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dc.contributor.authorSieluk, Jan
dc.date.accessioned2019-05-06T13:29:37Z
dc.date.available2019-05-06T13:29:37Z
dc.date.issued2018
dc.identifier.urihttp://hdl.handle.net/10713/8994
dc.description2018
dc.descriptionPharmaceutical Health Services Research
dc.descriptionUniversity of Maryland, Baltimore
dc.descriptionPh.D.
dc.description.abstractObjectives: The objective of this study was to isolate the healthcare resource utilization and economic burden attributable to the presence of a genetic factor among Chronic Obstructive Pulmonary Disease (COPD) patients with and without Alpha-1 Antitrypsin Deficiency (AATD), twelve months before and after their initial COPD diagnosis. Methods: Retrospective analysis of OptumLabs® Data Warehouse claims (OLDW; 2000 – 2017). The OLDW is a comprehensive, longitudinal real-world data asset with de-identified lives across claims and clinical information. AATD-associated COPD cases were matched with up to 10 unique non-AATD-associated COPD controls. Healthcare resource use and costs were assigned into the following categories: office (OV), outpatient (OP), and emergency room visits (ER), inpatients stays (IP), prescription drugs (RX), and other services (OTH). A generalized linear model was used to estimate total pre- and post-index (initial COPD diagnosis) costs from a third-party payer’s perspective (2018 USD) controlling for age, gender, race/ethnicity, census region, augmentation therapy use, oxygen use, insurance type, year of COPD diagnosis, and Charlson Comorbidity Score. Healthcare resource utilization was estimated using a negative binomial regression. Results: The study population consisted of 8,881 patients (953 cases matched with 7,928 controls). The AATD-associated COPD cohort had higher expenditures and use of OV and OTH services, as well as OV, OP, ER, RX, and OTH before and after the index date, respectively. Adjusted total cost ratios for AATD-associated COPD patients as compared to controls were 2.036 [95% CI: 1.601 – 2.590] and 1.976 [95% CI: 1.550 – 2.517] while the incremental cost difference totaled $6,861 [95% CI: $3,025 - $10,698] an $5,772 [95% CI: $1,940 - $9,604] per patient before and after the index date, respectively. Conclusions: Twelve months before and after their initial COPD diagnosis, patients with AATD incur higher healthcare utilization costs that are double the cost of similar patients without AATD. This study also suggests that increased costs of AATD-associated COPD are not solely attributable to augmentation therapy use. Future studies should further explore the relationship between augmentation therapy, healthcare resource use, and other AATD-associated COPD expenditures.
dc.subjectEconomics
dc.subjectPharmaceutical sciences
dc.subjecteconomic analysisen_US
dc.subjecthealth care resourcesen_US
dc.subject.meshalpha 1-Antitrypsin Deficiency--economicsen_US
dc.subject.meshCost-Benefit Analysisen_US
dc.subject.meshCost of Illnessen_US
dc.subject.meshPulmonary Disease, Chronic Obstructiveen_US
dc.subject.meshRare Diseasesen_US
dc.titleMedical Costs of Alpha-1 Antitrypsin Deficiency-associated Chronic Obstructive Pulmonary Disease in the United States
dc.typedissertationen_US
dc.date.updated2019-04-30T11:35:49Z
dc.language.rfc3066en
dc.contributor.advisorMullins, C. Daniel
dc.description.embargo07/01/2019
dc.contributor.orcid0000-0002-1833-0273
refterms.dateFOA2019-05-06T13:29:38Z


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