A half million Americans have ESRD, which puts them at high risk for cardiovascular disease and poor outcomes. Little is known about the epidemiology of atrial fibrillation among patients with ESRD. We analyzed data from annual cohorts (1992 to 2006) prevalent hemodialysis United States Renal Data System. In each cohort, we searched 1 year medical claims relevant diagnosis codes determine prevalence fibrillation. Among 2.5 patient observations, 7.7% had fibrillation, increasing 3-fold 3.5%...

Background: The goal of restricting study populations is to make patients more homogeneous regarding potential confounding factors and treatment effects thereby achieve less biased effect estimates. Objectives: This article describes increasing levels restrictions for use in pharmacoepidemiology examines what extent they change rate ratio estimates reduce bias a statin 1-year mortality. Methods: cohort was drawn from population seniors age 65 years older enrolled both Medicare the...

Bias in studies of preventive medications can occur when healthier patients are more likely to initiate and adhere therapy than less healthy patients. We sought evidence this bias by examining associations between statin exposure various outcomes that should not be causally affected exposure, such as workplace motor vehicle accidents.We conducted a prospective cohort study using data from British Columbia, Canada, multiethnic society with population 4.3 million people. Study subjects were...

Estimating drug effectiveness and safety among older adults in population-based studies using administrative health care claims can be hampered by unmeasured confounding as a result of frailty. A claims-based algorithm that identifies patients likely to dependent, proxy for frailty, may improve control. Our objective was develop an predict dependency activities daily living (ADL) sample Medicare beneficiaries.Community-dwelling respondents the 2006 Current Beneficiary Survey, >65 years old,...

Background— Dabigatran, an oral thrombin inhibitor, and rivaroxaban apixaban, factor Xa inhibitors, have been found to be safe effective in reducing stroke risk patients with atrial fibrillation. We sought compare the efficacy safety of 3 new agents based on data from their published warfarin-controlled randomized trials, using method adjusted indirect comparisons. Methods Results— included findings 44 535 enrolled trials dabigatran (Randomized Evaluation Long-Term Anticoagulation Therapy...

ABSTRACT Purpose To examine the effect of variable selection strategies on performance propensity score (PS) methods in a study statin initiation, mortality, and hip fracture assuming true mortality reduction < 15% no fracture. Methods We compared seniors initiating statins with glaucoma medications. Out 202 covariates prevalence > 5%, PS included none, priori, factors predicting exposure, outcome. estimated hazard ratios (HRs) for initiation from Cox models controlling various PSs....

ABSTRACT Fractures related to osteoporosis are associated with $20 billion in cost the United States, majority of born by federal health-care programs, such as Medicare and Medicaid. Despite proven fracture reduction benefits several treatments, less than one-quarter patients older 65 years age who receive care. A postfracture liaison service (FLS) has been developed many health systems but not widely implemented States. We a Markov state-transition computer simulation model assess...

Health care databases are natural sources for estimating prevalence and incidence of chronic conditions, but substantial variation in estimates limits their interpretability utility. We evaluated the effects design choices when claims electronic health record databases.Prevalence five diseases at increasing levels expected frequencies, from cystic fibrosis to COPD, were estimated Clinical Practice Research Datalink (CPRD) MarketScan 2011 2014. Estimates compared using different definitions...

Effective therapies for the secondary prevention of coronary heart disease-related events are significantly underused, and attempts to improve adherence have often yielded disappointing results. Elimination patient out-of-pocket costs may be an effective strategy enhance medication use. We sought estimate incremental cost-effectiveness providing full coverage aspirin, beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, statins (combination...

As medication spending grows, Medicare Part D will need to adapt its coverage policies according emerging evidence from a variety of insurance policies. We sought evaluate the consequences copayment and coinsurance on initiation statin therapy after acute myocardial infarction adherence in initiators using natural experiment all British Columbia residents aged 66 years older.Three consecutive cohorts that included patients who began during full drug (2001), with $10 or $25 copay (2002), 25%...

Although outreach and enhanced treatment interventions improve depression outcomes, uptake has been poor in part because purchasers lack information on their return investment.To estimate the costs benefits of care for workers from societal employer-purchaser perspectives.Cost-effectiveness cost-benefit analyses using state-transition Markov models. Simulated movements between health states were based probabilities drawn clinical literature.Hypothetical cohort 40-year-old workers....

CYP2C9 and VKORC1 genotyping has been advocated as a means of improving the accuracy warfarin dosing. However, effectiveness in anticoagulation control reducing major bleeding not yet compellingly demonstrated. Genotyping currently costs $400 to $550.We constructed Markov model evaluate whether under what circumstances genetically-guided dosing could be cost-effective for newly diagnosed atrial fibrillation patients. Estimates clinical event rates, treatment adverse costs, utilities health...

The objective of this study was to assess the risk suicide attempts and suicides after initiation antidepressant medication use by children adolescents, for individual agents.We conducted a 9-year cohort using population-wide data from British Columbia. We identified new users antidepressants who were 10 18 years age with recorded diagnosis depression. Study outcomes hospitalization attributable intentional self-harm death.Of 20,906 initiated therapy, 16,774 (80%) had no previous use. During...

This study evaluates the effect of Medicare Part D among seniors who previously lacked drug coverage, using time-trend analyses patient-level dispensing data from three pharmacy chains. Of 114,766 without benefits, 55 percent initiated insurance under D. After penalty-free enrollment period, use statins, clopidogrel, and proton pump inhibitors stabilized at levels ranging 11 to 37 above trend that would have been expected if had not implemented. Patients reaching coverage gap (12 percent)...

A previous study suggested an increased risk of preeclampsia among women treated with selective serotonin reuptake inhibitors (SSRIs). Using population-based health-care utilization databases from British Columbia (1997–2006), the authors conducted a 69,448 pregnancies in depression. They compared using SSRIs, serotonin-norepinephrine (SNRIs), or tricyclic antidepressants (TCAs) between gestational weeks 10 and 20 depressed not antidepressants. Among prepregnancy antidepressant users, who...

Background— New anticoagulants may improve health outcomes in patients with atrial fibrillation, but it is unclear whether their use cost-effective. Methods and Results— A Markov state transition was created to compare 4 therapies: dabigatran 150 mg BID, apixaban 5 rivaroxaban 20 QD, warfarin therapy. The population included those newly diagnosed fibrillation who were eligible for treatment warfarin. Compared warfarin, apixaban, rivaroxaban, dabigatran, costs $93 063, $111 465, $140 557 per...

When using claims data, dichotomous covariates (C) are often assumed to be absent unless a claim for the condition is observed. available historical data differs among subjects, investigators must choose between all versus from fixed window assess C. Our purpose was compare estimation under these two approaches.We simulated cohorts of 20,000 subjects with variables representing exposure (E), outcome (D), and single time-invariant C, as well varying availability data. C operationally defined...

Decision makers need to have Canadian-specific cost information in order develop an accurate picture of diabetes management. The objective this study is estimate direct medical costs managing complications diabetes. Complication were estimated by applying unit typical resource use profiles. For each complication, the event refer those associated with acute episode and subsequent care first year. State are annual continued Data obtained from many Canadian sources, including Ontario Case Cost...

The purpose of this study was to determine the direct medical US cost managing multiple sclerosis relapses. Direct data analysis and modeling were employed derive typical resource use profiles costs in 2002 dollars, from perspective a third-party payer responsible for comprehensive health-care. location scope health care services provided over 90-day period used define three levels relapse management. Hospitalization resulting subsequent defined as high intensity A medium level intervention...