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Biomedical subjects

Michael S Broder

Publications and source records attributed to Michael S Broder.

9 recordsLinked to original sources
PubMed2006

Treatment patterns for women with new episodes of uterine myomas in an insured population in the US.

INTRODUCTION: Uterine myomas are the most common benign tumors in reproductive-aged women and a leading reason for gynecologist visits and hysterectomies in the United States. This study examines the treatment patterns of insured women with new episodes of uterine myomas. MATERIALS AND METHODS: We used administrative claims from a proprietary research database to evaluate services (inpatient, outpatient, and prescription claims) incurred from January 1, 2001 to December 31, 2003. We identified women with CPT or ICD-9-CM codes suggestive of myoma and described treatment patterns for all women with a new episode of myoma and those with abnormal bleeding. RESULTS: The primary study group included 35 329 women with new episodes of care and at least three months of data before and after their index date for myoma. Most women (82.9%) had no code for diagnostic testing in the three months before or after the first myoma marker. Of 14 434 women with one year of follow-up, 26.1% had surgery and 24.7% were treated pharmacologically (oral contraceptives, progestins, or gonadotropin-releasing hormone agonists). Over half (55.1%) of women were untreated, including 45% of those with an ICD-9 code that indicated abnormal bleeding. CONCLUSIONS: Women with new myoma episodes rarely had codes for confirmatory diagnostic tests. Many women with myomas go untreated for at least a year. This is true even for those with evidence of abnormal bleeding. Myoma care may be improved through the introduction of new, safe, and effective therapies.

Adolescent↗
PubMed2006

A method classifying biologics for formulary decision making.

Pharmacy and Therapeutics Committees have been trying to determine the correct way to incorporate biologic agents into their formularies. As with any new drug, the first step is to determine the appropriate category or classification in which they will be evaluated. The biologics present some challenges to classification in significant ways. Even though two or more biologics may have a common indication, their differences in mechanism of action, method of delivery, dosing schedule, and other factors may be important considerations in choice of a useful classification. A method is suggested and illustrated, utilizing the group of biologic agents commonly used to treat psoriasis (including, for illustrative purposes, alefacept, efalizumab, etanercept, and infliximab).

Biological Products↗
PubMed2006

Cost-effectiveness of treatments for dysfunctional uterine bleeding.

OBJECTIVE: To compare the cost-effectiveness of treatments for dysfunctional uterine bleeding (DUB). STUDY DESIGN: The decision analytic model used a third-party payer perspective and 18-month horizon to compare treatment of DUB patients > or = 40 years old with no desire for fertility. Treatments were oral contraceptives (OCs) vs. surgery (first-/second-generation ablation or hysterectomy) after 3-9 months of OCs. Costs were based on publications and expert opinion. Efficacy measures were based on months with pictorial blood loss assessment chart (PBAC) score < 100 and number of months of amenorrhea. RESULTS: Treatment costs were estimated at 513 dollars per patient per year (OCs), 3,500 dollars (first-generation ablation), 3,000 dollars (second-generation ablation) and 7,500 dollars (hysterectomy). Adverse event costs ranged from 12 dollars per year or episode (OCs, second-generation ablation) to 164 dollars per episode (hysterectomy). To achieve PBAC < 100, second-generation ablation after 3 months of OCs was the most cost-effective (7.6 additional DUB-free months vs. OCs, 215 dollars per additional month). Second-generation ablation was less costly and more effective than first-generation ablation. Early treatment with hysterectomy was more effective than ablation, but at substantial cost. When using the end point of amenorrhea, hysterectomy was most cost-effective. Results were not sensitive to variations in costs, effectiveness or length of OC use. CONCLUSION: A short OC trial followed by second-generation ablation is the most cost-effective strategy for women with DUB, although hysterectomy is more cost-effective to achieve amenorrhea. Hysterectomy cost-effectiveness might improve if evaluated over more time. Cost-effectiveness and patient preference must all play a role in treatment decisions.

Adult↗
PubMed2005

Ovarian conservation at the time of hysterectomy for benign disease.

OBJECTIVE: Prophylactic oophorectomy is often recommended concurrent with hysterectomy for benign disease. The optimal age for this recommendation in women at average risk for ovarian cancer has not been determined. METHODS: Using published age-specific data for absolute and relative risk, both with and without oophorectomy, for ovarian cancer, coronary heart disease, hip fracture, breast cancer, and stroke, a Markov decision analysis model was used to estimate the optimal strategy for maximizing survival for women at average risk of ovarian cancer. For each 5-year age group from 40 to 80 years, 4 strategies were compared: ovarian conservation or oophorectomy, and use of estrogen therapy or nonuse. Outcomes, as proportion of women alive at age 80 years, were measured. Sensitivity analyses were performed, varying both relative and absolute risk estimates across the range of reported values. RESULTS: Ovarian conservation until age 65 benefits long-term survival for women undergoing hysterectomy for benign disease. Women with oophorectomy before age 55 have 8.58% excess mortality by age 80, and those with oophorectomy before age 59 have 3.92% excess mortality. There is sustained, but decreasing, benefit until the age of 75, when excess mortality for oophorectomy is less than 1%. These results were unchanged following multiple sensitivity analyses and were most sensitive to the risk of coronary heart disease. CONCLUSION: Ovarian conservation until at least age 65 benefits long-term survival for women at average risk of ovarian cancer when undergoing hysterectomy for benign disease.

Adult↗
PubMed2005

Measures of surgical quality: what will patients know by 2005?

RATIONALE, AIMS AND OBJECTIVES: Many objective measures rating quality of doctors, hospitals, and medical groups are publicly reported. Surgical patients may have more opportunity to use quality measures than other types of patients to guide their choice of provider. If surgical patients are able to choose higher quality providers, overall surgical quality might increase. OBJECTIVE: To determine what procedure-specific measures of surgical quality are available to consumers facing surgery in California and what new measures will be available by 2005. METHODS: We searched for and surveyed organizations publicly reporting data on health care quality in California. We asked about current quality measures and new measures set for public release by 2005. Included measures had to be procedure-specific and results separated by hospital. The main outcome measures were the number of quality measures; conceptual aspect of quality measured; and type of risk-adjustment used. RESULTS: Eighteen organizations publicly report any health care quality measures in California. These organizations report 333 measures, of which 32 (10%) are procedure-specific measures of surgical quality. There is at least one quality measure for 21 different procedures; these procedures account for 14% of all major operations. Three new measures will be released by 2005. CONCLUSIONS: Californians facing surgery have limited information regarding quality of their care; few new measures are planned. Eighty-six per cent of patients would find no quality measures related to planned procedures. Public release of performance data is unlikely to improve the quality of health care unless the number and comprehensiveness of measures increase dramatically.

California↗
PubMed2003

Postpartum length of stay and newborn health: a cost-effectiveness analysis.

OBJECTIVE: To evaluate the cost-effectiveness of increasing lengths of brief postpartum hospitalizations. METHODS: A cost-effectiveness model extrapolating from secondary data was used. Social costs in 2000 US dollars were estimated using several sources, including a randomized controlled trial, a retrospective study, and survey data. Life-years saved from reduced infant mortality were estimated from administrative data from Washington State. A total of 113147 singleton newborns who were born in nonmilitary hospitals in Washington State in 1989 or 1990 and had postpartum stays short enough to be affected by length of stay legislation were studied. The cost-effectiveness of increases in postpartum lengths of stay similar to those that would occur if all mothers and singleton newborns used at least the time allotted to them under the federal length of stay legislation was measured. RESULTS: Estimated lower-bound cost per newborn life-year saved was 19 800 dollars (95% confidence interval: 11600-61300 dollars) when only neonatal deaths were considered. The corresponding upper-bound estimate was 94800 dollars (95% confidence interval: 55200-286800 dollars ). The results were very sensitive to assumptions about the discount rate for future life-years and the time from birth during which averted deaths are considered (neonatal deaths, postneonatal infant deaths, or all infant deaths). CONCLUSIONS: At hospitals that do not experience additional capacity costs as a result of increased lengths of stay, lengthening short postpartum stays seems to be more cost-effective than many common health interventions and well below cost-effectiveness thresholds suggested by the literature. Even at hospitals that experience additional capacity costs, the cost-effectiveness of lengthening short postpartum stays seems to be roughly equal to the benchmark of 100000 dollars per quality-adjusted life-year suggested by the literature.

Age Factors↗
PubMed2002

Comparison of long-term outcomes of myomectomy and uterine artery embolization.

OBJECTIVE: To compare long-term outcomes of uterine artery embolization and abdominal myomectomy in patients with symptomatic uterine myomas. METHODS: At a single institution in an 18-month time, 59 patients had bilateral uterine artery embolization and 38 patients had abdominal myomectomy to treat symptomatic uterine myomas. We reviewed medical records and surveyed patients 3 or more years after their procedures to assess how many needed further surgical procedures in the intervening years, to what extent symptoms remained improved, and how satisfied the patients were with the long term results of the index procedure. RESULTS: Follow-up was available on 51 embolization and 30 myomectomy patients and ranged from 37 to 59 months. Patients who had embolization were older (44 versus 38 years, P <.001) and more likely to have had previous surgical procedures (P <.001) than those who had myomectomy. Taking into account the variable follow-up period, embolization patients were more likely to have had further invasive treatment for myomas (29% versus 3%) (P =.004). Among women not needing further surgery, overall symptoms improved in 92% (33/36) of embolization and 90% (26/29) of myomectomy patients (P =.78). Ninety-four percent (34/36) of embolization patients and 79% (23/29) of myomectomy patients were at least somewhat satisfied with their choice of procedure (P =.06). CONCLUSION: Women who had embolization were more likely than those who had myomectomy to need further invasive treatment (surgery or repeat embolization) in the 3-5 years after the index procedure. Among women who did not need such treatment, satisfaction and relief of symptoms were similar. Large, randomized trials are needed to more accurately compare these two procedures.

Adult↗
PubMed2002

Improving treatment outcomes with a clinical pathway for hysterectomy and myomectomy.

OBJECTIVE: To determine if using a postoperative clinical pathway for women having hysterectomy or myomectomy would improve clinical care. STUDY DESIGN: Data from the literature and patient focus groups guided development of a clinical pathway. Nurses, pharmacists and physicians participated in the development process. Implementation relied on accepted quality improvement methods. We used a case-control design to compare administrative and clinical data for patients managed with (n = 28) and without (n = 28) the aid of the clinical pathway between June 1997 and January 1998. RESULTS: Case and control groups did not differ in age, race, payer status, severity of illness or procedure type. Clinical differences between pathway and nonpathway patients included a mean six-hour-shorter period of indwelling bladder catheters (P = .019), mean 11-hour more rapid return to regular diet (P = .014) and more pain assessments among pathway patients (mean, five vs. two; P < .001). There was no significant difference in length of stay between groups. Clinicians used the pathway for approximately one year, but with personnel changes the pathway gradually fell out of use. CONCLUSION: Clinical pathways can improve quality of care, even if they do not reduce length of stay. A team approach that focuses on patient concerns during pathway development may help ensure that quality improvement, rather than simply cost reduction, arises from the use of clinical pathways.

Adult↗