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Gerry Oster

Publications and source records attributed to Gerry Oster.

At least 37 records · Page 2Linked to original sources
PubMed2004

Clinical characteristics and economic costs of patients with painful neuropathic disorders.

UNLABELLED: Using a large US health insurance claims database, we identified all persons aged 18 years or older with 2 or more medical encounters in calendar year 2000 for painful neuropathic disorders (PNDs). We also identified an age- and gender-matched group of patients without PNDs (matched control subjects). We then compared the clinical characteristics and economic costs of PND patients with those of matched control subjects. There were a total of 55,686 patients with PNDs in the study database. The most frequently noted PNDs were back and neck pain with neuropathic involvement (62.3% of PND patients), causalgia (12.1%), and diabetic neuropathy (10.8%). In comparison with matched control subjects, PND patients were more likely to have other pain-related conditions, including fibromyalgia (6.0% vs 0.6% for control subjects), osteoarthritis (13.6% vs 3.6%), and other chronic comorbidities, such as coronary heart disease (13.6% vs 6.5%) and depression (6.4% vs 2.3%). Total calendar year 2000 health care charges were 3-fold higher for PND patients than matched control subjects ($17,355 vs $5,715, respectively). Our results suggest that patients with PNDs are generally in poorer health and have higher health care costs than their peers without these conditions. PERSPECTIVE: Use of nonsteroidal anti-inflammatory agents and opioids was widespread in patients with PNDs, while relatively few received antiepileptic drugs and tricyclic antidepressants, both of which are often more effective against neuropathic pain. Our study raises questions about the optimality of PND treatment in clinical practice.

Adolescent↗
PubMed2004

The cost of treatment of skeletal-related events in patients with bone metastases from lung cancer.

PURPOSE: Patients with bone metastases from lung cancer often experience skeletal-related events (SREs) including pathological fracture, spinal cord compression, hypercalcemia or pain requiring surgery, radiotherapy or opioid analgesics. These complications result in impaired mobility and reduced quality of life and have a significant negative impact on survival. The economic consequences of SREs in patients with lung cancer have not been examined. METHODS: We conducted a retrospective analysis using a large US health insurance claims database to estimate the incidence and costs of treatment of SREs in patients with bone metastases of lung cancer treated in a naturalistic setting. Study subjects had >/=2 encounters with a diagnosis of primary lung cancer and >/=2 encounters with a diagnosis of metastases to bone. SREs were identified based on the occurrence on or after the date of first diagnosis of bone metastases, of (1) >/=1 encounter with a diagnosis of pathological fracture, spinal cord compression or hypercalcemia, (2) >/=1 bone surgery or radiotherapy procedure, or (3) the initiation of opioid analgesic therapy. Survival and costs of SRE-related care in patients with SREs were estimated using Kaplan-Meier methods. RESULTS: We identified 534 patients with lung cancer and bone metastases, including 295 (55%) with >/=1 SRE. Radiotherapy (68%) and fracture (35%) were the most common SREs. Median survival after the first identified SRE was 4.1 months (95% confidence interval: 3.6-5.5 months). The estimated lifetime SRE-related cost per patient was USD 11,979 (95% confidence interval: USD 10,193-13,766). Radiotherapy accounted for the greatest proportion of cost (61%) by SRE type. CONCLUSION: The economic burden of SREs in patients with bone metastases of lung cancer is substantial. Intravenous bisphosphonates, such as zoledronic acid, which have been shown to prevent these events, may reduce these costs.

Aged↗
PubMed2004

A cost-effectiveness analysis of fondaparinux sodium compared with enoxaparin sodium as prophylaxis against venous thromboembolism: use in patients undergoing major orthopaedic surgery.

OBJECTIVE: To determine the cost effectiveness of fondaparinux sodium compared with enoxaparin sodium for prophylaxis against venous thromboembolism in patients undergoing major orthopaedic surgery. METHODS: Using a cohort simulation model, two primary analyses were conducted from the perspective of the US healthcare payer. Probabilities for a trial-based analysis were obtained from patients participating in the fondaparinux clinical trial programme supplemented with data from published literature. Probabilities for a label-based analysis were estimated for a hypothetical cohort of US patients receiving either fondaparinux or enoxaparin as recommended by US FDA-approved labelling. Resource use and costs were obtained from large US healthcare databases. Outcome measures were rates of symptomatic thromboembolic events and healthcare costs. Costs were in 2003 values. RESULTS: In the trial-based analysis, fondaparinux was estimated to prevent 15.1 symptomatic venous thromboembolic events (per 1,000 patients) at 3 months for patients undergoing major orthopaedic surgery compared with enoxaparin. The cost savings (per patient) of using fondaparinux over enoxaparin are US 61 dollars at 30 days, US 89 dollars at 3 months, and US 155 dollars at 5 years. In the label-based analysis, fondaparinux was estimated to prevent 17.8 venous thromboembolic events (per 1,000 patients) at 3 months compared with enoxaparin, producing savings per patient of US 25 dollars at discharge, US 112 dollars over 1 month, US 141 dollars over 3 months and US 234 dollars over 5 years. Results remain robust to clinically plausible variation in input parameters and assumptions. CONCLUSION: Our model suggests that fondaparinux, when compared with the current standard regimen of enoxaparin for prophylaxis of venous thromboembolism in major orthopaedic surgery, improves outcomes and is cost saving from a US healthcare-payer perspective over the broad range of assumptions evaluated.

Aged↗
PubMed2004

Opioid use and health care charges at the end of life in patients with metastatic cancer.

Opioid use and health care charges during the final year of life in patients with metastatic cancer who received controlled-release oxycodone (CRO), transdermal fentanyl (TF), or controlled-release morphine sulfate (CRM) were examined in the following study. A total of 704 patients were identified who met study entry criteria; CRO, TF, or CRM was the first-received long-acting opioid (LAO) during the last year of life for 36% (N = 250), 29% (N = 203), and 36% (N = 251) of study subjects, respectively. On average, patients initiated LAO therapy three to four months before death. One-half of patients received less than 60 days of LAO therapy. Mean total health care charges in the final year of life were dollars 84,572 for patients receiving CRO, dollars 90,935 for patients receiving TF, and dollars 76,446 for patients receiving CRM. Patients receiving TF started LAO therapy closer to their date of death, and had significantly higher hospitalization charges than did patients receiving CRO and CRM.

Aged↗
PubMed2003

Change in opioid use after the initiation of gabapentin therapy in patients with postherpetic neuralgia.

BACKGROUND: Postherpetic neuralgia (PHN) is a chronic painful disorder that sometimes develops after an acute episode of herpes zoster infection (shingles) and can be difficult to treat. Although opioids are sometimes effective for chronic neuropathic pain, adverse effects are common, particularly among the elderly, and may cause many patients to discontinue therapy. OBJECTIVE: This study examined changes in opioid use after the initiation of gabapentin therapy in patients with PHN. METHODS: A health insurance claims database was used to identify all persons aged >or= 18 years who began therapy with gabapentin in 2000 or 2001 and had either (1) >or=2 medical claims with a diagnosis of PHN during the 6-month period before the first receipt of gabapentin (index date) or (2) 1 such claim or=2 prescriptions for gabapentin. RESULTS: Forty-five patients with PHN began therapy with gabapentin during the period of interest; 35 (77.8%) received >or=2 prescriptions for gabapentin. The proportion of patients receiving opioids decreased significantly between pretreatment and follow-up (from 88.9% to 71.1%; P = 0.03); the mean number of opioid prescriptions per patient also decreased significantly (from 3.9 to 3.0; P = 0.03). These reductions were observed only in patients who received >or=2 prescriptions for gabapentin; there was no significant change in opioid use among those who received only 1 prescription for gabapentin. CONCLUSION: In this study, initiation of gabapentin therapy in patients with PHN was associated with a reduction in the use of opioid analgesics.

Acetates↗
PubMed2003

Use of oral and transdermal opioids among patients with metastatic cancer during the last year of life.

This study documents the use of oral and transdermal opioids among patients with metastatic cancer during their final year of life. Using a large, integrated health-insurance claims database, we identified all patients who had metastatic lung, breast, colorectal, prostate, or breast cancer and who also died in 1998 or 1999. We then examined all pharmacy claims for these patients over their final 12 months of life. A total of 2,132 patients were identified who met study entrance criteria. Among patients with bone metastases (n=717), 86.9% received opioids at some point during their final year of life; 71.2% of those without bone metastases (n=1,415) received them. Corresponding figures for long-acting opioids were 52.9% and 23.5%. Coverage ratios (total days supplied/total noninstitutionalized days) for any opioids and long-acting opioids were 25.1% and 12.5%, respectively, among patients with bone metastases, and 13.9% and 4.2% for those without bone metastases. During the final month of life, these ratios were 50.8% and 31.3%, and 28.7% and 13.1%. These relatively low rates of opioid use among patients with metastatic cancer in their final year of life suggest that pain in many cases may be suboptimally treated.

Administration, Cutaneous↗
PubMed2003

Long-term mortality and medical care charges in patients with severe sepsis.

OBJECTIVE: To estimate long-term mortality and medical care charges among patients with severe sepsis. DESIGN: Retrospective cohort study. SETTING: Large, integrated, geographically diverse, U.S. health-insurance claims database covering three million lives annually. PATIENTS: All persons with bacterial or fungal infections and acute organ dysfunction (severe sepsis) who were hospitalized between January 1, 1991, and August 31, 2000. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: All patients were followed from the date of hospitalization with severe sepsis (index admission) to August 31, 2000, disenrollment from the health plan, or death, whichever occurred first. Measures of interest included mortality and medical care charges and were estimated for the index admission, the 90- and 180-day periods following the index admission, and annually thereafter (up to 5 yrs), using techniques of survival analysis. A total of 16,019 patients were identified who met study entrance criteria. Most patients (81.2%) were >/=65 yrs of age; 53.4% were men. Mortality was 21.2% for the index admission, 51.4% at 1 yr, and 74.2% at 5 yrs. Mean cumulative total medical care charges were 44,600 US dollars for the index admission, 78,500 US dollars at 1 yr, and 118,800 US dollars at 5 yrs. Hospitalization accounted for the largest component of total medical care charges. CONCLUSIONS: Mortality and economic costs are high in patients with severe sepsis, during the period of acute illness as well as subsequently.

Adolescent↗
PubMed2003

Use of thiazolidinediones and risk of heart failure in people with type 2 diabetes: a retrospective cohort study.

OBJECTIVE: To compare the incidence of heart failure in individuals with type 2 diabetes receiving thiazolidinediones (TZDs) versus other oral antihyperglycemic agents. RESEARCH DESIGN AND METHODS: We conducted a retrospective cohort study using a health insurance claims database. The study sample included patients with type 2 diabetes who received an oral antihyperglycemic agent between January 1995 and March 2001. Those with any claims for TZDs were designated "exposed," and each was compared with five randomly selected unexposed patients. Those with diagnoses of heart failure or who received digoxin or a diuretic in the year before their index date were excluded. The primary measure of interest was incidence of heart failure, which was defined as a hospitalization or outpatient visit with a diagnosis of heart failure. RESULTS: TZD patients (n = 5441) were younger than control subjects (n = 28103) but more likely to have coronary artery disease or diabetes complications, receive ACE inhibitors, beta-blockers, metformin, or insulin, and have undergone HbA(1c) tests or eye exams; they also had more comorbidities and higher costs (all P < 0.05). However, TZD use was predictive of heart failure even after controlling for these variables (hazard ratio = 1.7, P < 0.001). Adjusted incidence of heart failure at 40 months was 8.2% for TZD patients and 5.3% for control subjects. CONCLUSIONS: The results of this observational study suggest that TZDs may increase the risk of heart failure. Physicians should use TZDs with caution in patients with heart failure, remain vigilant for manifestations of heart failure in those receiving these drugs (especially patients with cardiovasculopathy), and consider alternate therapies for patients who develop symptoms of heart failure, such as shortness of breath.

Cohort Studies↗
PubMed2002

Cost of venous thromboembolism following major orthopedic surgery in hospitalized patients.

The economic costs of clinical venous thromboembolism (VTE) in hospitalized patients after major orthopedic surgery were assessed. The discharge summaries and itemized bills from 220 U.S. acute care hospitals were examined. All patients who underwent total hip or knee replacement surgery or hip-fracture repair at these hospitals between January 1998 and June 1999 were identified and included in the study sample. Length of hospital stay, use of intensive care services, and costs of inpatient care were compared between patients with and without secondary diagnoses of deep vein thrombosis (DVT) without pulmonary embolism (PE) (DVT only) or PE with or without DVT. Mean length of hospital stay was more than twice as long for patients with VTE (11.5 and 12.4 days for DVT only and PE, respectively, versus 5.4 days for no VTE; p < 0.0001 for both comparisons). Mean time in the intensive care unit was roughly 10-fold greater (1.7 days for DVT only and 2.7 days for PE versus 0.2 day for no VTE; p < 0.0001). Mean total costs of inpatient care were almost twofold higher for patients with VTE ($17,114 for DVT only and $18,521 for PE versus $9,345 for no VTE; p < 0.0001 for both comparisons). Findings were unchanged in multivariate analyses controlling for differences in baseline characteristics between patients with and without VTE. Patients who develop in-hospital clinical VTE following major orthopedic surgery have significantly longer stays in the 'hospital and approximately twofold higher costs of inpatient care.

Aged↗
PubMed2002

Use of oral antithrombotic agents among health maintenance organization members with atherosclerotic cardiovascular disease.

BACKGROUND: Numerous randomized trials document the value of antithrombotic agents for the treatment of cardiovascular disease (CVD). Although antithrombotic agents are often prescribed at hospital discharge after CVD-related events, much less is known about the ongoing use of such agents. METHODS: We examined the use of oral antithrombotic agents among a random sample of 2500 persons with atherosclerotic CVD who were enrolled in Kaiser Permanente Northwest Region, a not-for-profit group-model health maintenance organization. Study subjects were identified based on a diagnosis of coronary heart disease, ischemic stroke or transient ischemic attack, or peripheral arterial disease in outpatient problem lists, visit records, and hospital discharge abstracts. Use of prescription antithrombotic agents was identified from pharmacy dispensing records. Regular use of aspirin, recall of aspirin advice and education, and other patient characteristics were ascertained by mail survey. RESULTS: Among the 1844 subjects who returned the survey and answered the question regarding aspirin use, 84% were using either aspirin (72%) or a prescription antithrombotic agent (12%), typically warfarin sodium. Antithrombotic therapy was relatively underused in persons with peripheral arterial disease (75% used an antithrombotic agent and 62% used aspirin). Use of antithrombotic agents, including aspirin, did not differ by age but was higher among men (87%, 76%) than women (81%, 67%). Nearly all subjects reported having received aspirin education (94%) or advice (81%); recall of education or advice was associated with a dramatically higher likelihood of using antithrombotic agents. To a lesser extent, so was contact with a cardiologist or vascular surgeon during the prior year. CONCLUSIONS: High rates of use of antithrombotic agents can be achieved among persons with CVD in integrated not-for-profit health systems with mechanisms in place to encourage such use, including guidelines, messages to clinicians, nurse care management, alerts and routines embedded in electronic medical records, and direct mailings to patients. Continued efforts should be made in all settings to optimize the use of antithrombotic therapy among persons at an elevated risk of atherothrombotic events.

Administration, Oral↗
PubMed2002

Defining clinically meaningful outcomes in the evaluation of new treatments for oral mucositis: oral mucositis patient provider advisory board.

Oral mucositis (OM)-related outcomes constituting a meaningful clinical advance in bone marrow transplant patients were considered by an interdisciplinary panel. Meaningful outcomes are essential in product development for OM, a condition without effective prevention or treatment. The most important outcomes to measure, the feasibility of measuring these in a clinical trial, and clinically meaningful differences in these outcomes were determined by the panel. Most important are reduction in oral pain and use of opioid analgesics, improvement in oral intake and quality of life, and reduction of hospitalization duration. Reduction in the severity of OM measured by an objective evaluation of oral mucosa could provide insight regarding the biologic activity of an intervention. Further data are required to define the precise relationship between reduction in visible OM and improvement in outcome. Minimally, clinical trials for OM should assess oral pain, opioid use, oral intake, and include objective assessment of OM.

Analgesics, Opioid↗
PubMed2002

Epidemiology and outcomes of ventilator-associated pneumonia in a large US database.

OBJECTIVES: To evaluate risk factors for ventilator-associated pneumonia (VAP), as well as its influence on in-hospital mortality, resource utilization, and hospital charges. DESIGN: Retrospective matched cohort study using data from a large US inpatient database. PATIENTS: Patients admitted to an ICU between January 1998 and June 1999 who received mechanical ventilation for > 24 h. MEASUREMENTS: Risk factors for VAP were examined using crude and adjusted odds ratios (AORs). Cases of VAP were matched on duration of mechanical ventilation, severity of illness on admission (predicted mortality), type of admission (medical, surgical, trauma), and age with up to three control subjects. Mortality, resource utilization, and billed hospital charges were then compared between cases and control subjects. RESULTS: Of the 9,080 patients meeting study entry criteria, VAP developed in 842 patients (9.3%). The mean interval between intubation, admission to the ICU, hospital admission, and the identification of VAP was 3.3 days, 4.5 days, and 5.4 days, respectively. Identified independent risk factors for the development of VAP were male gender, trauma admission, and intermediate deciles of underlying illness severity (on admission) [AOR, 1.58, 1.75, and 1.47 to 1.70, respectively]. Patients with VAP were matched with 2,243 control subjects without VAP. Hospital mortality did not differ significantly between cases and matched control subjects (30.5% vs 30.4%, p = 0.713). Nevertheless, patients with VAP had a significantly longer duration of mechanical ventilation (14.3 +/- 15.5 days vs 4.7 +/- 7.0 days, p < 0.001), ICU stay (11.7 +/- 11.0 days vs 5.6 +/- 6.1 days, p < 0.001), and hospital stay (25.5 +/- 22.8 days vs 14.0 +/- 14.6 days, p < 0.001). Development of VAP was also associated with an increase of > $40,000 USD in mean hospital charges per patient ($104,983 USD +/- $91,080 USD vs $63,689 USD+/- $75,030 USD, p < 0.001). CONCLUSIONS: This retrospective matched cohort study, the largest of its kind, demonstrates that VAP is a common nosocomial infection that is associated with poor clinical and economic outcomes. While strategies to prevent the occurrence of VAP may not reduce mortality, they may yield other important benefits to patients, their families, and hospital systems.

Cohort Studies↗
PubMedDate not supplied

The incidence and cost of hospitalization for 5-FU toxicity among Medicare beneficiaries with metastatic colorectal cancer.

OBJECTIVE: To estimate the incidence and associated cost of hospitalizations for toxicities associated with 5-fluorouracil (5-FU) among patients with metastatic colorectal cancer. METHODS: Using the 1994 Medicare 5% sample, we identified all patients with metastatic colorectal cancer who had undergone colorectal surgery. We then stratified them into those who received 5-FU therapy within 90 days of their surgery (5-FU group) and those who did not receive chemotherapy (no-chemotherapy group); patients who received chemotherapeutic agents other than 5-FU were excluded from the sample. Using techniques of survival analysis, we then compared the incidence and associated cost of all hospital admissions with listed International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes (primary or secondary) for conditions possibly related to 5-FU toxicity (e.g., volume depletion, stomatitis, nausea, and vomiting). RESULTS: A total of 441 patients met all study entry criteria, including 192 who received 5-FU and 249 who did not receive chemotherapy following surgery. Patients in the 5-FU group were younger than those in the no-chemotherapy group (p < .001). Mean (+/- SD) follow-up time was slightly longer in the 5-FU group (137 +/- 96 days vs. 117 +/- 88 days for no chemotherapy). The incidence of toxicity-related hospitalizations at 10.5 months (principally volume depletion, agranulocytosis, gastroenteritis, and nausea and vomiting) was 31% among patients who received 5-FU and 8% among those who did not receive chemotherapy. The cost of inpatient care at 10.5 months was $2716 higher among 5-FU patients. CONCLUSIONS: Hospitalization for toxicity of Medicare patients with metastatic colorectal cancer receiving 5-FU is frequent and costly.

Age Factors↗
PubMedDate not supplied

Is sepsis accurately coded on hospital bills?

OBJECTIVE: To examine whether sepsis is accurately coded on hospital bills. METHODS: Hospital inpatient uniform bills (UB-92) for 122 patients with clinically documented severe sepsis of presumed infectious origin were retrospectively examined. Final UB-92 hospital bills were obtained for all study subjects. ICD-9-CM diagnosis codes from these bills were then reviewed to ascertain the number of subjects for whom one or more diagnostic codes for septicemia and/or bacteremia were present. RESULTS: A total of 92 hospital bills (75.4%) contained one or more ICD-9-CM diagnostic codes for septicemia and/or bacteremia. Of the 30 that did not, 15 (12.3%) had codes for major systemic infection and organ failure. No diagnoses indicative of sepsis (i.e., organ failure and major infection) were present on the remaining 15 (12.3%) bills. CONCLUSIONS: Our findings suggest that use of ICD-9-CM codes for identifying patients with sepsis using hospital bills is only moderately sensitive. Strict reliance on administrative data sources for sepsis surveillance or research planning may therefore be prone to substantial error.

Database Management Systems↗
PubMedDate not supplied

Outcomes and costs of risperidone versus olanzapine in patients with chronic schizophrenia or schizoaffective disorders: a Markov model.

OBJECTIVE: To compare expected outcomes and costs of care in patients with chronic schizophrenia or schizoaffective disorders who are treated with risperidone versus olanzapine. METHODS: A Markov model was developed to examine outcomes and costs of care in patients with chronic schizophrenia or schizoaffective disorders receiving risperidone or olanzapine. The time frame of interest was 1 year. The model focused particular attention on the likelihood of therapy switching and discontinuation as a result of treatment-emergent side effects, as the efficacy of these two agents is similar. Measures of interest included the incidence of relapse and selected side effects including extrapyramidal symptoms (EPS), prolactin-related disorders and diabetes, expected change in body weight, and the percentage of patients remaining on initial therapy at the end of 1 year. Costs of antipsychotic therapy and psychiatric and nonpsychiatric services also were examined. RESULTS: At 1 year, the rate of EPS was estimated to be slightly higher for risperidone, as was the incidence of symptomatic prolactin-related disorders. The expected incidence of diabetes mellitus, while low, was slightly higher for olanzapine. Approximately 25% and 4% of olanzapine and risperidone patients, respectively, were projected to experience an increase in body weight > or = 7%. The estimated percentage of patients remaining on initial therapy at the end of 1 year was higher for risperidone than olanzapine (76.9% vs. 45.6%, respectively). Expected mean total costs of care per month of therapy were $2163 for risperidone and $2316 for olanzapine. Results from sensitivity analyses suggest that the probability of therapy discontinuation following weight gain >5 kg would have to be lower than 0.1 for the number of patients remaining on therapy at the end of 1 year to be the same for risperidone and olanzapine. CONCLUSIONS: Compared with risperidone, treatment with olanzapine may result in greater increases in body weight, higher rates of therapy discontinuation, and higher costs of medical-care services.

Antipsychotic Agents↗