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Biomedical subjects

W H Crown

Publications and source records attributed to W H Crown.

At least 19 recordsLinked to original sources
PubMed2001

Hospitalization and total medical costs for privately insured persons with schizophrenia.

This study used data from the 1991-1993 MarketScan files, a large database of private sector inpatient, outpatient, and prescription drug medical claims, to identify a sample of 665 patients with schizophrenia. Descriptive and multivariate analyses were conducted on the subsamples with hospitalizations (N = 185) and without hospitalizations (N = 480) in the 1-year period following the initial diagnosis for schizophrenia observed in the 1991-1993 time period. After controlling for patient demographic characteristics, medical co-morbidities, and other factors, the cost of hospitalization itself was found to be $15,805.

Cost of Illness↗
PubMed2001

Antidepressant selection and economic outcome: a review of methods and studies from clinical practice.

BACKGROUND: Economic considerations increasingly play a role in the selection of antidepressant drugs and are often based on analyses from prospective and retrospective studies. However, the non-randomisation found in retrospective studies may result in significant selection bias. AIMS: To highlight the use of statistical methods in non-randomised studies and the application of those methods to economic analyses. METHOD: The literature on the observational studies of economic outcomes with alternative antidepressants is reviewed and several statistical methodologies to control for biases that can occur in non-randomised study designs are described. RESULTS: In comparisons of antidepressant drugs, differences in acquisition costs are consistently found to be at least offset by other components of care when broad measures of health care resource utilisation are considered. CONCLUSIONS: Economic evaluations of antidepressants should be based on broad measures of health care expenditure and can rely on data generated in real-world settings if appropriate statistical methods are used to control for the potential biases of non-randomisation.

Antidepressive Agents↗
PubMed2000

Economic outcomes associated with tricyclic antidepressant and selective serotonin reuptake inhibitor treatments for depression.

OBJECTIVE: To compare the economic outcomes associated with the tricyclic antidepressants (TCAs) and the selective serotonin reuptake inhibitors (SSRIs) in the treatment of depression. METHOD: A literature review of pertinent studies was performed. The advantages and disadvantages of clinical trials versus observational studies are described, and the breadth of the economic outcome measure chosen for the conclusions reached is discussed. RESULTS: The inclusion and exclusion criteria of clinical trials, in combination with their strict provider and patient study protocols, limit their generalizability to naturalistic treatment settings. Retrospective studies of patients can provide valuable information about the experiences and costs incurred by patients in actual treatment. However, confounding factors (both observable and unobservable) limit the amount of confidence that can be placed in inferences about treatment effects. Randomized prospective studies with naturalistic follow-on may help to mitigate some of the concern about treatment confounders which has traditionally been associated with non-randomized observational studies. CONCLUSION: Retrospective studies and one randomized prospective study of the economic outcomes of TCA versus SSRI treatment have found the SSRIs to be less expensive than TCAs when total direct medical expenditures are considered. However, additional studies are needed to address this issue.

Antidepressive Agents, Tricyclic↗
PubMed2000

The cost of productivity losses associated with allergic rhinitis.

OBJECTIVE: To measure the cost of absenteeism and reduced productivity associated with allergic rhinitis. METHODS: The National Health Interview Survey (NHIS) was used to obtain information on days lost from work and lost productivity due to allergic rhinitis. Wage estimates for occupations obtained from the Bureau of Labor Statistics (BLS) were used to calculate the costs. RESULTS: Productivity losses associated with a diagnosis of allergic rhinitis in the 1995 NHIS were estimated to be $601 million. When additional survey information on the use of sedating over-the-counter (OTC) allergy medications, as well as workers' self-assessments of their reduction in at-work productivity due to allergic rhinitis, were considered, the estimated productivity loss increased dramatically. At-work productivity losses were estimated to range from $2.4 billion to $4.6 billion. CONCLUSION: Despite the inherent difficulty of measuring productivity losses, our lowest estimate is several times higher than previous estimates of the indirect medical costs associated with allergic rhinitis treatment. The most significant productivity losses resulted not from absenteeism but from reduced at-work productivity associated with the use of sedating OTC antihistamines.

Absenteeism↗
PubMed2000

A national inpatient cost estimate of percutaneous endoscopic gastrostomy (PEG)-associated aspiration pneumonia.

OBJECTIVE: To present national estimates of the prevalence and costs of inpatient admissions for aspiration pneumonia (AP) associated with percutaneous endoscopic gastrostomies (PEGs) inserted before or during an admission. STUDY DESIGN: Retrospective analysis using medical claims. PATIENTS AND METHODS: National estimates of the prevalence of inpatient admissions associated with AP and mortality rates were developed, using data from the Nationwide Inpatient Sample of the Hospital Cost and Utilization Project (HCUP-3) Database. The MEDSTAT Group's MarketScan Private Pay Fee-for-Service (FFS) and Medicare FFS databases were used to calculate the percentage of admissions for AP that were preceded by a PEG or that entailed a PEG placement. Associated statistics, such as average length of stay and mean payments for these admissions, also were estimated. RESULTS: Approximately 300,000 inpatient admissions for AP took place in the United States in 1995, of which roughly 70,000 (23.9%) resulted in death. Approximately 10% of all AP admissions occurred after or entailed a PEG placement. After adjusting for differences in patients' age, gender, and health status, the total mean payments were estimated to be $26,618 per patient. This per-patient estimate translates into a national estimate of the cost of PEG-associated AP of approximately $808.2 million. CONCLUSION: The cost of PEG-associated AP is relatively high, as estimated in this study. The high inpatient mortality rates of AP imply that future efforts should be directed toward preventing AP.

Adolescent↗
PubMed1999

SSRI antidepressant drug use patterns in the naturalistic setting: a multivariate analysis.

BACKGROUND: The study of the duration and pattern of antidepressant use in actual clinical practice can provide important insights into how antidepressant prescribing patterns compare with recommended depression treatment guidelines. OBJECTIVE: The purpose of this study, using data available from depressed outpatients in the United States, is to assess the effects of initial SSRI antidepressant selection on the subsequent pattern and duration of antidepressant use. RESEARCH DESIGN: Multiple logistic regression analysis of data from a large prescription and medical claims database (MarketScan) for the years 1993 and 1994 were used to estimate the determinants of antidepressant drug use patterns for 1,034 patients with a "new" episode of antidepressant therapy who were prescribed one of three most often prescribed selective serotonin reuptake inhibitors (SSRIs), paroxetine, sertraline, or fluoxetine. RESULTS: Patients initiating therapy on sertraline or paroxetine were less likely than patients initiating therapy on fluoxetine to have four or more prescriptions of their initial antidepressant within the first 6 months. CONCLUSIONS: The findings suggest that antidepressant selection is an important determinant of the initial duration and pattern of antidepressant use which is consistent with current recommended depression treatment guidelines.

Adult↗
PubMed1999

[The costs of treatment with the new antidepressants in clinical practice].

OBJECTIVE: To assess if, in usual clinical practice, the patterns of use of new antidepressant are associated to different health resource utilisation. DESIGN: Naturalistic, retrospective, observational study. SETTING: Urban health center. PATIENTS: DSM-IIIR diagnostic criteria of depressive disorder and treatment with a new antidepressant (n = 328). INTERVENTIONS: Information on resource utilisation was collected in those patients treated with fluoxetine (FLX), fluvoxamine (FLV) sertraline (SER), paroxetine (PAR) and venlafaxine (VLF). Direct, indirect and total costs were compared according to the different patterns of use (stable therapy, upward dose titration, switching or augmentation) and according to the initially prescribed antidepressant. The follow-up period was 6 months. RESULTS: Direct and total daily costs of those patients with unestable therapy (upward dose titration, switching or augmentation) were 55% (p < 0.01) and 87% (p = 0.001) higher than for patients with stable therapy, respectively. Patients who initiated therapy on SER, VLF and PAR had 35% (p < 0.05), 80% (p < 0.05) and 37% (p < 0.05), respectively, higher average total costs per day than patients who initiated therapy with FLX. Regarding direct costs, patients who initiated therapy on SER and VLF had 48% (p < 0.001) and 58% (p < 0.05) higher average costs per day than patients who initiated therapy with FLX. CONCLUSIONS: New antidepressants show different patterns of use in a clinical practice setting, being FLX the agent more associated to a stable pattern of use. The pattern of use is associated to different health resource utilisation. Patients under stable therapy show lower health costs than those who need upward titration, switching or augmentation strategies. It is necessary to conduct randomized naturalistic studies to confirm these results.

Adult↗
PubMed1998

The application of sample selection models to outcomes research: the case of evaluating the effects of antidepressant therapy on resource utilization.

Non-randomized studies of treatment effects have come under criticism because of their failure to control for potential biases introduced by unobserved variables correlated with treatment selection and outcomes. This paper describes the basic concepts of sample selection models--a technique used widely in the economics evaluation literature for nearly two decades--and discusses the potential role of these models in outcomes research. In addition, it presents a case study of the application of the sample selection modelling approach to evaluation of the effects of antidepressant therapies on medical expenditures for physician services. This case study presents empirical comparisons of alternative model specifications and discusses practical issues in evaluation of sample selection models. We demonstrate that, in this particular case, sample selection models yield very different conclusions regarding treatment effects than traditional ordinary least squares regression.

Antidepressive Agents↗
PubMed1998

Tricyclic antidepressant and selective serotonin reuptake inhibitors antidepressant selection and health care costs in the naturalistic setting: a multivariate analysis.

BACKGROUND: Providers and payers have an interest in the total health care costs following the initiation of antidepressant treatment in the real world of clinical practice. Analyses of these costs can help evaluate the economic consequences of patient management decisions associated with initial antidepressant selection. OBJECTIVE: The purpose of this study was to assess the 1-year total direct health care costs for patients initiating therapy with one of the available tricyclic antidepressants (TCAs) or one of the three most often prescribed selective serotonin reuptake inhibitors (SSRIs) - paroxetine, sertraline, or fluoxetine. METHOD: A two-stage multivariate econometric model and data from fee-for-service private insurance claims between 1990 and 1994 were used to estimate the total direct health care costs following initial antidepressant drug selection for 2693 patients with a 'new' episode of antidepressant treatment. After controlling for both observed and unobserved characteristics, the 1-year total direct health care costs were found to be (1) statistically significantly lower for patients initiating therapy on fluoxetine than for patients initiating therapy on a TCA; (2) statistically significantly lower for patients who initiated therapy on fluoxetine than for patients initiating therapy on sertraline. CONCLUSIONS: Broadly considered, the findings in this study suggest that total direct health care costs differ across initial antidepressant selection after controlling for both observed and unobserved characteristics.

1-Naphthylamine↗
PubMed1998

Antidepressant selection and use and healthcare expenditures. An empirical approach.

The purpose of this study was to evaluate whether 1-year total healthcare expenditures differed between patients who initiated therapy on a tricyclic antidepressant (TCA) or a selective serotonin reuptake inhibitor (SSRI) after controlling for initial antidepressant selection and antidepressant use pattern. A retrospective claims database covering a privately insured population in the US was used. Patients who initiated therapy in the outpatient setting (primary care or psychiatrist) were considered. Two-stage sample selection models were estimated that included controls for initial antidepressant selection and use pattern. The analyses indicated that: (i) self-selection due to initial antidepressant selection was a statistically significant determinant of expenditures for patients who initiated therapy on a TCA but not an SSRI; (ii) after controlling for initial antidepressant selection, antidepressant use pattern was a statistically significant and positive determinant of expenditures for both TCA and SSRI patients; and (iii) after controlling for initial antidepressant selection and use pattern, 1-year total direct healthcare expenditures were significantly lower for patients who initiated therapy on an SSRI than for patients who initiated therapy on a TCA.

Antidepressive Agents↗
PubMed1997

Asthma treatment costs using inhaled corticosteroids.

Asthma is a chronic inflammatory disorder of the airways that affects 10 to 17.5 million people and leads to more than $5 billion in treatment costs in the Unites States annually. This retrospective study is an initial step in understanding the beneficial economic outcomes of inhaled corticosteroid therapy by determining whether differences exist in healthcare utilization expenditures for three inhaled corticosteroids available for use in the United States: (1) beclomethasone dipropionate (Vanceril/Schering and Beclovent/Allan & Hanburys); (2) flunisolide (Aerobid/Forest); and (3) and triamcinolone acetonide (Azmacort/Rhône-Poulenc Rorer). This study was based on an analysis of 4,441 patients with at least one pharmaceutical claim for one of the study drugs, using inpatient, outpatient, and prescription drug claims data obtained from The MEDSTAT Group's MarketScan database for calendar years 1990 through 1993. We tested a null hypothesis for no differences in total asthma treatment costs, when drugs were excluded, using multivariate linear regression modeling controlling for patient demographic and clinical characteristics that might affect the study outcome. We found that, after excluding study drug payments and controlling for other contributing factors, total asthma healthcare expenditures to triamcinolone acetonide (Azmacort) users were higher than those for beclomethasone dipropionate (Vanceril and Beclovent) and flunisolide (Aerobid) users. When study drug costs were included in the expenditure measure, both triamcinolone acetonide (Azmacort) and flunisolide (Aerobid) users had higher expenditures than did beclomethasone dipropionate (Vanceril and Beclovent) users. No significant differences in expenditures were detected between Vanceril and Beclovent patients, a finding consistent with the fact that these drugs are the same type of inhaled corticosteroid. Other factors contributing to differences in total asthma healthcare costs included patient age, patterns of switching among and continuing with study drugs, prestudy asthma utilization or drug proxy severity, and comorbidities of precipitating illnesses.

Administration, Inhalation↗
PubMed1995

The demographic and employment characteristics of home care aides: a comparison with nursing home aides, hospital aides, and other workers.

This article uses data from the 1987, 1988, and 1989 Current Population Surveys (CPS) to compare the characteristics of hospital, nursing home, and home care aides. The different types of aides were identified through cross-tabulations of the detailed industry and occupation codes available in the CPS. The results verify previous findings in the literature that home care workers tend to be older, less likely to be married, and have poorer educations than other types of aides. In addition, the three types of aides fall into a clear economic continuum with hospital aides tending to be the most affluent, followed by nursing home aides, and finally, by home care workers.

Adult↗
PubMed1993

Net worth and the economic diversity of the elderly.

Using data from the 1984 panel of the Survey of Income and Program Participation (SIPP), this article examines characteristics of the older population disaggregated by net-worth quintiles. The authors argue that income is not a sufficient measure of economic status for current policy discussions on issues such as changing Medicare co-payments, increasing the taxation of social security benefits, or means-testing under Medicaid. Net worth is a better measure of economic status, particularly for the elderly, because it represents the net value of assets accumulated over the life course. Their results indicate that there is considerable diversity in the economic status of the older population, which is masked by aggregate statistics (such as means and medians) typically used to summarize the economic status of population groups. Stereotypical views of the elderly based on such aggregates result in misdirected policy formulation. In the future, policymakers will need to formulate policies and programs using information on the distributions of income and assets among the older populations rather than relying on statistical aggregates.

Aged↗
PubMed1992

Economic rationality, the affordability of private long-term care insurance, and the role for public policy.

This study uses data from the 1984 panel of the Survey of Income and Program Participation (SIPP) of the U.S. Bureau of the Census to develop new estimates of the potential market for private long-term care insurance. It found that this market is potentially significant--especially among individuals in the 65-69 age group who are willing to spend up to 50% of their discretionary income on such insurance--but considerably lower than previous estimates, such as those of Cohen and colleagues (1987).

Aged↗
PubMed1992

Alternative sources of social support and their impacts on institutional risk.

We examined the direct and buffering effects of different dimensions of social support on the risk of being institutionalized over a 2-year period. Multivariate analyses indicated that specific aspects of social support, such as having a spouse or adult child caregiver, or having a caregiving relationship of at least 3 years' duration, moderated the impact of one type of stress (being highly dependent on others for care) on the risk of entering a nursing home. Networks that included a paid provider modestly offset the impact that multiple IADL impairments had on being admitted at least once to a nursing home.

Activities of Daily Living↗
PubMed1991

State and regional policy implications of elderly migration.

This paper uses the 1980 Census data to estimate the size of the economic transfers associated with the 1985 to 1990 interregional migration of older persons. Total economic transfers are estimated by multiplying interregional migration flows of older persons by the average income of older persons in each migration stream. Assuming an average life expectancy of 15 years for elderly migrants and an expenditure multiplier of 2, the total redistribution of income as a result of 1985 to 1990 elderly migration is estimated to be over $600 billion. The South Atlantic and Mountain regions are the recipients of the largest positive net transfers; the East North Central and West North Central regions have the largest negative net transfers.

Aged↗
PubMed1990

Retirement migration and interstate income transfers.

This paper examines one aspect of the economic impact of elderly migration, the transfer of income from state to state, a concern of policymakers, planners, and researchers. Using 1980 census microdata files it was determined that billions of dollars are transferred between states each year, some states (especially Florida) gaining and others losing. The 1980/1981 Consumer Expenditure Interview Survey was used to estimate the consumption patterns of the typical migrant household. These findings are discussed in the context of state economic development.

Aged↗