Jonathan Bouchard

The LabPET II modular technology was identified as a promising platform for a new generation of Ultra-High Resolution (UHR) brain PET scanners. Scaling up from preclinical systems to achieve a human brain field-of-view introduces significant challenges that require high-density, low-noise detection modules capable of dissipating over 1.1 kW of heat within a confined volume. To address these constraints, a new UHR detection module, referred to as the UHR-DM, was developed based on a 2.5D stacked PCB architecture. This design embeds two readout ASICs between two circuit boards to enhance thermal management, mechanical alignment, and electrical performance, while preserving full backward compatibility with the existing LabPET II platform. This paper presents a detailed comparison between the UHR-DM and the original LabPET II detection module (LP2-DM). Key improvements include improved heat extraction through direct conduction, reduced parasitic capacitance via shorter and more uniform trace routing, and enhanced noise immunity enabled by embedded shielding. A dedicated testbench was used to evaluate thermal performance, baseline stability, noise characteristics, intrinsic and full-system coincidence time resolution (CTR), and time-over-threshold (ToT) energy resolution. Results show that the UHR-DM design reduces ASIC operating temperature by up to 43%, lowers noise by 60% when using high electronic gains, and improves channel-to-channel noise uniformity. It also achieves more consistent CTR and energy resolution without compromising any performance aspect of the original design. These enhancements will facilitate the upcoming integration all 129 024 individual channels required by the UHR brain PET scanner to achieve a spatial resolution of 1.25 mm at the center of the field of view.

Aim: To assess patient characteristics, treatment patterns, botulinum toxin type-A (BoNT-A) costs and describe safety in adults with spasticity who switched from onabotulinumtoxinA to abobotulinumtoxinA. Materials & methods: Chart data from three US-based treatment centers was collected in patients aged ≥18 years with upper limb (ULS), lower limb (LLS) or ULS and LLS (ULS + LLS) spasticity. Eligible patients had ≥2 onabotulinumtoxinA treatment cycles before switching to abobotulinumtoxinA; they were followed for three additional abobotulinumtoxinA treatment cycles. A post hoc analysis of estimated drug costs was conducted. Results: Eighty-eight patients (mean age 44.9 years; 62.5% male) switched from onabotulinumtoxinA to abobotulinumtoxinA; in 84 (95.5%), the switch was due to ‘medical need/effectiveness not achieved.’ Most common spasticity etiologies were cerebral palsy (43.2%) and stroke (25.0%). Fifty-one patients (58.0%) had bilateral spasticity with a mean ± SD of 5.1 ± 2.2 muscles injected at each visit over the 5-injection-cycle treatment period. No adverse events were reported following switching. Mean estimated cost per visit was $2731 with onabotulinumtoxinA and $1452 with abobotulinumtoxinA. Conclusion: In this real-world study, patients with ULS, LLS or ULS + LLS who were switched from onabotulinumtoxinA to abobotulinumtoxinA continued for ≥3 treatment cycles without any reported adverse events. Switching resulted in lower estimated BoNT-A costs.

Introduction Post-stroke spasticity (PSS) occurs in ~25–43% of patients between 2 weeks and 3 months following a stroke. This retrospective claims study examined the occurrence of spasticity, treatment patterns, healthcare resource utilization, and healthcare costs among patients who experienced a stroke over a 2-year period. Methods Analyses were conducted using healthcare claims from the IQVIA PharMetrics Plus database of commercially/self-insured members from 2015 to 2021. Patients were selected based on two International Classification of Diseases, 10th revision diagnosis codes for stroke requiring an inpatient stay (index date) with continuous enrollment with medical/pharmacy benefits 12 months before (pre-index) and 24 months starting on the index date (post-index). PSS was defined by a diagnosis code for spastic hemiplegia or muscle contracture starting ≥ 7 days post-index, or claims indicating PSS treatment [botulinum toxin A (BoNT-A) or muscle relaxants] any time in the post-index period. A generalized linear model was developed to estimate cost ratios between patients with and without PSS. Results Overall, 7851 patients fulfilled study criteria; 47.7% were treated with physical or occupational therapy, 11.3% with muscle relaxants, and 0.8% with BoNT-A; 12.4% met the post-index definition of PSS; 84.2% were identified using muscle relaxant or BoNT-A codes, 6.6% using diagnosis codes, and 9.2% using both. Median time to codes identifying PSS was 213 days. Patients treated with BoNT-A received an average of three treatments, starting 253 days (median) post-stroke. Mean all-cause healthcare costs were US$62,875 among patients with PSS versus $44,472 among patients without (P < 0.001), representing 39.6% higher adjusted all-cause healthcare costs among patients with PSS versus patients without PSS. Conclusion Patients with PSS utilized numerous treatment modalities and experienced higher mean all-cause healthcare costs than did those without PSS. Earlier identification to optimize treatment of PSS may represent an opportunity for cost savings within managed healthcare systems.

Spasticity and cervical dystonia (CD) are movement disorders with considerable direct and indirect health care cost implications. Although several studies have discussed their clinical impact, few have calculated the economic burden of these disorders. To assess the all-cause health care resource utilization (HCRU) and costs in adults and children with spasticity or CD. This retrospective, observational cohort-based study was conducted using administrative insurance claims from the IQVIA PharMetrics Plus database from October 1, 2015, to December 31, 2019. Patients were selected based on International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes for first evidence of spasticity (associated with a spasticity etiology) or CD (index date) during the selection window, from April 1, 2016, through December 31, 2018. Cases were stratified into 3 mutually exclusive cohorts: adult patients with spasticity, pediatric patients with spasticity, and patients with CD; those with spasticity who had a history of stroke or cerebral palsy were also evaluated in subcohorts. Patients without evidence of spasticity or CD during the study period were identified as a matched comparator group and were randomly assigned an index date. Patients with spasticity were matched 1:1 to the comparator group based on age, sex, index year, and payer type using descriptive analyses. 215,739 adult patients with spasticity, 29,644 pediatric patients with spasticity, and 9,035 adult patients with CD were identified after matching. Adult patients with spasticity and CD had mean (SD) ages of 48.4 (15.6) years and 48.0 (13.1) years, respectively. Stroke was identified in 31.9% (n = 68,928) of adult patients with spasticity, and cerebral palsy was identified in 11.3% (n = 3,364) of pediatric patients with spasticity. Adult and pediatric patients with spasticity and patients with CD had significantly higher HCRU (including mean number of outpatient, emergency department, and inpatient visits and proportions of patients with prescription fills) and higher mean total health care costs per patient (adult patients with spasticity $29,912 vs $7,464; pediatric patients with spasticity $16,089 vs $2,963; and patients with CD $20,168 vs $7,141) than matched comparators (all P<0.0001). The management of patients with spasticity or CD results in considerably higher health care expenses. Within managed health care systems, more effective management of spasticity and CD in adult and pediatric patients represents a significant opportunity for cost savings.

Date Presented 04/22/2023 Patients with poststroke spasticity experienced higher mean health care costs than those with stroke without spasticity. Earlier identification to optimize treatment of spasticity represents an opportunity for cost savings in health care systems. Primary Author and Speaker: Jonathan Bouchard Contributing Authors: Michael Hull, Ruthwik Anupindi, Jing He, Mitchell DeKoven, Jumaah Goldberg, Jonathan Bouchard

Introduction Spasticity and cervical dystonia (CD) are movement disorders with considerable direct and indirect healthcare cost implications. Although several studies have discussed their clinical impact, few have calculated the economic burden of these disorders. This study aimed to understand treatment/injection patterns of botulinum toxins type A (BoNT-As) and the characteristics, healthcare resource utilization (HCRU), and costs among patients with spasticity or CD. Methods Retrospective analyses were conducted using administrative healthcare claims from the IQVIA PharMetrics^® Plus database, from October 1, 2015 to December 31, 2019. Eligible patients were selected based on Healthcare Common Procedure Coding System codes for BoNT-A (index date) and ICD-10 diagnosis codes for spasticity or CD with 6 months of continuous enrollment pre-index and 12 months post-index. Patients were stratified into adult spasticity, pediatric spasticity, and CD cohorts, and were evaluated for injection patterns, HCRU, and costs in the post-index period. Results Overall, 2452 adults with spasticity, 1364 pediatric patients with spasticity, and 1529 adults with CD were included. Total mean all-cause healthcare costs were US$42,562 (adult spasticity), $54,167 (pediatric spasticity), and $25,318 (CD). Differences were observed in the cost of BoNT-A injection visits between toxins, with abobotulinumtoxinA (aboBoNT-A) having the lowest injection cost across all indications. Conclusions AboBoNT-A had the lowest injection visit costs across indications. These results are suggestive of real-world resource utilization patterns and costs, and, while helpful in informing insurers’ BoNT-A management strategies, further research into cost differences is warranted.

To assess changes in the clinical characteristics and treatment patterns of patients with newly diagnosed type 2 diabetes (T2D), the electronic health record system at Cleveland Clinic was used to create cross-sectional summaries of all patients with new-onset T2D in 2008 and 2013. Differences between the 2008 and 2013 data sets were assessed after adjusting for age, gender, race, and income. Approximately one-third of patients with newly diagnosed T2D in 2008 and 2013 had an A1C ≤8%, suggesting the continued presence of a delayed recognition of the disease. Patients with newly diagnosed T2D in 2008 were older than those in 2013. Hypertension, cardiovascular disease, and neuropathy were highly prevalent among patients diagnosed with T2D. The prevalence of neuropathy, cerebrovascular disease, and peripheral vascular disease increased from 2008 to 2013. Metformin was the most commonly prescribed antidiabetic medication. Sulfonylurea usage remained unchanged, while use of thiazolidinediones decreased considerably.