Idiopathic pulmonary fibrosis (IPF) is a chronic interstitial lung disease of unknown cause, with median survival of 3 to 5 years. Establishing a diagnosis of IPF can be challenging, with misdiagnoses and delays commonly reported, which cause delays in treatment that can slow the disease progression. The researchers at PHAR recently published a study in which they used Medicare data to examine patterns of diagnostic respiratory testing and pulmonologist visits that precede IPF diagnosis to investigate potential diagnostic delays. This paper was then highlighted in an editorial in the Annals of the American Thoracic Society, where the author “commended [them] for taking on this challenge of examining the real-world temporal relationship between test performance and IPF diagnosis” and commented, “Their findings raise important questions with practical implications for the clinical care of subjects with IPF.” The study and related publications can be found on the PHAR publications page.
A real-world study of lymphoma costs conducted by PHAR in conjunction with Kite, a Gilead Company, was recently published in The Oncologist. This study identified multiple important drivers of cost in the understudied population of patients with diffuse large B-cell lymphoma (DLBCL) receiving second-line treatment, such as hematopoietic stem cell transplant (HSCT) and chemotherapy. Even though HSCT is currently the only curative therapy for DLBCL, less than one third of patients receiving second-line and subsequent treatment underwent transplant, which indicates potential underuse. The variation in chemotherapy regimens suggested a lack of consensus for best practices. The full text of the article, as well as a related poster, can be accessed on the PHAR website.
Two real-world studies completed by PHAR in partnership with Otsuka Pharmaceuticals Development & Commercialization, Inc. and H. Lundbeck A/S were recently published in Advances in Therapy and the Journal of Medical Economics. Together the studies highlight potential treatment options that may reduce healthcare costs in patients with chronic mental illness. The Advances in Therapy article focused on the association between timing of augmentation of antidepressants (ADs) with antipsychotics (APs) and healthcare costs in patients with major depressive disorder. Adding an AP earlier in patients who had inadequately responded to first-line ADs reduces overall healthcare costs. The Journal of Medical Economics article examined medication adherence to oral atypical APs and the impact on psychiatric-related hospitalizations and associated costs in patients with bipolar I disorder (BD-I). Better medication adherence to oral atypical APs was associated with fewer psychiatric-related hospitalizations and lower costs in patients with BD-I. The full text of both articles, as well as related posters, can be accessed on the PHAR website.
A study done by PHAR in partnership with Prothena Biosciences Inc., was recently published in the Journal of Comparative Effectiveness Research. The study estimated the healthcare utilization and costs in amyloid light-chain (AL) amyloidosis. The authors identified AL amyloidosis patients in claims data from 2007 to 2015 and reported inpatient hospitalizations, emergency department visits, non-ED outpatient service visits, and pharmacy utilization. The study found that the general prescribing practices changed over time, with the use of bortezomib increasing and the use of melphalan decreasing. Healthcare utilization and costs decreased between the first and second year after diagnosis. The full text of the study can be read here.
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.