Biomedical subjects

Eric Q Wu

Publications and source records attributed to Eric Q Wu.

11 recordsLinked to original sources

PubMed2006

Impact of stroke on health-related quality of life in the noninstitutionalized population in the United States.

BACKGROUND AND PURPOSE: Stroke is a major cause of long-term disability in the United States. This study examined the national impact of stroke on health-related quality of life (HRQoL) and disparities in HRQoL across different demographic groups. METHODS: Combined 2000 and 2002 Medical Expenditure Panel Survey data were used, which include quality-of-life measures based on the short-form generic measures (SF-12) and the EuroQol Group measures (EQ-5D index and EQ VAS) for 39,680 adults aged >18 years. Stratified analysis and ordinary least square regressions were used to compare HRQoL scores between stroke and nonstroke populations. RESULTS: The study included 1040 noninstitutionalized stroke survivors. After adjustment for sociodemographics, risk factors, and comorbidities, stroke survivors had statistically significantly lower mean scores for mental health (-4.1%), physical health (-7.9%), health utility (-6.9%), and self-rated health (-7.2%) (all P<0.01). In general, stroke did not affect differences in HRQoL among age or gender groups. However, racial and ethnic disparities in HRQoL were greater among stroke survivors than nonstroke individuals, particularly in health utility scores for black vs white participants (-0.06 in stroke survivors and -0.02 in the nonstroke population, P<0.01) and Hispanic versus non-Hispanic participants (-0.11 in stroke survivors and -0.01 in the nonstroke population). CONCLUSIONS: Stroke significantly impairs HRQoL in the United States. The findings suggest that racial and ethnic disparities in HRQoL among stroke survivors are more pronounced than in the nonstroke population. The burden of nonfatal stroke, especially among racial and ethnic minorities, should be recognized more widely.

Adult↗

PubMed2006

Annual prevalence of diagnosed schizophrenia in the USA: a claims data analysis approach.

BACKGROUND: Schizophrenia is a debilitating chronic mental illness. However, the annual prevalence of schizophrenia is not well understood because of under-representation of schizophrenia patients in epidemiological surveys. This study used multiple administrative claims databases to estimate the annual prevalence of diagnosed schizophrenia in the USA. METHOD: The annual prevalence of diagnosed schizophrenia in the USA was estimated for different health insurance coverage groups. The prevalence for privately insured individuals was calculated from an administrative claims database of approximately 3 million privately insured beneficiaries covering the period 1999-2003. The prevalence for Medicaid enrollees was calculated from California Medicaid claims covering the period 2000-2002. The prevalence for Medicare and Medicaid/Medicare dual eligibles was estimated using a combination of both databases. Published statistics were used to estimate the prevalence of schizophrenia in the uninsured and veteran populations and to weight the prevalence rates obtained to the population of the USA. RESULTS: The 12-month prevalence of diagnosed schizophrenia in the USA in 2002 was estimated at 5.1 per 1000 lives. The Medicaid population was identified with the highest prevalence rate among the populations studied. Sensitivity analyses taking into consideration the Veterans Affairs population only changed the estimate slightly to 5.3 per 1000 lives. CONCLUSION: Analyses of administrative claims data contribute to the understanding of the prevalence of diagnosed schizophrenia.

Adolescent↗

PubMed2006

Cost-effectiveness of duloxetine versus routine treatment for U.S. patients with diabetic peripheral neuropathic pain.

UNLABELLED: The purpose of this study was to compare the cost-effectiveness of duloxetine versus routine treatment in management of diabetic peripheral neuropathic pain (DPNP). Two hundred thirty-three patients with DPNP who completed a 12-week, double-blind, placebo-controlled, randomized, multicenter duloxetine trial were re-randomized into a 52-week, open-label trial of duloxetine 60 mg twice daily versus routine treatment. Routine treatment included pain management therapies. Effectiveness was measured by using the bodily pain domain (BP) of the Medical Outcomes Study Short Form 36 (SF-36). Costs were analyzed from 3 perspectives: third party payer (direct medical costs), employer (direct and indirect medical costs), and societal (patient's out-of-pocket costs and total medical costs). Costs of study medications were not included because of limited data. Bootstrap method was applied to calculate statistical inference of the incremental cost-effectiveness ratio (ICER). Routine treatment most frequently used included gabapentin (56%), venlafaxine (36%), and amitripytline (15%). From employer and societal perspectives, duloxetine was cost-effective (ICER= -342 dollars and -429 dollars, respectively, per unit of SF-36 BP; both P <or= .03) and the dominant therapy compared with routine DPNP treatment (both P < .05). From payer perspective, duloxetine trended toward cost-effectiveness (ICER= -249 dollars per unit of SF-36 BP; P <or= .06). These results, however, reflect the controlled environment of a clinical trial. An analysis of real-world data would be beneficial. PERSPECTIVE: Evaluation of the cost and benefit of new pharmacologic treatments is highly desired by decision makers. From both employer perspective and societal perspective (including patient's out-of-pocket costs), this study demonstrated that duloxetine was more cost-effective than routine treatment in management of DPNP.

Adrenergic Uptake Inhibitors↗

PubMed2006

Annual costs associated with diagnosis of uterine leiomyomata.

OBJECTIVE: To describe the annual care, direct health care, and indirect work loss costs for women with a diagnosis of uterine leiomyomata. METHODS: We examined data from an employer claims database of 1.2 million beneficiaries (1999 to 2003). Analysis was restricted to women with at least 12 months of continuous coverage and ages 18 to 64 years with at least one diagnosis of leiomyomata (International Classification of Diseases, 9th Revision, 218.xx, 654.1x). We selected a comparison group of women without a leiomyoma diagnosis using a 1:1 match on age, employment, region, health plan type, and length of enrollment. We compared resource use, disability claims, and excess costs in the year after the index diagnosis. RESULTS: The average age of women diagnosed with leiomyomata in this study was 43.7 years. Women with leiomyomata (N = 5,122) had more clinic visits (relative risk [RR] 1.2, 95% confidence interval [CI] 1.2-1.2), diagnostic tests (RR 3.1, 95% CI 2.9-3.2), and procedures (RR 34.6, 95% CI 25.8-46.5) than controls (N = 5,122). Within 1 year of the diagnosis of leiomyomata, 42% of women had a complete blood count, 66% had pelvic imaging, and 30% had surgery (68% of surgical procedures involved hysterectomy). Women with leiomyomata were 3-fold more likely to have disability claims (RR 3.1, 95% CI 2.7-3.6). Estimated average annual excess cost for each woman with leiomyomata (adjusted for confounders) was Dollars 4,624 (Dollars 771 in work loss costs). Total costs for women with leiomyomata were 2.6 times greater than for controls. CONCLUSION: Diagnosed uterine leiomyomata are associated with increased resource use and with substantially higher health care and work loss costs. LEVEL OF EVIDENCE: II-3.

Adult↗

PubMed2006

Healthcare and workloss costs associated with patients with persistent asthma in a privately insured population.

OBJECTIVE: The objective of this study was to estimate annual healthcare and workloss costs of patients with persistent asthma by severity. METHODS: A persistent asthma patient sample (<65 years) was selected from an employer claims database. Asthma persistence and severity were determined by a novel algorithm based on Health Plan Employer Data and Information Set criteria, Leidy's Reliever and Oral Steroid Method, and Global Initiative for Asthma guidelines. Healthcare costs were compared between asthma patients and demographically matched controls and by asthma severity. RESULTS: Average annual excess costs for persistent patients were $4412 for health care and $924 for workloss (P < 0.01). Although costs for severe patients were higher than moderate patients (P < 0.05), moderate patients' costs were similar to that for mild patients. Persistent use of inhaled corticosteroids was lower in mild (9.0%) relative to moderate (78.1%) and severe (86.4%) patients. CONCLUSIONS: Persistent asthma is expensive. Underutilization of inhaled corticosteroids is higher in patients with mild persistent asthma.

Adolescent↗

PubMed2006

A retrospective claims database analysis to assess patterns of interstitial cystitis diagnosis.

OBJECTIVE: Interstitial cystitis (IC) is often misdiagnosed as one of several other conditions manifesting similar symptoms. This analysis assesses the potential extent of IC misdiagnosis while considering concomitant conditions in a managed care population and identifies predictors of IC diagnosis. RESEARCH DESIGN AND METHODS: Administrative insurance claims data covering 1.7 million lives (1999-2003) were analyzed. Insurance enrollees with >or= 1 IC diagnosis (ICD-9-CM of 595.1x) were identified as IC patients. A random sample of non-IC controls was selected using a 10:1 matching ratio. Six-month incidence rates of 'commonly misdiagnosed conditions', (overactive bladder, urinary tract infection, chronic pelvic pain, endometriosis, prostatitis) were compared before and after patients' initial IC diagnosis and the reduction in incidence rate of commonly misdiagnosed conditions was used as a suggestive measure of the extent of IC misdiagnosis. The Kaplan-Meier method was used to assess the extent that commonly misdiagnosed conditions were predictors of subsequent IC. A Cox Proportional Hazards regression model (that adjusts for patient demographics, concomitant and misdiagnosed conditions) was used to estimate the hazard ratio (HR) of these conditions. Similar analyses were performed for the 'commonly concomitant conditions' (fibromyalgia, irritable bowel syndrome, vulvodynia). RESULTS: There were 992 IC patients and 9920 controls identified. The reduced incidence of commonly misdiagnosed conditions after initial IC diagnosis suggests that the misdiagnosis rate could be as high as 38% within the 6-month period before initial IC diagnosis. CONCLUSIONS: Diagnoses of commonly misdiagnosed conditions are significant predictors of future IC diagnosis. When overlooked, potential misdiagnosis of IC can lead to underestimation of the true prevalence of IC. Similarly, diagnoses of commonly concomitant conditions are significant predictors of future IC diagnosis. These initial findings based on claims data suggest hypotheses for further investigation with clinical data. These results suggest more consideration of IC as a diagnosis is warranted, especially when certain diagnoses are repeatedly made and the resulting treatments do not alleviate the patient's symptoms.

Adolescent↗

PubMed2006

Interstitial Cystitis: Cost, treatment and co-morbidities in an employed population.

INTRODUCTION: Recent literature indicates that interstitial cystitis (IC) may affect 20% of women and a smaller proportion of men, although many individuals with IC may be misdiagnosed or remain undiagnosed. Factors that can contribute to the cost of IC include medical and drug utilisation related to treatment and diagnosis of IC and associated conditions (e.g. depression), as well as employee work loss. This study assesses the direct medical cost and indirect cost of work loss for IC patients in the first year after diagnosis, and evaluates IC treatment patterns and prevalence of co-morbidities. METHODS: Data for patients under the age of 65 years with at least one diagnosis of IC (n = 749) were drawn from a de-identified, administrative database of approximately 2 million beneficiaries that included medical, drug and disability claims for 1999-2002. A 2 : 1 matched control sample of patients without an IC diagnosis (non-IC sample) was randomly selected based on patient characteristics. Indirect costs were calculated from a subgroup of 152 IC patients (plus their matched controls) who had disability information available. Costs incurred in the first year after IC diagnosis and co-morbidities were compared between IC patients and the non-IC sample, with the difference in costs defined as 'excess costs' of IC patients. Treatment patterns were profiled in the 2 months following initial diagnosis of IC. Descriptive statistics are presented. A multivariate two-part model was applied to estimate the IC direct medical cost, indirect cost and total cost to adjust for observed patient demographics and co-morbidities. Statistical significance was evaluated by the bootstrap method. RESULTS: The average IC patient had 130% higher direct costs (p < 0.05) and the average IC employee patient had 84% higher indirect costs than the average non-IC control individual. IC patients also had a higher diagnostic prevalence of prostatitis (relative risk [RR] = 40.0), endometriosis (RR = 7.4), vulvodynia (RR = 6.9), chronic pelvic pain (RR = 5.8) and urinary tract infections (RR = 5.1) [all p < 0.05]. IC patients were also more likely to report depression (RR = 2.8) and anxiety (RR = 4.5 ) than non-IC controls (all p < 0.05). Seventeen percent of IC patients received pentosan polysulfate therapy, the only US FDA-approved oral drug therapy indicated for treating IC, within the first 2 months after diagnosis. Of these patients, 69% received at least one 'other' drug from the non-approved oral medications studied. Approximately one-third of IC patients received only 'other' drug therapies, and almost half of IC patients received no drug treatment within the first 2 months after the initial diagnosis. CONCLUSIONS: IC is a costly disease associated with co-morbidities. Following diagnosis, patients with IC are commonly untreated or treated with non-approved drug therapies. It is possible that more accurate diagnosis and earlier and more appropriate treatment of IC would lead to better management (or even prevention) of co-morbidities and reduce healthcare costs, and this should be investigated in future studies.

Adolescent↗

PubMed2005

The prevalence and correlates of nonaffective psychosis in the National Comorbidity Survey Replication (NCS-R).

BACKGROUND: To estimate the prevalence and correlates of clinician-diagnosed DSM-IV nonaffective psychosis (NAP) in a national household survey. METHODS: Data came from the United States National Comorbidity Survey Replication (NCS-R). A screen for NAP was followed by blinded sub-sample clinical reappraisal interviews. Logistic regression was used to impute clinical diagnoses to respondents who were not re-interviewed. The method of Multiple Imputation (MI) was used to estimate prevalence and correlates. RESULTS: Clinician-diagnosed NAP was well predicted by the screen (area under the curve [AUC] = .80). The MI prevalence estimate of NAP (standard error in parentheses) is 5.0 (2.6) per 1000 population lifetime and 3.0 (2.2) per 1000 past 12 months. The vast majority (79.4%) of lifetime and 12-month (63.7%) cases met criteria for other DSM-IV hierarchy-free disorders. Fifty-eight percent of 12-month cases were in treatment, most in the mental health specialty sector. CONCLUSIONS: The screen for NAP in the NCS-R greatly improved on previous epidemiological surveys in reducing false positives, but coding of open-ended screening scale responses was still needed to achieve accurate prediction. The lower prevalence estimate than in total-population incidence studies raises concerns that systematic nonresponse bias causes downward bias in survey prevalence estimates of NAP.

Adolescent↗

PubMed2005

Employees with overactive bladder: work loss burden.

OBJECTIVE: This study assessed the indirect work loss costs to employers as the result of employees with overactive bladder (OAB). METHODS: Study samples were drawn from an administrative database of 1.2 million beneficiaries, including medical and disability claims (1999-2002). OAB employees were compared with matched employees without OAB. RESULTS: OAB was associated with higher annual occurrences of work loss (P < 0.01). Employees with OAB had 2.2 excess work loss days as the result of medically related absenteeism and 3.4 excess days as the result of disability compared with employees without OAB (P < 0.01 for both comparisons). Employees with OAB had increased risk of disability (P < 0.01), and female employees with OAB had a higher risk of disability than male employees (P < 0.01). CONCLUSIONS: This study found that OAB was associated with work loss costs to employers resulting from increased number of employee sick days and increased risk of employee disability.

Absenteeism↗

PubMed2005

Economic burden and co-morbidities of atrial fibrillation in a privately insured population.

OBJECTIVE: This study assesses the direct (medical and drugs) and indirect (work loss) annual costs associated with Atrial Fibrillation (AFIB) in a privately insured population. BACKGROUND: AFIB is the most common sustained rhythm disturbance, affecting 2.3 million people in the United States. METHODS: Cost and co-morbidity measures for AFIB patients were compared to matched controls using a privately insured administrative database (including medical, drug, and disability claims) for 2 million enrollees, 1999-2002 from 16 employers across the United States. Patients with an AFIB diagnosis on at least two occasions were included in the co-morbidity analysis (n = 3944). A non-AFIB control sample was randomly selected with a 1:1 ratio, with characteristics (i.e., age, gender, health plan) matched to AFIB patients. Excess medical costs (i.e., employer payments) were estimated for AFIB patients, defined as the difference in average annual costs between AFIB and control patients (n = 3944); excess work-loss costs were defined similarly for employees with available work-loss data (n = 603). Statistical significance in the descriptive analysis was measured by paired t-tests for cost, or Chi-square tests for co-morbidity comparisons. A two-part multivariate model of excess cost was further estimated to control for co-existing conditions and other patient characteristics. The excess costs of AFIB patients were estimated as the difference between the observed costs of AFIB patients and their estimated costs, assuming they did not have AFIB. RESULTS: The multivariate analysis found that the excess annual direct cost of AFIB was $12,349 (p < 0.01), with AFIB patients approximately 5 times as costly as non-AFIB individuals ($15,553 versus $3204, respectively). The excess annual total cost was $14,875 (p < 0.01), with AFIB patients again approximately 5 times as costly as non-AFIB individuals ($18,454 versus $3,579, respectively). AFIB was associated with increased incidence of atrial flutter (p < 0.01), heart failure (Relative Risk (RR) = 29, p < 0.01), other arrhythmias/conduction disorders (RR = 16, p < 0.01), heart attack (RR = 8, p < 0.01), and stroke (RR = 6, p < 0.01). CONCLUSIONS: AFIB is a costly disease and one for which more definitive therapies might offer some potential for reducing, not only the clinical impact, but also the economic burden of the disease.

Atrial Fibrillation↗

PubMed2005

The economic burden of schizophrenia in the United States in 2002.

OBJECTIVE: This study quantifies excess annual costs associated with schizophrenia patients in the United States in 2002 from a societal perspective. METHOD: Annual direct medical costs associated with schizophrenia were estimated separately for privately (N = 1090) and publicly (Medicaid; N = 14,074) insured patients based on administrative claims data, including a large private claims database and the California Medicaid program (MediCal) database, and compared separately to demographically/geographically matched control samples (1 case:3 controls). Medicare costs of patients over age 65 years were imputed using the Medicare/MediCal dual-eligible patients (N = 1491) and published statistics. Excess annual direct non-health care costs were estimated for law enforcement, homeless shelters, and research/training related to schizophrenia. Excess annual indirect costs were estimated for 4 components of productivity loss: unemployment, reduced workplace productivity, premature mortality from suicide, and family caregiving using a human capital approach based on market wages. All costs were adjusted to 2002 dollars using the Medical Care Consumer Price Index and were based on the reported prevalence in the National Comorbidity Survey Replication. RESULTS: The overall U.S. 2002 cost of schizophrenia was estimated to be $62.7 billion, with $22.7 billion excess direct health care cost ($7.0 billion outpatient, $5.0 billion drugs, $2.8 billion inpatient, $8.0 billion long-term care). The total direct non-health care excess costs, including living cost offsets, were estimated to be $7.6 billion. The total indirect excess costs were estimated to be $32.4 billion. CONCLUSION: Schizophrenia is a debilitating illness resulting in significant costs. The indirect excess cost due to unemployment is the largest component of overall schizophrenia excess annual costs.

Absenteeism↗