BACKGROUND: Medication nonadherence to antipsychotic drugs, which is commonly seen in patients with schizophrenia who have comorbidities, not only affects the quality of life of individuals suffering from the condition, but can also lead to worsening of disease condition, adverse outcomes, excessive use of health care resources, and higher medical costs. OBJECTIVE: To determine the effect of nonadherence to antipsychotics and related disease comorbidities on medical care utilization with respect to inpatient hospital visits, outpatient visits, office visits, and emergency room (ER) visits. METHODS: Retrospective, cross-sectional research data was obtained from the Medical Expenditure Panel Surveys (MEPS) for the years 2010-2014. The proportion of days covered (PDC) adherence measure was used to identify and classify individuals as adherent (PDC ≥ 80%) or nonadherent (PDC < 80%). A logistic regression analysis was used to further examine the effect of key study variables and comorbidity on medication nonad...

BACKGROUND: Limited evidence exists regarding long-term effectiveness and safety of aldosterone antagonists (AAs) versus beta blockers (BBs) as fourth-line antihypertensive agents in patients with resistant hypertension (RH). We evaluated the comparative effectiveness and safety of aldosterone AA versus BB. METHODS: We conducted a real-world retrospective cohort study using IBM MarketScan commercial claims and Medicare Supplemental claims (2007–2019). Patients with RH entered the cohort (ie, index date) when they newly initiated either AA or BB. The effectiveness outcome was major adverse cardiovascular events. Safety outcomes were hyperkalemia, gynecomastia, and kidney function deterioration. Potential confounding was addressed by adjustment for baseline characteristics via stabilized inverse probability of treatment weighting (SIPTW) based on propensity scores. Cox proportional hazards regression with SIPTWs were used to estimate adjusted hazard ratio (aHR) and 95% CI comparing risk for outcomes between AA and BB groups. RESULTS: We identified 80 598 patients with RH (mean age: 61 years, 51% males), of which 6626 initiated AA and 73 972 initiated BB as the fourth antihypertensive agent. Among patients with RH, initiation of AA as a fourth-line antihypertensive agent did not significantly reduce major adverse cardiovascular event risk relative to BB initiation (aHR, 0.77 [95% CI, 0.50–1.19]) but did substantially increase the risk of hyperkalemia (aHR, 3.86 [95% CI, 2.78–5.34]), gynecomastia (aHR, 9.51 [95% CI, 5.69–15.89]), and kidney function deterioration (aHR, 1.63 [95% CI, 1.34–1.99]). CONCLUSIONS: Long-term clinical trials powered to assess major adverse cardiovascular events are necessary to understand the risk-benefit trade-off of AA as fourth-line therapy for RH.

Purpose: Pain medications are widely prescribed to treat chronic back pain (CBP). However, the effect of using pain medications on individuals with CBP has received very little attention. Objective: The aim of this study was to determine the patterns of pharmacological treatment in the population with CBP and assess its impact on quality of life, health care utilization and associated costs in USA. Patients and methods: Retrospective, cross-sectional data obtained from the Medical Expenditure Panel Survey (MEPS), from 2011 to 2015, were utilized for this study. Pharmacological treatment for CBP was categorized into three mutually exclusive categories: 1) opioids only, 2) nonsteroidal anti-inflammatory drugs (NSAIDs) only, 3) opioids and NSAIDs (combination). The effect of the use of these treatments was also evaluated. Results: A total of 5,203 individuals with CBP were identified. Of these, 2,568 (49.4%) utilized opioids only, 1,448 (27.8%) utilized NSAIDs only and 1,187 (22.8%) utilized both pain medications. Lower health-related quality-of-life scores on both the Short Form Health Survey-12 version 2 (SF-12v2) components (mental component summary score: 44.42 vs 46.67, P<0.001; physical component summary score: 35.34 vs 40.11, P<0.001) were observed for the opioid-only group compared to the NSAID-only group. In addition, individuals utilizing opioids only had greater utilization of inpatient services, office-based services, outpatient services and emergency room visits along with higher related health care costs. Conclusion: Future researchers need to investigate the long-term risks and benefits of opioids, and policy makers should evaluate the prescribing guidelines to aim for a more patient-centered care.

Pneumonia is the leading cause of hospitalization in pediatric patients. Disease severity greatly influences pneumonia progression and adverse health outcomes such as hospital readmission. Hospital readmissions have become a measure of healthcare quality to reduce excess expenditures. The aim of this study was to examine 30-day all-cause readmission rates and evaluate the association between pneumonia severity and readmission among pediatric pneumonia hospitalizations. Using 2018 Nationwide Readmissions Database (NRD), we conducted a cross-sectional study of pediatric hospitalizations for pneumonia. Pneumonia severity was defined by the presence of respiratory failure, sepsis, mechanical ventilation, dependence on long-term supplemental oxygen, and/or respiratory intubation. Outcomes of interest were 30-day all-cause readmission, length of stay, and cost. The rate of 30-day readmission for the total sample was 5.9%, 4.7% for non-severe pneumonia, and 8.7% for severe pneumonia (p < 0.01). Among those who were readmitted, hospitalizations for severe pneumonia had a longer length of stay (6.5 vs. 5.4 days, p < 0.01) and higher daily cost (USD 3246 vs. USD 2679, p < 0.01) than admissions for non-severe pneumonia. Factors associated with 30-day readmission were pneumonia severity, immunosuppressive conditions, length of stay, and hospital case volume. To reduce potentially preventable readmissions, clinical interventions to improve the disease course and hospital system interventions are necessary.

AimsTo compare all-cause and Alzheimer's disease (AD)-related healthcare resource utilization (HCRU) by cognitive stage.Methods and MaterialsThis retrospective study analyzed insurance claims data linked to electronic health records (01/01/2015-12/31/2021). Patients with ≥1 cognitive assessment (Mini-Mental State Examination or Montreal Cognitive Assessment) and ≥1 medical or pharmacy claim for an AD diagnosis or AD medications were included. Inverse probability of treatment weighting (IPTW) was used to address potential confounding. All-cause and AD-related HCRU were summarized per patient per year (PPPY) and compared between early AD and advanced AD cohorts (defined according to cognitive scores) using generalized linear regression models; adjusted incidence rate ratios (IRRs), and 95% confidence intervals (CI) were reported.ResultsA total of 193 patients were included (median age: 82 years; 63.2% female), 108 with early AD and 85 with advanced AD, with similar mean follow up. All-cause HCRU, on average, was similar between early AD and advanced AD cohorts (37.4 PPPY and 38.9 encounters PPPY, respectively). For AD-related HCRU, patients with early AD had fewer encounters PPPY, on average, than patients with advanced AD (1.26 and 3.88 encounters, respectively). Following IPTW adjustment, the advanced AD cohort had significantly higher overall AD-related HCRU (IRR: 3.64 [95% CI: 1.96-6.75], p <0.001) and outpatient visits (IRR: 2.76 [95% CI: 1.68-4.54], p <0.001) compared to the early AD cohort.LimitationsThe relatively small sample size of patients with linked claims and cognitive score data limited the ability to assess contribution of all encounter types to HCRU trends, as well as generalizability to the broader AD population.ConclusionsAlthough all-cause HCRU was similar, patients with advanced AD incurred higher AD-related HCRU compared to patients living with early AD. Further research is needed to determine whether interventions earlier in disease progression can mitigate the AD-related healthcare burden for patients with advanced AD.