Nicole M. Zimmerman

PLAIN LANGUAGE SUMMARY Higher healthcare costs were observed in Black Medicaid patients with knee/hip osteoarthritis despite lower rates of inpatient admission. We observed these differences in this Medicaid population, where socioeconomic status is more homogeneous. Black patients had significantly higher healthcare costs compared to White patients and the difference persisted even after accounting for underlying differences in Black and White patients. Higher healthcare costs among Black patients were found in both the baseline and follow-up periods overall for all types of healthcare (hospitalizations, ER, office visit, other services). Higher hospitalization costs in Black patients were observed despite lower rates of hospitalizations in Black patients. These increased costs cannot be attributed to either longer or more frequent hospitalizations; no significant difference in either the length of stay or the number of hospitalizations was observed when comparing Black patients to White patients. Background Osteoarthritis (OA) is a leading cause of chronic pain and disability. Prior studies have documented racial disparities in the clinical management of OA. The objective of this study was to assess the racial variations in the economic burden of osteoarthritis within the Medicaid population. Methods We conducted a retrospective observational study using the MarketScan Multi-State Medicaid database (2012-2019). Newly diagnosed, adult, knee and/or hip OA patients were identified and followed for 24 months. Demographic and clinical characteristics were collected at baseline; outcomes, including OA treatments and healthcare resource use (HCRU) and expenditures, were assessed during the 24-month follow-up. We compared baseline patient characteristics, use of OA treatments, and HCRU and costs in OA patients by race (White vs. Black; White vs. Other) and evaluated racial differences in healthcare costs while controlling for underlying differences. The multivariable models controlled for age, sex, population density, health plan type, presence of non-knee/hip OA, cardiovascular disease, low back pain, musculoskeletal pain, presence of moderate to severe OA, and any pre-diagnosis costs. Results The cohort was 56.7% White, 39.9% Black and 3.4% of Other race (American Indian/Alaska Native, Hispanic, Asian, Native Hawaiian/Other Pacific Islander, two or more races and other). Most patients (93.8%) had pharmacologic treatment for OA. Inpatient admission during the 24-month follow-up period was lowest among Black patients (25.8%, p < .001 White vs. Black). In multivariable-adjusted models, mean all-cause expenditures were significantly higher in Black patients ($25,974) compared to White patients ($22,913, p < .001). There were no significant differences between White patients and patients of Other race ($22,352). Conclusions The higher expenditures among Black patients were despite a lower rate of inpatient admission in Black patients and comparable length and number of hospitalizations in Black and White patients, suggesting that other unmeasured factors may be driving the increased costs among Black OA patients.

In the United States (US), meningococcal serogroup B (MenB) vaccination has been recommended for 16–23-year-olds (preferably 16–18 years) based on shared clinical decision-making since 2015. MenB vaccine coverage (≥1 dose) by age 17 years has been reported, but initiation at older ages and by insurance type is unknown. In this retrospective cohort study, MarketScan claims data were analyzed to assess MenB vaccine series initiation (i.e. receipt of a first dose) during 2017–2020 among US commercially insured and Medicaid-covered individuals aged 16–18 and 19–23 years. Kaplan–Meier curves were generated to estimate series initiation at various times from index (latest of 1/1/2017 or 16^th/19^th birthday, depending on the cohort). Multivariable analyses were conducted to identify factors associated with series initiation. Among 1,450,354 Commercial and 1,140,977 Medicaid 16–18-year-olds, MenB vaccine series initiation rates within 3 years of each person’s first eligibility were estimated to be 33% and 20%, respectively; among 1,857,628 Commercial and 747,483 Medicaid 19–23-year-olds, 3% and 1%, respectively. Factors identified to be significantly associated with increased likelihood of initiating a MenB vaccine series included co-administration of meningococcal serogroups ACWY (MenACWY) vaccine, younger age, female sex, nonwhite race (Medicaid only), New England or Middle Atlantic location (Commercial only), urban residence, and previous influenza vaccination. MenB vaccine series initiation among the studied US adolescents and young adults was low. There is a need for continued efforts to better understand barriers to the uptake of vaccines that are recommended based on shared clinical decision-making.

Background: Respiratory syncytial virus (RSV) is a leading cause of infant hospitalization in the United States. Preterm infants and those with select comorbidities are at highest risk of RSV-related complications. However, morbidity due to RSV infection is not confined to high-risk infants. We estimated the burden of medically attended (MA) RSV-associated lower respiratory tract infection (LRTI) among infants in the United States. Methods: We analyzed commercial (MarketScan Commercial [MSC], Optum Clinformatics [OC]), and Medicaid (MarketScan Medicaid [MSM]) insurance claims data for infants born between April 2016 and February 2020. Using both specific and sensitive definitions of MA RSV LRTI, we estimated the burden of MA RSV LRTI during infants’ first RSV season, stratified by gestational age, comorbidity status, and highest level of medical care associated with the MA RSV LRTI diagnosis. Results: According to the specific definition 75.0% (MSC), 78.6% (MSM), and 79.6% (OC) of MA RSV LRTI events during infants’ first RSV season occurred among term infants without known comorbidities. Conclusions: Term infants without known comorbidities account for up to 80% of the MA RSV LRTI burden in the United States during infants’ first RSV season. Future prevention efforts should consider all infants.

To compare long-term healthcare resource utilization (HCRU) and costs among patients who initiated ixekizumab (IXE) or adalimumab (ADA) for treatment of psoriasis in the United States.Adult patient...

Objective This retrospective, observational study compares 6- and 12-months adherence and persistence among dulaglutide vs. matched semaglutide initiators using real-world administrative claims data from the IBM MarketScan Databases. Methods Adult patients with type 2 diabetes newly initiating dulaglutide or semaglutide between January 2018 and January 2020 (index date=earliest fill date), without evidence of GLP-1 RA use, pregnancy, gestational diabetes, or bariatric surgery in the 6-months baseline period, and with continuous enrollment in the 6-months baseline and 6- or 12-months follow-up periods were included. Dulaglutide initiators were propensity-score matched 1:1 to semaglutide initiators for each 6- and 12-months follow-up (26,284 and 13,837 pairs, respectively). Baseline characteristics were balanced with mean age 53 years and 50% females. Groups differences in categorical variables were assessed with the chi-squared test and the t-test was used to compare means. Results More dulaglutide patients were adherent than semaglutide patients (6-months: 63.4% vs. 47.8%, 12-months: 54.4% vs. 43.3%). More dulaglutide patients were persistent on therapy compared to semaglutide patients (6-months: 71.9% vs. 62.2%, 12-months: 55.5% vs. 45.3%) and had more mean (standard deviation [SD]) persistent days (6-months: 144.8 [55.7] vs. 132.2 [61.6], 12-months: 254.3 [134.3] vs. 220.7 [142.8]). Among patients who escalated and remained on a higher dose of index drug, most were adherent at 6-months (dulaglutide 82.7% [n=5014] vs. semaglutide 74.6% [n=2,635]) and 12-months (dulaglutide 76.4% [n=3,063] vs. semaglutide 71.8% [n=1,860]). Conclusion At both 6 and 12 months, dulaglutide initiators had significantly higher adherence and greater persistence on their therapy than semaglutide initiators. Article published online: 26 May 2022 © 2022. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Aim: Machine learning reveals pathways to neuroendocrine tumor (NET) diagnosis. Patients & methods: Patients with NET and age-/gender-matched non-NET controls were retrospectively selected from Mar... Lay abstract We present the novel analytic approach of machine learning using real-world data to describe patient pathways to neuroendocrine tumor (NET) diagnosis. Due to the rarity and presentatio...

Background: There is lack of real-world treatment pattern comparison data between ixekizumab and adalimumab which are approved for the treatment of moderate-to-severe plaque psoriasis. Objective: To compare real-world treatment patterns among psoriasis patients initiating ixekizumab or adalimumab in the United States. Methods: Psoriasis patients with ≥ 1 claim for ixekizumab or adalimumab between March 1, 2016, and May 31, 2018, were identified (index date = date of first ixekizumab or adalimumab claim) from the IBM Watson Health MarketScan^® databases. Patients were required to be continuously enrolled for ≥ 12 months before the index date and followed for a minimum of 6 months until inpatient death, enrollment end, or study end, whichever occurred first. Treatment persistence, adherence, discontinuation, restart, and switching were analyzed. Inverse probability of treatment weighting and multivariable regression modeling were employed to address cohort imbalances and estimate the adjusted risk of non-persistence, discontinuation, and switching, and the odds of adherence. Results: A total of 646 ixekizumab and 3668 adalimumab users were included and followed for a mean of 14.0 and 16.5 months, respectively. Compared to adalimumab, ixekizumab was associated with 19% lower risk of non-persistence (hazard ratio [HR]=0.81, 95% confidence interval [CI]: 0.69– 0.95), 26% lower risk of discontinuation (HR=0.74, 95% CI: 0.62– 0.88), and 28% lower risk of switching (HR=0.72, 95% CI: 0.57– 0.91). Ixekizumab users had higher odds of medication possession ratio ≥ 80% (odds ratio [OR]=1.36, 95% CI: 1.10– 1.69) but similar odds by proportion of days covered ≥ 80% (OR=1.22, 95% CI: 0.98– 1.53). Conclusion: Psoriasis patients treated with ixekizumab demonstrated longer persistency, higher adherence and were less likely to discontinue or switch treatment compared to adalimumab users. However, while patients achieving highly adherent threshold significantly differed by MPR ≥ 80%, it did not by PDC ≥ 80%; hence, further analysis using fixed-length follow-up is required.

We tested the primary hypothesis that surgical site infections (SSIs) are more common in patients who had longer periods of intraoperative low blood pressure. Our secondary hypothesis was that hospitalization is prolonged in patients experiencing longer periods of critically low systolic blood pressure (SBP) and/or mean arterial pressure (MAP). Hypotension compromises local tissue perfusion, thereby reducing tissue oxygenation. Hypotension might thus be expected to promote infection, but the extent to which low blood pressure contributes remains unclear. We considered patients who had colorectal surgery lasting at least 1 hour at the Cleveland Clinic between 2009 and 2013. The duration of hypotensive exposure and development of SSI was assessed with logistic regression; the association between hypotensive exposure and duration of hospitalization was assessed with Cox proportional hazard regression. A total of 2521 patients were eligible for analysis. There was no adjusted association between SBP hypotension < 80 mm Hg and SSI, with an estimated odds ratio (95% confidence interval) of 0.97 (0.81, 1.17) per 5-minute increase in SBP hypotension (P = 0.54). There was also no adjusted association between MAP hypotension time and SSI, with estimated odds ratio of 0.97 (0.81, 1.17) for a 5-minute increase in MAP hypotension < 55 mm Hg time (P = 0.71). There was no association between duration of hypotension and time to discharge. Intraoperative hypotension does not seem to be a clinically important predictor of SSI after colorectal surgery, probably because the outcomes are overwhelmingly determined by other baseline and surgical factors—and perhaps postoperative hypotension.