novartis Pharmaceuticals Corporation presented their study on the economic impact of Non-Infectious Diarrhea in Patients with Carcinoid Syndrome at the 2015 North American Neuroendocrine Tumor Society’s Annual Symposium. They found that non-infectious diarrhea in newly-diagnosed carcinoid syndrome patients is associated with a significantly increased annual healthcare utilization and an additional $30,000 in total annual healthcare costs. The poster can be viewed here.

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.

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.

PHAR, LLC, in collaboration with Bristol-Myers Squibb and Otsuka Pharmaceutical Development & Commercialization, Inc, conducted a study to evaluate how antipsychotic medication half-life affects the risk of psychiatric hospital admission and emergency department (ED) visits for patients with schizophrenia. The study found that patients taking medication with a longer half-life had fewer comorbid mental health conditions, took fewer psychiatric medications, and had a lower risk of hospital admission and ED visits for mental disorders. The full study can be found in the January 2012 edition of the Journal of Medical Economics.

The literature on chronic idiopathic urticaria (CIU) lacks information on demographic characteristics and comorbidities. To fill this gap, investigators at PHAR, LLC initiated an analysis to better define the insured population. By conducting a cross-sectional analysis of insurance claims, investigators found that although antihistamines were the most common treatment for CIU, physicians also frequently prescribed oral corticosteroids. The study was conducted in partnership with Genentech, Inc. as well as investigators at the David Geffen School of Medicine at UCLA and NOVA Southeastern University College of Osteopathic Medicine. View the abstract at the Annals of Allergy, Asthma & Immunology website.