Prescription Pattern Variability of Biologic Therapies in Treating Psoriasis

2018 ◽  
Vol 3 (3) ◽  
pp. 84-87 ◽  
Author(s):  
Emily Galli ◽  
Guodong Liu ◽  
Doug Leslie ◽  
Joslyn Kirby ◽  
Jeffrey J. Miller
Keyword(s):  
Geographic Location ◽  
Fold Increase ◽  
International Classification Of Diseases ◽  
Prescribing Patterns ◽  
Prescription Pattern ◽  
Pharmacy Claims ◽  
Included Patient ◽  
Classification Of Diseases ◽  
Us Census ◽  
Pattern Variability

Background: Medical conditions with high variability in clinical costs and outcomes, such as psoriasis, represent a critical area for health-care value improvement. Thus, the prescription pattern variability of psoriasis biologics merits further study. Objective: The purpose of our study was to determine whether there is variation in psoriasis biologic prescribing patterns. Methods: This study analyzed data from the Truven MarketScan Commercial Claims and Encounters database. Patients with International Classification of Diseases, Ninth Revision psoriasis diagnoses from January 1, 2008, to December 31, 2013, and continuously enrolled for at least 12 months were included. Patient sex, geographic location by census region, and new pharmacy claims for etanercept, adalimumab, and ustekinumab were included. Descriptive and multivariable analyses using logistic regression were performed. Results: Twenty nine thousand seven hundred thirty patients with psoriasis had 36 366 new prescription claims. Statistically significant differences in biologic pharmacy claims existed across US census region and year of claim. The South census region had the most prescriptions (per million population) of each biologic and the greatest increase in new prescriptions for adalimumab and ustekinumab, while the Northeast had the fewest. Etanercept pharmacy claims steadily decreased across all regions over time, while ustekinumab experienced an 8-fold increase. Conclusion: Prescription pattern variability for psoriasis biologics is associated with US census region and year of pharmacy claim.

scholarly journals Clinical and Economic Burden of Antineutrophil Cytoplasmic Antibody–associated Vasculitis in the United States

2015 ◽  
Vol 42 (12) ◽  
pp. 2383-2391 ◽  
Author(s):  
Karina Raimundo ◽  
Amanda M. Farr ◽  
Gilwan Kim ◽  
George Duna
Keyword(s):  
Economic Burden ◽  
Healthcare Costs ◽  
Fold Increase ◽  
Antineutrophil Cytoplasmic Antibody ◽  
International Classification Of Diseases ◽  
The United States ◽  
Administrative Databases ◽  
Classification Of Diseases ◽  
Associated Conditions

Objective.To describe the prevalence of major relapse and healthcare costs among patients with granulomatosis with polyangiitis (GPA); to find patients with microscopic polyangiitis (MPA) in administrative databases, because no MPA diagnosis code exists; and to describe the clinical and economic burden associated with MPA.Methods.Adults (≥ 18 yrs) with ≥ 2 diagnoses of GPA [International Classification of Diseases-9-Clinical Modification (ICD-9-CM 446.4)] during 2009–2013 were extracted from the Truven Health MarketScan Commercial and Medicare Supplemental databases. Evidence of major relapse (based on the Birmingham Vasculitis Activity Score) and healthcare costs were collected during 12-month and 24-month followup periods. Adults with ≥ 2 diagnoses of unspecified arteritis (ICD-9-CM 447.6) were found as potential patients with MPA and additional criteria based on clinical input were applied to refine the sample. Major relapse-associated conditions and healthcare costs in the 6 months pre- and post-diagnosis were measured. Costs were inflated to 2013 US$.Results.A total of 2784 patients with GPA were found and 18.7% experienced a major relapse in the 12-month followup period. The patients with a major relapse incurred higher average all-cause (12-month: $88,065 vs $30,682; p < 0.0001) and GPA-related costs (12-month: $61,636 vs $15,748; p < 0.0001) than patients without a relapse. Trends were consistent over the 24-month followup period. There were 612 incident patients with MPA. Following MPA diagnosis, healthcare costs nearly doubled ($30,166 vs $56,642; p < 0.0001).Conclusion.In a real-world setting, patients with GPA who experience major relapse have higher economic burden, compared to patients without a relapse. MPA diagnosis was associated with nearly a 2-fold increase in healthcare costs.

scholarly journals Use of Medicare Diagnosis and Procedure Codes to Improve Detection of Surgical Site Infections following Hip Arthroplasty, Knee Arthroplasty, and Vascular Surgery

2012 ◽  
Vol 33 (1) ◽  
pp. 40-49 ◽  
Author(s):  
Michael S. Calderwood ◽  
Allen Ma ◽  
Yosef M. Khan ◽  
Margaret A. Olsen ◽  
Dale W. Bratzler ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Knee Arthroplasty ◽  
Hip Arthroplasty ◽  
Surgical Site Infections ◽  
Fold Increase ◽  
International Classification Of Diseases ◽  
Medicare Claims ◽  
Classification Of Diseases ◽  
Control And Prevention ◽  
Procedure Codes

Objective.To evaluate the use of routinely collected electronic health data in Medicare claims to identify surgical site infections (SSIs) following hip arthroplasty, knee arthroplasty, and vascular surgery.Design.Retrospective cohort study.Setting.Four academic hospitals that perform prospective SSI surveillance.Methods.We developed lists of International Classification of Diseases, Ninth Revision, and Current Procedural Terminology diagnosis and procedure codes to identify potential SSIs. We then screened for these codes in Medicare claims submitted by each hospital on patients older than 65 years of age who had undergone 1 of the study procedures during 2007. Each site reviewed medical records of patients identified by either claims codes or traditional infection control surveillance to confirm SSI using Centers for Disease Control and Prevention/ National Healthcare Safety Network criteria. We assessed the performance of both methods against all chart-confirmed SSIs identified by either method.Results.Claims-based surveillance detected 1.8–4.7-fold more SSIs than traditional surveillance, including detection of all previously identified cases. For hip and vascular surgery, there was a 5-fold and 1.6-fold increase in detection of deep and organ/space infections, respectively, with no increased detection of deep and organ/space infections following knee surgery. Use of claims to trigger chart review led to confirmation of SSI in 1 out of 3 charts for hip arthroplasty, 1 out of 5 charts for knee arthroplasty, and 1 out of 2 charts for vascular surgery.Conclusion.Claims-based SSI surveillance markedly increased the number of SSIs detected following hip arthroplasty, knee arthroplasty, and vascular surgery. It deserves consideration as a more effective approach to target chart reviews for identifying SSIs.Infect Control Hosp Epidemiol 2012;33(1):40-49

scholarly journals Ethnozoological and commercial drivers of the pangolin trade in Benin

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Stanislas Zanvo ◽  
Sylvestre C. A. M. Djagoun ◽  
Fortuné A. Azihou ◽  
Bruno Djossa ◽  
Brice Sinsin ◽  
...  
Keyword(s):  
Focus Groups ◽  
Ethnic Groups ◽  
Geographic Location ◽  
International Classification Of Diseases ◽  
Local Communities ◽  
West African ◽  
Wildlife Trade ◽  
Chinese Community ◽  
Trade Networks ◽  
Classification Of Diseases

Abstract Background Pangolins are trafficked in unsustainable volumes to feed both local and global trade networks for their meat and the medicinal properties of their derivatives, including scales. We focus on a West African country (Benin) to assess the medicinal and spiritual values of pangolins among different ethnic groups and identify the cohort of buyers involved in the pangolin trade and related economic values along the chain, notably from local diasporas. Methods We organised 54 focus groups in villages surrounding occurrence habitats of pangolins across Benin and conducted 35 individual interviews with vendors from five major traditional medicine markets (TMMs). Our questionnaire addressed the different uses of pangolins, the commercial value of pangolin items, the categories of clients and the related selling prices. Results Pangolin meat was strictly consumed as food. Scales, head, bones, tongue, blood, heart and xiphisternum were the items used by local communities as part of medicinal (65% of the focus groups) and spiritual (37%) practices. Scales were the most frequently used item (use value index = 1.56). A total of 42 medicinal and spiritual uses, covering 15 International Classification of Diseases (ICD) categories, were recorded among ethnic groups. The ICD and spiritual categories-based analyses of similarity showed a partial overlapping of ethnozoological knowledge across Benin, although knowledge was significantly influenced by ethnicity and geographic location. The pricing of pangolins both varied with the category of stakeholders (local communities vs. stakeholders of TMMs) and clients (local and West African clients vs. Chinese community) and the type of items sold. The Chinese community was reported to only buy pangolins alive, and average selling prices were 3–8 times higher than those to West African clients. Conclusions Our results confirm that pangolins in Africa are valuable and versatile resources for consumption and medicinal / spiritual practices. The pangolin trade in Benin is based on an endogenous and complex network of actors that now appears influenced by the specific, high-valued demand from the Chinese diaspora. Further investigations are required to assess the growing impact of the Chinese demand on the African wildlife trade.

scholarly journals Are Increasing Trends in Opioid-Related Hospitalizations Attributable to Increases in Diagnosis Recordability? Evidence from 2 Large States

2019 ◽  
Vol 12 ◽  
pp. 117863291986133 ◽  
Author(s):  
Alina Denham ◽  
Teraisa Mullaney ◽  
Elaine L Hill ◽  
Peter J Veazie
Keyword(s):  
New York ◽  
Nonlinear Least Squares ◽  
Fold Increase ◽  
International Classification Of Diseases ◽  
Healthcare Research ◽  
Diagnosis Codes ◽  
Classification Of Diseases ◽  
Slope Change ◽  
Definition Of ◽  
National Trends

Based on calculations using all-listed diagnoses, the Agency for Healthcare Research and Quality (AHRQ) reports increasing national trends in opioid-related hospitalizations. It is unclear whether the reported increases are attributable to increases in available diagnosis fields. We leveraged increases in available diagnosis fields, ie, diagnosis recordability, in 2 states to examine their effects on opioid-related hospitalizations, graphically and with nonlinear least squares. Hospitalization data from Texas (1999-2011, N = 36 593 049) and New York (2005-2015Q3, N = 27 582 208) were aggregated to quarter-year in each state. Opioid-related hospitalizations were identified using the same International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Diagnosis Codes as AHRQ. In Texas, the increase in diagnosis recordability resulted in a 29.9% discrete shift in the number of recorded opioid diagnoses and a 3-fold increase in the slope. In New York, a smaller discrete shift (3.1%) and a 3-fold increase in the slope were identified, although a more pronounced change in the trend occurred 5 years earlier (slope change from flat to increasing). Increases in recordability lead to a broader definition of opioid-related hospitalizations, if all-listed diagnoses are used; we found that more hospitalizations are identified using the postchange definition than with the prechange definition (9.7% more in Texas and 4.9% more in New York after 4 years). We conclude that reported increases in opioid-related hospitalizations are partially attributable to increases in diagnosis recordability. Cross-state and temporal comparisons of opioid-related hospitalization rates based on all-listed diagnoses can misrepresent the true relative extent of opioid-related hospital use and therefore of the opioid epidemic.

scholarly journals Temporal Patterns of High-Spend Subgroups Can Inform Service Strategy for Medicare Advantage Enrollees

2021 ◽  
Author(s):  
Samuel J. Amodeo ◽  
Henrik F. Kowalkowski ◽  
Halley L. Brantley ◽  
Nicholas W. Jones ◽  
Lauren R. Bangerter ◽  
...  
Keyword(s):  
International Classification Of Diseases ◽  
Third Party ◽  
Fee For Service ◽  
Medicare Advantage ◽  
Care Needs ◽  
Targeted Interventions ◽  
Pharmacy Claims ◽  
Limited Effectiveness ◽  
Classification Of Diseases ◽  
Claims Data Analysis

Abstract Background Most healthcare costs are concentrated in a small proportion of individuals with complex social, medical, behavioral, and clinical needs that are poorly met by a fee-for-service healthcare system. Efforts to reduce cost in the top decile have shown limited effectiveness. Understanding patient subgroups within the top decile is a first step toward designing more effective and targeted interventions. Objective Segment the top decile based on spending and clinical characteristics and examine the temporal movement of individuals in and out of the top decile. Design Retrospective claims data analysis. Participants UnitedHealthcare Medicare Advantage (MA) enrollees (N = 1,504,091) continuously enrolled from 2016 to 2019. Main Measures Medical (physician, inpatient, outpatient) and pharmacy claims for services submitted for third-party reimbursement under Medicare Advantage, available as International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and National Drug Codes (NDC) claims. Key Results The top decile was segmented into three distinct subgroups characterized by different drivers of cost: (1) Catastrophic: acute events (acute myocardial infarction and hip/pelvic fracture), (2) persistent: medications, and (3) semi-persistent chronic conditions and frailty indicators. These groups show different patterns of spending across time. Each year, 79% of the catastrophic group dropped out of the top decile. In contrast, 68–70% of the persistent group and 36–37% of the semi-persistent group remained in the top decile year over year. These groups also show different 1-year mortality rates, which are highest among semi-persistent members at 17.5–18.5%, compared to 12% and 13–14% for catastrophic and persistent members, respectively. Conclusions The top decile consists of subgroups with different needs and spending patterns. Interventions to reduce utilization and expenditures may show more effectiveness if they account for the different characteristics and care needs of these subgroups.

Comparison of Alcohol Use Disorders in DSM and ICD

2020 ◽  
Vol 66 (3) ◽  
pp. 143-153
Author(s):  
Jessica W. M. Wong ◽  
Friedrich M. Wurst ◽  
Ulrich W. Preuss
Keyword(s):  
Alcohol Use Disorders ◽  
International Classification Of Diseases ◽  
Clinical Use ◽  
Diagnostic Systems ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Classification Of Diseases ◽  
Historical Developments

Abstract. Introduction: With advances in medicine, our understanding of diseases has deepened and diagnostic criteria have evolved. Currently, the most frequently used diagnostic systems are the ICD (International Classification of Diseases) and the DSM (Diagnostic and Statistical Manual of Mental Disorders) to diagnose alcohol-related disorders. Results: In this narrative review, we follow the historical developments in ICD and DSM with their corresponding milestones reflecting the scientific research and medical considerations of their time. The current diagnostic concepts of DSM-5 and ICD-11 and their development are presented. Lastly, we compare these two diagnostic systems and evaluate their practicability in clinical use.

Angststörungen – von der ICD-10 zur ICD-11

2020 ◽  
pp. 1-5
Author(s):  
Timo D. Vloet ◽  
Marcel Romanos
Keyword(s):  
Mental Disorders ◽  
International Classification Of Diseases ◽  
International Classification ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Classification Of Diseases ◽  
Icd 10

Zusammenfassung. Hintergrund: Nach 12 Jahren Entwicklung wird die 11. Version der International Classification of Diseases (ICD-11) von der Weltgesundheitsorganisation (WHO) im Januar 2022 in Kraft treten. Methodik: Im Rahmen eines selektiven Übersichtsartikels werden die Veränderungen im Hinblick auf die Klassifikation von Angststörungen von der ICD-10 zur ICD-11 zusammenfassend dargestellt. Ergebnis: Die diagnostischen Kriterien der generalisierten Angststörung, Agoraphobie und spezifischen Phobien werden angepasst. Die ICD-11 wird auf Basis einer Lebenszeitachse neu organisiert, sodass die kindesaltersspezifischen Kategorien der ICD-10 aufgelöst werden. Die Trennungsangststörung und der selektive Mutismus werden damit den „regulären“ Angststörungen zugeordnet und können zukünftig auch im Erwachsenenalter diagnostiziert werden. Neu ist ebenso, dass verschiedene Symptomdimensionen der Angst ohne kategoriale Diagnose verschlüsselt werden können. Diskussion: Die Veränderungen im Bereich der Angsterkrankungen umfassen verschiedene Aspekte und sind in der Gesamtschau nicht unerheblich. Positiv zu bewerten ist die Einführung einer Lebenszeitachse und Parallelisierung mit dem Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Schlussfolgerungen: Die entwicklungsbezogene Neuorganisation in der ICD-11 wird auch eine verstärkte längsschnittliche Betrachtung von Angststörungen in der Klinik sowie Forschung zur Folge haben. Damit rückt insbesondere die Präventionsforschung weiter in den Fokus.

Störungen durch Substanzgebrauch und abhängige Verhaltensweisen in der ICD-11

2020 ◽  
pp. 1-8
Author(s):  
Nicolas Arnaud ◽  
Rainer Thomasius
Keyword(s):  
International Classification Of Diseases ◽  
International Classification ◽  
Classification Of Diseases

Zusammenfassung. Der Beitrag informiert über die Eingliederung der Suchtstörungen in die 11. Auflage der International Classification of Diseases (ICD-11) der Weltgesundheitsorganisation (WHO). Die Revision der ICD soll einem gewandelten Verständnis der Suchtstörungen und deren Diagnostik Rechnung tragen und die klinische Anwendbarkeit vereinfachen. Im Bereich der substanzbezogenen und nicht substanzbezogenen Störungen sind gegenüber der Vorgängerversion erhebliche Neuerungen eingeführt worden. Die wichtigsten Änderungen betreffen ein erweitertes Angebot an Stoffklassen, deutliche (vereinfachende) Anpassungen in den konzeptuellen und diagnostischen Leitlinien der substanzbezogenen Störungsbilder und insbesondere der „Abhängigkeit“, sowie die Einführung der Kategorie der „abhängigen Verhaltensweisen“ und damit verbunden die Zuordnung der „Glücksspielstörung“ zu den Suchtstörungen sowie die Aufnahme der neuen (bildschirmbezogenen) „Spielstörung“. Zudem findet eine Erweiterung der diagnostischen Optionen für frühe, präklinische Phänotypen der Suchtstörungen („Episodisch Schädlicher Gebrauch“) erstmals Eingang in den ICD-Katalog. Im vorliegenden Beitrag werden die Änderungen Episodisch schädlicher Gebrauch für den Bereich der Suchtstörungen aus kinder- und jugendpsychiatrischer Sicht zusammenfassend dargestellt und diskutiert.

Zusatzklassifikation zur Kennzeichnung von Personen ohne akute Beschwerden oder Krankheiten)

1968 ◽  
Vol 07 (03) ◽  
pp. 141-151 ◽  
Author(s):  
H. Fassl
Keyword(s):  
International Classification Of Diseases ◽  
International Classification ◽  
Classification Of Diseases

In Krankenprotokollen finden sieb, nicht selten Angaben über den Patienten, die nicht mehr als Diagnosen anzusprechen sind. Dennoch sollten diese Feststellungen nicht verworfen werden, da sie wichtige Informationen darstellen. In der vorliegenden Arbeit wird (dem Vorschlag der Weltgesundheitsorganisation folgend) eine sog. Y-Klassifikation vorgestellt, mittels derer Feststellungen bei Personen ohne akute Klagen oder. Erkrankungen verschlüsselt werden können (z. B. Zustand nach einer Krankheit oder Verletzung, Verdacht auf eine Krankheit, Nachsorgemaßnahmen, prophylaktische Maßnahmen usw.). Der Entwurf folgt der Systematik der ICD (International Classification of Diseases) und kann dazu benutzt werden, gewisse Lücken darin zu überbrücken.

Four-Corner Arthrodesis versus Proximal Row Carpectomy: Risk Factors and Complications Associated with Prolonged Postoperative Opioid Use

2020 ◽  
Author(s):  
Neill Y. Li ◽  
Alexander S. Kuczmarski ◽  
Andrew M. Hresko ◽  
Avi D. Goodman ◽  
Joseph A. Gil ◽  
...  
Keyword(s):  
Risk Factors ◽  
International Classification Of Diseases ◽  
Opioid Use ◽  
Proximal Row Carpectomy ◽  
Use Patterns ◽  
Patient Demographics ◽  
Implant Complications ◽  
Increased Risk ◽  
Classification Of Diseases

Abstract Introduction This article compares opioid use patterns following four-corner arthrodesis (FCA) and proximal row carpectomy (PRC) and identifies risk factors and complications associated with prolonged opioid consumption. Materials and Methods The PearlDiver Research Program was used to identify patients undergoing primary FCA (Current Procedural Terminology [CPT] codes 25820, 25825) or PRC (CPT 25215) from 2007 to 2017. Patient demographics, comorbidities, perioperative opioid use, and postoperative complications were assessed. Opioids were identified through generic drug codes while complications were defined by International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification codes. Multivariable logistic regressions were performed with p < 0.05 considered statistically significant. Results A total of 888 patients underwent FCA and 835 underwent PRC. Three months postoperatively, more FCA patients (18.0%) continued to use opioids than PRC patients (14.7%) (p = 0.033). Preoperative opioid use was the strongest risk factor for prolonged opioid use for both FCA (odds ratio [OR]: 4.91; p < 0.001) and PRC (OR: 6.33; p < 0.001). Prolonged opioid use was associated with an increased risk of implant complications (OR: 4.96; p < 0.001) and conversion to total wrist arthrodesis (OR: 3.55; p < 0.001) following FCA. Conclusion Prolonged postoperative opioid use is more frequent in patients undergoing FCA than PRC. Understanding the prevalence, risk factors, and complications associated with prolonged postoperative opioid use after these procedures may help physicians counsel patients and implement opioid minimization strategies preoperatively.

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