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Ochuba A, Murdock CJ, Xu AL, Snow M, Schmerler J, Leland CR, McDaniel C, Thompson J, Aiyer AA. Open Reduction Internal Fixation vs Primary Arthrodesis for Lisfranc Fracture-Dislocations: A Cost Analysis. Foot Ankle Orthop 2024; 9:24730114231224727. [PMID: 38298264 PMCID: PMC10829492 DOI: 10.1177/24730114231224727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
Background Lisfranc fracture-dislocation is an uncommon but serious injury that currently lacks universal consensus on optimal operative treatment. Two common fixation methods are open reduction and internal fixation (ORIF) and primary arthrodesis (PA). The objective of this study is to analyze the cost difference between ORIF and PA of Lisfranc injuries, along with the contribution of medical services to overall costs. Methods This was a retrospective cost analysis of the MarketScan database from 2010 to 2020. MarketScan is an insurance and commercial claims database that integrates deidentified patient information. It captures person-specific clinical utilization, expenditures, and enrollment across inpatient and outpatient services. Patients undergoing primary ORIF (CPT code 28615) vs PA (28730 and 28740) for Lisfranc fracture-dislocation were identified. The primary independent variable was ORIF vs PA of Lisfranc injury. Total costs due to operative management was the primary objective. The utilization of and costs contributed by medical services was a secondary outcome. Results From 2010 to 2020, a total of 7268 patients underwent operative management of Lisfranc injuries, with 5689 (78.3%) ORIF and 1579 (21.7%) PA. PA was independently associated with increased net and total payment and coinsurance, clinic visits, and imaging, and patients attended significantly more PT sessions. Conclusion Using this large database that does not characterize severity or extent of injury, we found that treatment of Lisfranc fracture-dislocation with ORIF was associated with substantially lower initial episode of treatment costs compared with PA. Specific excessive cost drivers for PA were clinic visits, PT sessions, and imaging. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Arinze Ochuba
- Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Amy L. Xu
- Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Morgan Snow
- Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Christopher R. Leland
- Massachusetts General Hospital/Brigham and Women’s Hospital/Harvard Medical School, Boston, MA, USA
| | - Claire McDaniel
- Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - John Thompson
- Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
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Eisman JA, Cortet B, Boolell M, Ionescu-Ittu R, Vekeman F, Heroux J, Thomasius F. Fracture risk in women with osteoporosis initiated on gastro-resistant risedronate versus immediate release risedronate or alendronate: a claims data analysis in the USA. Osteoporos Int 2023; 34:977-991. [PMID: 36872338 PMCID: PMC10104910 DOI: 10.1007/s00198-022-06627-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/25/2022] [Indexed: 03/07/2023]
Abstract
UNLABELLED The study results indicate that women with osteoporosis initiated on gastro-resistant risedronate have a lower risk of fracture than those initiated on immediate release risedronate or alendronate. A large proportion of women discontinued all oral bisphosphonate therapies within 1 year of treatment start. PURPOSE Using a US claims database (2009-2019), we compared risk of fractures between women with osteoporosis initiated on gastro-resistant (GR) risedronate and those initiated on (a) immediate release (IR) risedronate or (b) immediate release alendronate. METHODS Women aged ≥ 60 years with osteoporosis who had ≥ 2 oral bisphosphonate prescription fills were followed for ≥ 1 year after the first observed bisphosphonates dispensing (index date). Fracture risk was compared between the GR risedronate and IR risedronate/alendronate cohorts using adjusted incidence rate ratios (aIRRs), both overall and in subgroups with high fracture risk due to older age or comorbidity/medications. Site-specific fractures were identified based on diagnosis codes recorded on medical claims using a claims-based algorithm. Persistence on bisphosphonate therapy was evaluated for all groups. RESULTS aIRRs generally indicated lower fracture risk for GR risedronate than IR risedronate and alendronate. When comparing GR risedronate to IR risedronate, statistically significant aIRRs (p < 0.05) were observed for pelvic fractures in the full cohorts (aIRRs = 0.37), for any fracture and pelvic fractures among women aged ≥ 65 years (aIRRs = 0.63 and 0.41), for any fracture and pelvic fractures among women aged ≥ 70 years (aIRRs = 0.69 and 0.24), and for pelvic fracture among high-risk women due to comorbidity/medications (aIRR = 0.34). When comparing GR risedronate to alendronate, statistically significant aIRRs were observed for pelvic fractures in the full cohorts (aIRR = 0.54), for any fracture and wrist/arm fractures among women aged ≥ 65 years (aIRRs = 0.73 and 0.63), and for any fracture, pelvic, and wrist/arm fractures among women aged ≥ 70 years (aIRRs = 0.72, 0.36, and 0.58). In all cohorts, ~ 40% completely discontinued oral bisphosphonates within 1 year. CONCLUSIONS Discontinuation rates of oral bisphosphonate therapy were high. However, women initiated on GR risedronate had a significantly lower risk of fracture for several skeletal sites than women initiated on IR risedronate/alendronate, particularly those aged ≥ 70 years.
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Affiliation(s)
- John A Eisman
- Bone Biology Division, Garvan Institute of Medical Research, Darlinghurst, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, Australia
- St Vincent's Hospital, UNSW Sydney, NSW, Sydney, Australia
| | - Bernard Cortet
- Service de Rhumatologie, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Mitra Boolell
- Theramex, Sloane Square House 1 Holbein Place Belgravia, London, SW1W 8NS, UK.
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A T, Lambrou GI, Samartzi A, Vlachou E, Papassotiriou I, Geronikolou SA, Kanaka-Gantenbein C, Chrousos GP, Kattamis A. Genotypic and Clinical Analysis of a Thalassemia Major Cohort: An Observational Study. Adv Exp Med Biol 2022; 1339:65-76. [PMID: 35023092 DOI: 10.1007/978-3-030-78787-5_10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Thalassemia major (TM) is a hereditary disease caused by defective globin synthesis. Because of the significant increase in life expectancy, these patients are suffering from various health conditions, including endocrinopathies and low bone mineral density. The aim of the present study was to investigate the correlation between clinical and biochemical parameters as well as to identify possible relations in a genotype to phenotype pattern. Sixty-four patients with TM (32 men and 32 women) participated in a cross-sectional study design. The patients were recruited from "Aghia Sofia" Children's Hospital. Clinical and biochemical parameters were evaluated as well as specific mutations were identified. We have found significant correlations between biochemical parameters and iron chelation, hormone replacement treatment as well as TM genotype and hematocrit and T-score. To conclude, the current study showed that clinical parameters of TM patients correlate significantly with both biochemical factors and genotypical patient parameters. Our present study showed that there is a connection between genotype and phenotype as, for example, the identified relation between hematocrit and T-scores and TM-specific mutations. This connection indicates that there is still much more to learn about the role of mutations not only in the disease itself but also in the underlying comorbidities.
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Affiliation(s)
- Tsartsalis A
- Department of Endocrinology Diabetes and Metabolism, Naval Hospital of Athens, Athens, Greece.
| | - George I Lambrou
- First Department of Pediatrics, Choremeio Research Laboratory, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasia Samartzi
- Department of Endocrinology Diabetes and Metabolism, Naval Hospital of Athens, Athens, Greece
| | - Eugenia Vlachou
- Department of Nursing, School of Health Sciences and Caring Professions, University of West Attica, Athens, Greece
| | - Ioannis Papassotiriou
- Department of Clinical Biochemistry, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Styliani A Geronikolou
- Clinical, Translational, Experimental Surgery Research Centerment of Pediatrics, Biomedical Research Foundation of Academy of Athens, Athens, Greece
| | - Christina Kanaka-Gantenbein
- First Department of Pediatrics, Division of Endocrinology Diabetes and Metabolism, National and Kapodistrian University of Athens, Athens, Greece
| | - George P Chrousos
- First Department of Pediatrics, Choremeio Research Laboratory, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonis Kattamis
- First Department of Pediatrics, Hematology/Oncology Unit, National and Kapodistrian University of Athens, Athens, Greece
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Thomasius F, Palacios S, Alam A, Boolell M, Vekeman F, Gauthier G. Fracture rates and economic outcomes in patients with osteoporosis prescribed risedronate gastro-resistant versus other oral bisphosphonates: a claims data analysis. Osteoporos Int 2022; 33:217-228. [PMID: 34490504 PMCID: PMC8758602 DOI: 10.1007/s00198-021-06108-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/17/2021] [Indexed: 01/22/2023]
Abstract
Patients with osteoporosis prescribed risedronate gastro-resistant had a lower incidence of fractures versus those prescribed other oral bisphosphonates. Administration of risedronate gastric-resistant does not require fasting, and this more convenient dosing administration may explain its improved efficacy. PURPOSE Up to half of patients do not follow complex dosing instructions of immediate-release bisphosphonates used for the prevention of osteoporotic fractures, which can result in suboptimal effectiveness. Risedronate gastro-resistant (GR) offers a more convenient dosing option by eliminating the need for fasting. This study compares fracture rates and outcomes between osteoporosis women treated with risedronate GR (GR cohort) versus other oral bisphosphonates (other cohort). METHODS Claims from women with osteoporosis in the USA were analyzed. Patients were classified into the two cohorts based on the first oral bisphosphonate observed (index date) and matched 1:1 based on patient characteristics. Patients were observed for ≥ 2 years following the index date. Fracture rates, health care resource utilization and costs, and treatment persistence were compared. RESULTS In total, 2,726 patients were selected in each cohort (median age: 60.0 years). The incidence of fractures was lower in the GR versus the other cohort for any fracture sites (incidence rate ratio, 95% CI: 0.83, 0.70-0.97) and spine fractures (0.71, 0.54-0.95), although the respective rate of medication discontinuation at 2 years was 80.5% and 74.4%. Time to first fracture was delayed for the GR cohort, reaching statistical significance after 36 months. The GR cohort incurred fewer hospitalizations (incidence rate per 1,000 patient-years: GR = 106.74; other = 124.20, p < 0.05) translating into lower hospitalization costs per patient per year (GR = $3,611; other = $4,603, p < 0.05). CONCLUSIONS Patients prescribed risedronate GR versus other bisphosphonates had a lower incidence of fractures, which may be explained by the fact that the GR formulation is absorbed even when taken with food.
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Tsartsalis AN, Lambrou GI, Vlachou E, Samartzi A, Chrousos GP, Kanaka-Gantenbein C, Kattamis A. The Effect of Treatment and Bone Metabolic Factors on Fracture Incidence in Patients with Thalassemia-Induced Osteoporosis: An Observational Study. CDTH 2020. [DOI: 10.2174/1574885515666200106110602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Thalassemia Major (TM) is a hereditary disease caused by defective globin synthesis. Because of the significant increase in life expectancy, these patients suffer from various health conditions, including endocrinopathies and low bone mineral density.
Aim:
The aim of the present study was to evaluate the fracture incidence regarding the markers of bone metabolism, bone mineral density and treatment of osteoporosis as well as treatment of comorbidities.
Methods:
Sixty-four patients with TM (32 men and 32 women) participated in a cross-sectional study design. The patients were recruited from “Aghia Sofia” Children’s Hospital and evaluated using dual-energy X-ray absorptiometry (DXA) of the lumbar spine and femoral neck and with markers of bone remodeling including receptor activator of nuclear factor kappa-Β ligand (RANKL), osteoprotegerin (OPG), C-terminal telopeptide (CTX), and sclerostin.
Results:
The statistical analysis of markers of bone metabolism in relation to fractures revealed no statistical significance. However, statistical analysis of bone mineral density and markers of bone metabolism in relation to fractures was also not significant.
Conclusions:
In TM patients, fractures are not related to bone mineral density. Maybe some other conditions are the cause, haemosidirosis, drugs, comorbid conditions.
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Affiliation(s)
- Athanasios N. Tsartsalis
- Naval Hospital of Athens, Department of Endocrinology Diabetes and Metabolism, Dinokratous 70, 11521, Athens, Greece
| | - George I. Lambrou
- First Department of Pediatrics, National and Kapodistrian University of Athens, Choremeio Research Laboratory, Thivon & Levadeias 8, 11527, Goudi, Athens, Greece
| | - Eugenia Vlachou
- Department of Nursing, School of Health Sciences and Care Professions, University of West Attica, Ag. Spydironos 28, 12243, Aigaleo, Athens, Greece
| | - Athanasia Samartzi
- Naval Hospital of Athens, Department of Endocrinology Diabetes and Metabolism, Dinokratous 70, 11521, Athens, Greece
| | - George P. Chrousos
- First Department of Pediatrics, National and Kapodistrian University of Athens, Choremeio Research Laboratory, Thivon & Levadeias 8, 11527, Goudi, Athens, Greece
| | - Christina Kanaka-Gantenbein
- First Department of Pediatrics, National and Kapodistrian University of Athens, Choremeio Research Laboratory, Thivon & Levadeias 8, 11527, Goudi, Athens, Greece
| | - Antonis Kattamis
- Hematology/Oncology Unit, First Department of Pediatrics, National and Kapodistrian University of Athens, Thivon & Levadeias 8, 11527, Goudi, Athens, Greece
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