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Shrestha A, Roach M, Joshi K, Sheehan JJ, Goutam P, Everson K, Heerlein K, Jena AB. Incremental Health Care Burden of Treatment-Resistant Depression Among Commercial, Medicaid, and Medicare Payers. Psychiatr Serv 2020; 71:593-601. [PMID: 32237982 DOI: 10.1176/appi.ps.201900398] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study compared health care use and costs among patients with treatment-resistant versus treatment-responsive depression across Medicaid, Medicare, and commercial payers. METHODS A retrospective cohort study was conducted by using Truven Health Analytics' commercial (2006-2017; N=111,544), Medicaid (2007-2017; N=24,036), and Medicare supplemental (2006-2017; N=8,889) claims databases. Participants were adults with major depressive disorder who had received one or more antidepressant treatments. Treatment resistance was defined as failure of two or more antidepressant treatments of adequate dose and duration. Annual use (hospitalizations and outpatient and emergency department [ED] visits) and costs were compared across patients by treatment-resistant status in each payer population. Incremental burden of treatment-resistant depression was estimated with regression analyses. Monthly changes in costs during 1-year follow-up were assessed to understand differential cost trends by treatment-resistant status. RESULTS In the three payer populations, patients with treatment-resistant depression incurred higher health care utilization than those with treatment-responsive depression (hospitalization, odds ratios [ORs]=1.32-1.76; ED visits, ORs=1.38-1.45; outpatient visits, incident rate ratio=1.29-1.54; p<0.001 for all). Compared with those with treatment-responsive depression, those with treatment resistance incurred higher annual costs (from $4,093 to $8,054 higher; p<0.001). Patients with treatment-resistant depression had higher costs at baseline compared with patients with treatment-responsive depression and incurred higher costs each month throughout follow-up. CONCLUSIONS Treatment-resistant depression imposes a significant health care burden on insurers. Treatment-resistant depression may exist and affect health care burden before a patient is identified as having treatment-resistant depression. Findings underscore the need for effective and timely treatment of treatment-resistant depression.
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Affiliation(s)
- Anshu Shrestha
- Public Health Institute, Oakland (Shrestha); Precision Health Economics, Los Angeles (Roach, Everson); TCV, Menlo Park, California (Goutam); Janssen Scientific Affairs, LLC, Titusville, New Jersey (Joshi, Sheehan); Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Heerlein); Department of Health Care Policy, Harvard Medical School, Boston (Jena)
| | - Meaghan Roach
- Public Health Institute, Oakland (Shrestha); Precision Health Economics, Los Angeles (Roach, Everson); TCV, Menlo Park, California (Goutam); Janssen Scientific Affairs, LLC, Titusville, New Jersey (Joshi, Sheehan); Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Heerlein); Department of Health Care Policy, Harvard Medical School, Boston (Jena)
| | - Kruti Joshi
- Public Health Institute, Oakland (Shrestha); Precision Health Economics, Los Angeles (Roach, Everson); TCV, Menlo Park, California (Goutam); Janssen Scientific Affairs, LLC, Titusville, New Jersey (Joshi, Sheehan); Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Heerlein); Department of Health Care Policy, Harvard Medical School, Boston (Jena)
| | - John J Sheehan
- Public Health Institute, Oakland (Shrestha); Precision Health Economics, Los Angeles (Roach, Everson); TCV, Menlo Park, California (Goutam); Janssen Scientific Affairs, LLC, Titusville, New Jersey (Joshi, Sheehan); Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Heerlein); Department of Health Care Policy, Harvard Medical School, Boston (Jena)
| | - Prodyumna Goutam
- Public Health Institute, Oakland (Shrestha); Precision Health Economics, Los Angeles (Roach, Everson); TCV, Menlo Park, California (Goutam); Janssen Scientific Affairs, LLC, Titusville, New Jersey (Joshi, Sheehan); Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Heerlein); Department of Health Care Policy, Harvard Medical School, Boston (Jena)
| | - Katie Everson
- Public Health Institute, Oakland (Shrestha); Precision Health Economics, Los Angeles (Roach, Everson); TCV, Menlo Park, California (Goutam); Janssen Scientific Affairs, LLC, Titusville, New Jersey (Joshi, Sheehan); Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Heerlein); Department of Health Care Policy, Harvard Medical School, Boston (Jena)
| | - Kristin Heerlein
- Public Health Institute, Oakland (Shrestha); Precision Health Economics, Los Angeles (Roach, Everson); TCV, Menlo Park, California (Goutam); Janssen Scientific Affairs, LLC, Titusville, New Jersey (Joshi, Sheehan); Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Heerlein); Department of Health Care Policy, Harvard Medical School, Boston (Jena)
| | - Anupam B Jena
- Public Health Institute, Oakland (Shrestha); Precision Health Economics, Los Angeles (Roach, Everson); TCV, Menlo Park, California (Goutam); Janssen Scientific Affairs, LLC, Titusville, New Jersey (Joshi, Sheehan); Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Heerlein); Department of Health Care Policy, Harvard Medical School, Boston (Jena)
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Sussell J, Silverstein AR, Goutam P, Incerti D, Kee R, Chen CX, Batty DS, Jansen JP, Kasiske BL. The economic burden of kidney graft failure in the United States. Am J Transplant 2020; 20:1323-1333. [PMID: 32020739 DOI: 10.1111/ajt.15750] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 11/13/2019] [Accepted: 12/04/2019] [Indexed: 01/25/2023]
Abstract
Despite improvements in outcomes for kidney transplant recipients in the past decade, graft failure continues to impose substantial burden on patients. However, the population-wide economic burden of graft failure has not been quantified. This study aims to fill that gap by comparing outcomes from a simulation model of kidney transplant patients in which patients are at risk for graft failure with an alternative simulation in which the risk of graft failure is assumed to be zero. Transitions through the model were estimated using Scientific Registry of Transplant Recipients data from 1987 to 2017. We estimated lifetime costs, overall survival, and quality-adjusted life-years (QALYs) for both scenarios and calculated the difference between them to obtain the burden of graft failure. We find that for the average patient, graft failure will impose additional medical costs of $78 079 (95% confidence interval [CI] $41 074, $112 409) and a loss of 1.66 QALYs (95% CI 1.15, 2.18). Given 17 644 kidney transplants in 2017, the total incremental lifetime medical costs associated with graft failure is $1.38B (95% CI $725M, $1.98B) and the total QALY loss is 29 289 (95% CI 20 291, 38 464). Efforts to reduce the incidence of graft failure or to mitigate its impact are urgently needed.
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Affiliation(s)
| | | | | | | | - Rebecca Kee
- Precision Health Economics, Los Angeles, California
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Wagner G, Glick P, Khamma-sh U, Shaheen M, Brown R, Goutam P, Karam R, Linnemayr S, Massad S. Exposure to violence and its relationship to mental health in Palestinian youth. East Mediterr Health J 2019. [DOI: 10.26719/emhj.19.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Glick P, Khammash U, Shaheen M, Brown R, Goutam P, Karam R, Linnemayr S, Massad S. Perceived peer norms, health risk behaviors, and clustering of risk behaviors among Palestinian youth. PLoS One 2018; 13:e0198435. [PMID: 29927957 PMCID: PMC6013164 DOI: 10.1371/journal.pone.0198435] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 05/20/2018] [Indexed: 11/18/2022] Open
Abstract
Relatively little is known about patterns of health risk behaviors among Middle Eastern youth, including how these behaviors are related to perceived peer norms. In a sample of approximately 2,500 15–24 year old Palestinian youth, perceived engagement of general peers in alcohol consumption, drug use and sexual activity was substantially greater than youths’ own (self-reported) engagement in these activities, suggesting a tendency to overestimate the prevalence of risk-taking behavior among peers. Individual participation in a risk behavior strongly covaries with the perceived levels of both friends’ and peers’ engagement in that behavior (p = 0.00 in each case). In addition, significant clustering of risk behaviors is found: youth who participate in one risk behavior are more likely to participate in others. These findings for a rare representative sample of Middle Eastern youth are strikingly similar to those in the US and Europe. The clustering of behaviors suggests that prevention programs should be structured to deal with a range of connected risk behaviors for which certain youth may be at risk. The findings also suggest that adjusting expectations about peers’ behavior may reduce young Palestinians’ engagement in risk taking.
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Affiliation(s)
- Peter Glick
- Millennium Challenge Corporation, Washington, DC, United States of America
- * E-mail:
| | | | | | - Ryan Brown
- RAND Corporation, Santa Monica, California, United States of America
| | - Prodyumna Goutam
- RAND Corporation, Santa Monica, California, United States of America
| | - Rita Karam
- RAND Corporation, Santa Monica, California, United States of America
| | | | - Salwa Massad
- Palestinian National Institute of Public Health, Ramallah, Palestine
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Glick P, Al-Khammash U, Shaheen M, Brown R, Goutam P, Karam R, Linnemayr S, Massad S. Health risk behaviours of Palestinian youth: findings from a representative survey. East Mediterr Health J 2018; 24:127-136. [PMID: 29748941 PMCID: PMC9206082] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 05/15/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is little systematic information about health risk behaviours among youth in Middle Eastern countries, leaving public health authorities unprepared to deal with emerging public health threats at a time of major social change. AIM The Palestinian Youth Health Risk study investigates patterns of risk behaviours among Palestinian youth, their perceptions of the risks and benefits of such behaviours, and the relationship of exposure to violence with mental health and engagement in risk behaviours. METHODS We conducted a representative survey among 2500 individuals aged 15-24 years in the West Bank and East Jerusalem, permitting reliable comparison across sex and rural-urban divisions. A stratified 2-stage random sample was drawn from the 2007 population census, with strata formed by crossing the 12 governorates with urban, rural and refugee camp locations. Within strata, 208 survey clusters were sampled with probability proportional to size. Within each cluster, 14 households with youth of the appropriate age were sampled. RESULTS Among youth aged 20-24 years, 22.4% of males and 11.6% of females reported trying alcohol; 10.5% of males and 4.3% of females reported trying drugs. Almost one quarter of unmarried youth aged 20-24 years reported any sexual experience. Tobacco use is high, even among younger youth (45.4% of males and 21.2% of females aged 15-19 smoke). Risk behaviours are higher among males, older youth and in urban areas and refugee camps. CONCLUSION While smoking is of particular concern, prevention outreach for all behaviours should be directed at subgroups and areas identified as highest risk.
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Affiliation(s)
- Peter Glick
- RAND Corporation, Santa. Monica, California, United States of America
| | - Umaiyeh Al-Khammash
- Juzoor for Health and Social Development, Ramallah, West Bank.,United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), East Jerusalem, Palestine
| | | | - Ryan Brown
- RAND Corporation, Santa. Monica, California, United States of America
| | - Prodyumna Goutam
- RAND Corporation, Santa. Monica, California, United States of America
| | - Rita Karam
- RAND Corporation, Santa. Monica, California, United States of America
| | | | - Salwa Massad
- United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), East Jerusalem, Palestine.,Palestinian National Institute of Public Health, West Bank
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Glick P, Al Khammash U, Shaheen M, Brown R, Goutam P, Karam R, Linnemayr S, Massad S. Health risk behaviours of Palestinian youth: findings from a representative survey. East Mediterr Health J 2018. [DOI: 10.26719/2018.24.2.127] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Ramchand R, Jaycox L, Ebener P, Gilbert ML, Barnes-Proby D, Goutam P. Characteristics and Proximal Outcomes of Calls Made to Suicide Crisis Hotlines in California. Crisis 2017; 38:26-35. [DOI: 10.1027/0227-5910/a000401] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Background: Suicide hotlines are commonly used to prevent suicides, although centers vary with respect to their management and operations. Aims: To describe variability across suicide prevention hotlines. Method: Live monitoring of 241 calls was conducted at 10 suicide prevention hotlines in California. Results: Call centers are similar with respect to caller characteristics and the concerns callers raise during their calls. The proportion of callers at risk for suicide varied from 3 to 57%. Compliance with asking about current suicide risk, past ideation, and past attempts also ranged considerably. Callers to centers that were part of the National Suicide Prevention Lifeline (NSPL) were more likely to experience reduced distress than callers to centers that were not part of the NSPL. Conclusion: Because callers do not generally choose the center or responder that will take their call, it is critical to promote quality across call centers and minimize the variability that currently exists. Accrediting bodies, funders, and crisis centers should require that centers continuously monitor calls to ensure and improve call quality.
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Romley J, Goutam P, Sood N. National Survey Indicates that Individual Vaccination Decisions Respond Positively to Community Vaccination Rates. PLoS One 2016; 11:e0166858. [PMID: 27870907 PMCID: PMC5117726 DOI: 10.1371/journal.pone.0166858] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 11/05/2016] [Indexed: 11/25/2022] Open
Abstract
Some models of vaccination behavior imply that an individual's willingness to vaccinate could be negatively correlated with the vaccination rate in her community. The rationale is that a higher community vaccination rate reduces the risk of contracting the vaccine-preventable disease and thus reduces the individual's incentive to vaccinate. At the same time, as for many health-related behaviors, individuals may want to conform to the vaccination behavior of peers, counteracting a reduced incentive to vaccinate due to herd immunity. Currently there is limited empirical evidence on how individual vaccination decisions respond to the vaccination decisions of peers. In the fall of 2014, we used a rapid survey technology to ask a large sample of U.S. adults about their willingness to use a vaccine for Ebola. Respondents expressed a greater inclination to use the vaccine in a hypothetical scenario with a high community vaccination rate. In particular, an increase in the community vaccination rate from 10% to 90% had the same impact on reported utilization as a nearly 50% reduction in out-of-pocket cost. These findings are consistent with a tendency to conform with vaccination among peers, and suggest that policies promoting vaccination could be more effective than has been recognized.
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Affiliation(s)
- John Romley
- Price School of Public Policy, University of Southern California, Los Angeles, California, United States of America
- School of Pharmacy, University of Southern California, Los Angeles, California, United States of America
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, United States of America
| | - Prodyumna Goutam
- Pardee RAND Graduate School, RAND Corporation, Santa Monica, California, United States of America
| | - Neeraj Sood
- Price School of Public Policy, University of Southern California, Los Angeles, California, United States of America
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, United States of America
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Wagner GJ, Ngo V, Goutam P, Glick P, Musisi S, Akena D. A Structured Protocol Model of Depression Care versus Clinical Acumen: A Cluster Randomized Trial of the Effects on Depression Screening, Diagnostic Evaluation, and Treatment Uptake in Ugandan HIV Clinics. PLoS One 2016; 11:e0153132. [PMID: 27167852 PMCID: PMC4864192 DOI: 10.1371/journal.pone.0153132] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 03/24/2016] [Indexed: 11/18/2022] Open
Abstract
UNLABELLED Depression is common among people living with HIV, and it has consequences for both HIV prevention and treatment response, yet depression treatment is rarely integrated into HIV care in sub-Saharan Africa, partly due to the paucity of mental health professionals. We conducted a cluster randomized controlled trial of two task-shifting models to facilitating depression care delivered by medical providers: one that utilized a structured protocol, and one that relied on clinical acumen, in 10 HIV clinics in Uganda. Both models started with routine depression screening of all clients at triage using the 2-item Patient Health Questionnaire (PHQ-2), from which we enrolled 1252 clients (640 at structured protocol clinics, 612 at clinical acumen clinics) who had screened positive over 12 months. We compared the two models on (1) proportion of all client participants, and those clinically depressed (based on survey-administered 9-item PHQ-9>9), who received post-screening evaluation for depression using the PHQ-9; and (2) proportion of clinically depressed who were prescribed antidepressant therapy. Linear probability regression analyses were conducted using a wild cluster bootstrap to control for clustering; patient characteristics, clinic size and time fixed effects were included as covariates. Among all client participants, those in the structured protocol arm were far more likely to have received further evaluation by a medical provider using the PHQ-9 (84% vs. 49%; beta = .33; p = .01). Among the clinically depressed clients (n = 369), the advantage of the structured protocol model over clinical acumen was not statistically significant with regard to PHQ-9 depression evaluation (93% vs. 68%; beta = .21; p = .14) or prescription of antidepressants (69% vs. 58%; beta = .10; p = .50), in part because only 30% of clients who screened positive were clinically depressed. These findings reveal that in both models depression care practices were widely adopted by providers, and depression care reached most depressed clients. The structured protocol model is advantageous for ensuring that positively screened clients receive a depression evaluation, but the two models performed equally well in ensuring the treatment of depressed clients in the context of strong supervision support. TRIAL REGISTRATION ClinicalTrials.gov NCT02056106.
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Affiliation(s)
- Glenn J. Wagner
- RAND Corporation, Santa Monica, California, United States of America
| | - Victoria Ngo
- RAND Corporation, Santa Monica, California, United States of America
| | - Prodyumna Goutam
- RAND Corporation, Santa Monica, California, United States of America
| | - Peter Glick
- RAND Corporation, Santa Monica, California, United States of America
| | - Seggane Musisi
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | - Dickens Akena
- Department of Psychiatry, Makerere University, Kampala, Uganda
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Johnson G, Roberts D, Brown R, Cox E, Evershed Z, Goutam P, Hassan P, Robinson R, Sahdev A, Swan K. Infertile or childless by choice? A multipractice survey of women aged 35 and 50. Br Med J (Clin Res Ed) 1987; 294:804-6. [PMID: 3105749 PMCID: PMC1245864 DOI: 10.1136/bmj.294.6575.804] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Eleven general practitioners examined the medical records of all women on their lists born in 1950 (617 patients) and 1935 (533 patients) to determine the prevalence of childlessness and specialist consultations about infertility. Eighty eight (14.3%) of the women born in 1950 and 41 (7.7%) of those born in 1935 were childless. Sixty eight women born in 1950 (11.0%) and 17 born in 1935 (3.2%) were considered childless by choice. Involuntary childlessness was found in 20 (3.3%) of the women born in 1950 and 24 (4.5%) born in 1935. Forty two (6.8%) of the women born in 1950 had consulted a specialist about infertility as compared with 19 (3.6%) born in 1935. This study found a significant increase in voluntary childlessness among the younger women; there was no evidence of a change in the prevalence of involuntary childlessness despite the increasing demand for specialist referral, which appeared to be made by women who were parous or destined to become so.
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