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Biomedical subjects

Ya-Chen Tina Shih

Publications and source records attributed to Ya-Chen Tina Shih.

13 recordsLinked to original sources
PubMed2006

The association between symptom burdens and utility in Chinese cancer patients.

OBJECTIVES: This study explored the relationship between the M. D. Anderson Symptom Inventory (MDASI), an instrument measuring the severity of symptoms common to patients with cancer, and utility derived from the SF-36. METHODS: Cancer patients from Tianjin Cancer Hospital in China (n = 249) completed a demographic questionnaire and Chinese versions of the MDASI and SF-36. Using a published algorithm converting SF-36 scores to standard gamble (SG) utilities, we examined the association between utility and individual symptoms using Spearman's rank correlation, and explored the association between utility and aggregate symptom scores through multivariate regression analyses. RESULTS: The mean SG utility was 0.81 (SD = 0.11); utilities were significantly but moderately correlated with the majority of symptoms, especially those of distress, sadness, fatigue, and pain. Regression models showed a significantly negative association between the total symptom score and the utility. After controlling for sociodemographics, cancer stage and performance status, a significantly negative association between the total symptom scores and utility was found in the multivariate analyses. We also found the total number of severe symptoms to be a stronger predictor of "disutility." CONCLUSIONS: Symptom measures were significantly albeit moderately associated with utility derived from the SF-36 scores, suggesting that a full study with rigorously collected utilities is worth exploring.

Aged↗
PubMed2005

Impact of initial dialysis modality and modality switches on Medicare expenditures of end-stage renal disease patients.

BACKGROUND: The number of end-stage renal disease (ESRD) enrollees and Medicare expenditures have increased dramatically. Pathways and associated Medicare expenditures in ESRD treatment need to be examined to potentially improve the efficiency of care. METHODS: This study examines the impact of initial dialysis modality choice and subsequent modality switches on Medicare expenditure in a 3-year period. The Dialysis Morbidity and Mortality Study Wave 2 data by the United States Renal Data System (USRDS) is used along with the USRDS Core CD and USRDS claims data. RESULTS: A total of 3423 incident dialysis patients (approximately equal number of peritoneal dialysis and hemodialysis) were included in the analysis. Unadjusted average annual Medicare expenditure (in 2004 dollars) for peritoneal dialysis as first modality was 53,277 dollars(95% CI 50,626 dollars-55,927 dollars), and 72,189 dollars (95% CI 67,513 dollars-76,865 dollars) for hemodialysis. Compared to "hemodialysis, no switch" subgroup, "peritoneal dialysis, no switch" had a significantly lower annual expenditure (44,111 dollars vs. 72,185 dollars) (P < 0.001). "Peritoneal dialysis, with at least one switch" and "hemodialysis, with at least one switch" had a lower or similar annual expenditure of 66,639 dollars and 72,335 dollars, respectively. After adjusting for patient characteristics, annual Medicare expenditure was still significantly lower for patients with peritoneal dialysis as the initial modality (56,807 dollars vs. 68,253 dollars) (P < 0.001). Similarly, compared to "hemdialysis, no switch" subgroup, "peritoneal dialysis, no switch" and "peritoneal dialysis, with at least one switch" had a significantly lower total expenditure. Further analysis showed that time-to-first switch also independently impacted total expenditure. CONCLUSION: Initial modality choice (peritoneal dialysis or hemodialysis) and subsequent modality switches had significant implications for Medicare expenditure on ESRD treatments.

Adult↗
PubMed2004

Health care provider knowledge of drug formulary status in ambulatory care settings.

PURPOSE: Health care providers' knowledge of whether the medications they prescribed were on the formulary of their patients' insurance plan and factors associated with this knowledge were examined. METHOD: The 2000 National Ambulatory Medical Care Survey was used to construct a nationally representative sample of outpatient prescription drugs and determine providers' knowledge of the formulary status of the drugs they prescribed. In addition to univariate analysis, random-effects logistic regression models were conducted to examine the association between providers' knowledge of whether a patient's medication was on the formulary, payment types, and provider and medication characteristics. RESULTS: Providers did not know whether the drug they prescribed was on the formulary for over 64% of the prescriptions. Physicians were more likely to know whether HMO patients' medications were on the formulary. Internal medicine physicians were significantly less likely to know if their patients' medications were on the formulary than general and family practice physicians. Among HMO-paid outpatient visits, providers practicing in the West were significantly less likely to know if their patients' medications were on the formulary than those practicing in the Northeast. CONCLUSION: In over half of cases, health care providers did not know whether the medications they prescribed were on the formulary.

Ambulatory Care↗
PubMed2004

The economic burden of supportive care of cancer patients.

GOALS OF WORK: Economic and regulatory healthcare policy is limited by the lack of population-based information on the cost of supportive care of cancer patients. The goal of this study was to estimate these costs and to explore the impact of these costs on policy decisions. PATIENTS AND METHODS: We identified estimates of the cost of outpatient and inpatient supportive care from published reports in the literature. The range of these costs (from lowest to highest) is described for each supportive care condition. These estimates were supplemented by computing the cost of all hospitalizations for these conditions in Texas between June 2000 and December 2001. Medicare payments were used to estimate average reimbursement. Costs (not charges) were standardized to 2002 US dollars using the consumer price index for medical care and Medicare's cost-to-charge ratio for Texas. MAIN RESULTS: Inpatient care for most conditions exceeded 7,000 US dollars per episode. Our population-based estimates of the cost of care were similar to literature-based estimates, except in the case where conditions could be managed in the outpatient setting. Average Medicare payments were often far lower than the estimated cost of care. For example, the estimated cost of hospitalization for management of diarrhea was 6,616 US dollars while the average Medicare payment was only 2,809 US dollars. CONCLUSIONS: Many supportive care interventions are quite expensive. In an environment focused on cost containment, a risk-based approach to expensive supportive care treatments is essential. Further study of the cost effectiveness of supportive care management strategies is indicated.

Ambulatory Care↗
PubMed2004

A review of self-report instruments measuring health-related work productivity: a patient-reported outcomes perspective.

Health impairment often leads to work impairment in the form of both absenteeism and presenteeism (i.e. reduced productivity while at work). Several self-report productivity instruments have been designed over the past few years to measure the impact of illness on productivity at work and/or in non-work activities. In a review of the literature we identified six generic subjective instruments - the Endicott Work Productivity Scale, Health and Labor Questionnaire, Health and Work Questionnaire, Health and Work Performance Questionnaire, Work Limitations Questionnaire (WLQ) and the Work Productivity and Activity Impairment Questionnaire (WPAI) - that could theoretically be used in any working population. These instruments were usually validated against other subjective measures (such as health-related QOL). Each productivity instrument has benefits in certain research settings, but the psychometric properties of the WPAI have been assessed most extensively. It was the most frequently used instrument and has also been modified to measure productivity reductions associated with specific diseases (e.g. allergic rhinitis, gastro-oesophageal reflux disease, chronic hand dermatitis). The WLQ has also been tested extensively to measure the general health impact and impact of specific conditions. Two migraine-specific subjective instruments were also identified: the Migraine Disability Assessment questionnaire and the Migraine Work and Productivity Loss Questionnaire, of which the latter was found to have better psychometric properties. Productivity outcomes are useful in that they characterise the impact of an illness in the workplace and show the effect of treatment on productivity. Evidence of psychometric properties and generalisability of different instruments was found to a varying degree. Thus, further research is needed to assess the accuracy and usefulness of individual instruments in certain research settings. Health-related productivity has been increasingly recognised as an important component of the burden of illness associated with a given disease; without it, one cannot reliably assess this burden.

Clinical Trials as Topic↗
PubMed2003

Labor costs associated with incontinence in long-term care facilities.

OBJECTIVES: To understand the labor resource consumption in caring activities of long-term care residents with versus without urinary incontinence (UI) and the variation in consumption patterns across shifts and facility types. METHODS: This prospective study was conducted in three phases. Phase I of the study developed a taxonomy of the caring activities involved in the care of the incontinent patient and of the control group patient. In Phase II, the frequency of these activities was assessed. Phase III extrapolated the cost impacts of incontinence. The sample consisted of 37 long-term care facilities in the vicinity of Winston-Salem, North Carolina, along with a supplemental sample of 12 facilities in the vicinity of Chapel Hill, North Carolina. The study examined the costs of labor, supplies, and services. To our knowledge, this is the first study to apply microcosting approaches to UI. RESULTS: All things being equal, the incremental labor costs (per shift) were 3.31 dollars (in 2002 dollars) for patients with occasional UI and 5.16 dollars for patients with frequent UI. Combining patients with frequent UI (more than 70% of all UI patients) and occasional UI, the weighted average incremental costs per shift were 4.52 dollars. CONCLUSIONS: With incremental labor costs of 4.52 dollars per patient per shift, UI costs an additional 13.57 dollars to treat per day, or 4957 dollars annually. Our findings can be used to capture the "averted costs" in long-term care facilities from curing UI.

Aged↗
PubMed2003

Factors associated with hospitalization costs for patients with community-acquired pneumonia.

BACKGROUND: Combined mortality rates for pneumonia and influenza suggest that the 2 conditions represent the sixth leading cause of death in the United States. The total cost of pneumonia, including indirect costs, was estimated to be approximately $23 billion per year in 1994. OBJECTIVE: The objective of this study was to assess variables that may be significantly associated with the cost of treating patients hospitalized with community-acquired pneumonia (CAP). We also assessed the impact of treatment guidelines for management of CAP (developed by managed care plans) on total costs. METHODS: Patients in 3 managed care plans who were hospitalized with a primary or secondary diagnosis of CAP in Maryland and Washington, DC, between January 1, 1997, and April 30, 1997, or between January 1, 1998, and April 30, 1998, were identified based on International Classification of Diseases, Ninth Revision codes. Clinical data were abstracted from patients' medical charts by nurses, and billing data were acquired from these plans. A retrospective data analysis was carried out using billing data from 3 managed care plans and clinical data from hospitals associated with the plans. A multivariate regression model was developed using the natural logarithm of cost as the dependent variable. Independent variables that were studied included severity of illness, days in the intensive care unit (ICU), triage per guidelines, drug therapy per guidelines, mortality, and managed care plan identifiers. RESULTS: The charts of 569 patients were assessed. The mean age of the study sample was 75.3 years. ICU days (P < 0.001), mortality, and drug therapy (both P < 0.01) per guidelines significantly affected costs. As expected, an increase in the number of ICU days led to an increase in costs. However, patients who received drug therapy recommended by the guidelines had significantly lower costs than patients not treated according to the guidelines (P = 0.001). CONCLUSIONS: The findings of this study suggest that guidelines for CAP management, such as those developed by managed care plans, may help reduce costs by minimizing unnecessary ICU admissions and appropriately managing patients with CAP.

Aged↗
PubMed2003

Sociological influences on antidepressant prescribing.

This study examined how patient characteristics, physician characteristics, the physician's interaction with the health care system, and the physician's interaction with the patient influenced whether patients with a depression diagnosis received an antidepressant prescription and whether they received a SSRI antidepressant, a non-SSRI antidepressant, or both. The 1998 National Ambulatory Medical Care Survey (NAMCS), in the USA, was used for the analysis. Logistic regression was used to examine what characteristics influenced whether a patient with a depression diagnosis received an antidepressant prescription. Next, a multinomial logistic regression model was applied to examine the relative risk of using one type of antidepressant versus another among antidepressant users while correcting for possible sample selections using the Heckman selection model. Sixty-seven percent of patients with a depression diagnosis received an antidepressant. Patients who were seeing providers who were not primary care physicians or psychiatrists, self-paying patients, and patients with neurotic depression were significantly less likely to receive an antidepressant prescription. Patients with depression listed as their first diagnosis were significantly more likely to receive an antidepressant prescription. Patients seeing a psychiatrist were more likely than patients seeing a primary care physician to receive a non-SSRI antidepressant than a SSRI antidepressant. Patients belonging to an HMO that had capitated visits were over four times more likely to receive non-SSRI antidepressants than SSRI antidepressants. Patients with major depression were significantly more likely to receive a non-SSRI antidepressant. Patients with depression as their primary diagnosis and patients who saw psychiatrists were significantly more likely to receive both SSRI and non-SSRI antidepressants rather than just SSRI antidepressants. Patient characteristics, physician characteristics, the physician's interaction with the health care system, and the physician's interaction with the patient all influenced antidepressant prescribing. An especially important finding was that insurance status influenced whether patients received an antidepressant. Health care providers need to take the time to help patients without insurance obtain antidepressant medication if it is needed.

Adolescent↗
PubMed2002

The effect on social welfare of a switch of second-generation antihistamines from prescription to over-the-counter status: a microeconomic analysis.

BACKGROUND: The US Food and Drug Administration (FDA) recently held a meeting to determine whether the status of second-generation antihistamines (SGAs) should be switched from prescription (Rx) to over-the-counter (OTC) status. OBJECTIVE: This article provides a conceptual microeconomic framework for addressing issues regarding the impact of such a switch on social welfare. METHODS: A review of the economic literature on Rx-to-OTC switches was conducted. Relevant articles published in English between 1990 and 2001 were identified through searches of ABI Info, EconLit, PsychInfo, MEDLINE, CANCERLIT, AIDSLINE, and HealthStar, as well as a general Internet search for statements in the press or on the FDA Web site. The search terms used were Rx, prescription, OTC, over-the-counter, second-generation antihistamines, nonsedating antihistamines, first-generation antihistamines, and sedating antihistamines. Microeconomic models focusing on consumer surplus were employed to determine the potential price response and social-welfare implications of a switch of SGAs to OTC status. RESULTS: Unlike the agents involved in previous Rx-to-OTC switches, SGAs are still under patent protection. Economic theory suggests that a firm that is protected by a patent will price aggressively. The market for OTC SGAs is likely to be more elastic due to a lack of insurance coverage for OTC products; hence, drug manufacturers would be likely to charge a lower price if SGAs were sold OTC. However, a lower price does not necessarily guarantee an improvement in social welfare; the net impact is determined by whether the increase in consumer surplus outweighs the deadweight loss (losses of consumer and producer surplus not transferred to other parties). Additionally, the assumption of a price reduction would be called into question if there were inequalities in marginal costs between the Rx and OTC markets. In this situation, the postswitch price might increase or not be reduced significantly. CONCLUSIONS: It is uncertain whether granting OTC status to SGAs would be cost saving to society, particularly as these drugs are patent protected. The social-welfare implications of such a switch would depend heavily on pricing strategies and consumer behavior. Further analyses are needed to determine how both factors influence social welfare; only then can the costs and benefits of a switch be understood completely.

Drug Industry↗
PubMed2002

Resource utilization associated with irritable bowel syndrome in the United States 1987-1997.

This study uses national databases to examine the impact of irritable bowel syndrome (IBS) on resource utilization in the United States. Approximately 1.5-2.7 million physician visits (599-1,043 per 100,000) yearly were related to IBS, with 45.3% seen by gastroenterologists, and 89% prescribed medications. Rates of physician visits by women were approximately 2.4-3.3 times higher than that for men. The average number of medication prescribed per visit was 1.83. Approximately 89% of the visits were prescribed with medications. The rate of hospitalization (5.1 per 100,000 in 1997) decreased by 60% and length of stay decreased from 5.5 to 3.1 days in the past decade. The average charges of IBS-related hospitalization were US$7,882. Our study found an apparent decreasing trend of IBS-related hospitalizations and no marked increase in office consultations in the past decade. However, a better case identification criterion is necessary to estimate the true disease burden.

Adult↗
PubMedDate not supplied

Impact of generic drug entry on cost-effectiveness analysis.

The market share of generic drugs has grown substantially since the passage of the Waxman-Hatch Act, increasing from 19% in 1984 to 50% in 2001. At entry, the generic drugs typically are priced lower than brand-name drugs; thus, incorporating the impact of the generic drug entry introduces an additional source of uncertainty in economic models as both the timing of entry and the level of generic drug pricing are subject to variation. In this article, the authors explored the impact of generic drug entry on cost-effectiveness analyses of new or brand-name drugs. Using a mathematical model, they argue that failure to incorporate the impact of generic drug entry will underestimate the incremental cost-effectiveness ratio (ICER) and, thus, overstate the economic benefit of the new product. The authors provide 2 examples to illustrate such impact on short-term and long-term cost-effectiveness analyses. To better assess the uncertainty associated with the impact of generic drug entry, in addition to a deterministic analysis, they also employed a Bayesian probabilistic approach to analyze these examples and presented the results using cost-effectiveness acceptability curves. They conclude that incorporating generic drug entry into pharmacoeconomic models will yield more accurate projections of the ICER and lead to better decision making.

Bayes Theorem↗
PubMedDate not supplied

Does Medicare coverage of colonoscopy reduce racial/ethnic disparities in cancer screening among the elderly?

Racial and ethnic disparities in colorectal cancer screening have been documented extensively in the literature. In July 2001 Medicare began covering colonoscopy for average-risk beneficiaries. We examined the effect of Medicare reimbursement on the rate and disparity of colorectal cancer screening among the elderly in the United States. This policy alleviated the screening disparity between non-Hispanic whites and blacks, but the gap between Hispanics and non-Hispanic whites has widened. Overall, fewer than half of the elderly are screened, even though Medicare now covers colonoscopy.

Aged↗