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Medicare Database (medicare + database)
Selected AbstractsProphylactic strategies for hepatitis B patients undergoing liver transplant: A cost-effectiveness analysisLIVER TRANSPLANTATION, Issue 5 2006Yock Young Dan Hepatitis B immunoglobulin with lamivudine prophylaxis (LAM/HBIG) is effective in preventing Hepatitis B (HBV) recurrence posttransplant but is expensive and inconvenient. Lamivudine-resistant HBV, which has limited the usefulness of lamivudine monoprophylaxis in transplant, can now be effectively controlled with adefovir dipivoxil. We performed a cost-effectiveness analysis on the strategies of lamivudine prophylaxis with adefovir rescue(LAM/ADV) compared to combination LAM/intravenous fixed high-dose HBIG prophylaxis(LAM/ivHBIG) or LAM/intramuscular HBIG prophylaxis(LAM/imHBIG). Markov modeling was performed with analysis from societal perspective. Probability rates were derived from systematic review of the literature and cost taken from MEDICARE database. Outcome measures were incremental cost-effectiveness ratio(ICER) and cost to prevent each HBV recurrence and death. Analysis was performed at 5 years posttransplant as well as at end of life expectancy (15 years). Combination LAM/ivHBIG cost an additional USD562,000 at 15 years, while LAM/imHBIG cost an additional USD139,000 per patient compared to LAM/ADV. Although there is an estimated increase in recurrence of 53% with LAM/ADV and 7.6% increased mortality at the end of life expectancy (15 years), the ICER of LAM/ivHBIG over LAM/ADV treatment is USD760,000 per quality-adjusted life-years and for LAM/imHBIG, USD188,000. Cost-effectiveness is most sensitive to cost of HBIG. Lamivudine prophylaxis with adefovir dipivoxil salvage offers the more cost-effective option for HBV patients undergoing liver transplant but with higher recurrence and death rate using a model that favors LAM/HBIG. Lowering the cost of HBIG maintenance will improve cost-effectiveness of LAM/HBIG strategy. In conclusion, a tailored approach based on individual risks will optimize the cost-benefit of HBV transplant prophylaxis. Liver Transpl 12:736,746, 2006. © 2006 AASLD. [source] Assessment of the abbreviated Duke Social Support Index in a cohort of older Australian womenAUSTRALASIAN JOURNAL ON AGEING, Issue 2 2004Jennifer R Powers Objectives: To assess the acceptability, reliability and validity of the 11-item Duke Social Support Index (DSSI) in community-dwelling older Australian women, and to describe its relationship with the women's sociodemographic and health characteristics. Methods: Women aged 70,75 years were randomly selected from the national Medicare database, with over-sampling of rural and remote areas. The mailed survey included items about social support, Medical Outcomes Study Short Form Health Survey (SF-36), health service use, recent life events and sociodemographics. Results: All DSSI items were completed by 94% of the 12 939 participants. Internal reliability was reasonable for 10 of the 11 DSSI items and its factors, social interaction (four items) and satisfaction with social support (six items; Cronbach's alpha of 0.8, 0.6, 0.8). The factor structure was consistent for subgroups of women: urban/non-urban; English speaking/non-English speaking background; married/widowed. Summed scores were highly correlated with factor scores and showed good construct validity. Higher social support was associated with better physical and mental health, being Australian born, more educated and better able to manage on income. Conclusion: Ten of the 11 DSSI items provided an acceptable, brief and valid measure of social support for use in mailed surveys to community-dwelling older women. [source] Tracing 8,600 participants 36 years after recruitment at age seven for the Tasmanian Asthma StudyAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2 2006Cathryn Wharton Objective: To trace all participants 36 years after the original Tasmanian Asthma Study (TAS). Methods: In 1968, the TAS investigated asthma in 8,583 children who were born in 1961. We attempted to trace these participants in 2002,04 using names, dates of birth and gender. Current addresses were sought by computer linkage to the Commonwealth Electoral Roll, the Medicare database and the Tasmanian marriage records. Computer linkage was conducted with the National Death Index (NDI). Siblings of participants were also linked to the Commonwealth Electoral Roll and those identified were sent a letter requesting the participant's address. The Australian Twin Registry (ATR) and the 1991,93 TAS substudy were used to locate participant addresses. Results: After three rounds of electoral roll linkage, 56% of all cohort members were traced. Name changes were identified for 49% of the 3,477 females not initially matched to the electoral roll using linkage to marriage records. NDI linkage yielded a 0.7% match. Medicare linkage identified addresses for 27% of the 1,982 remaining participants. Writing to siblings located 60% of 1,661 participants. One hundred and eighty-three participants were matched to the 1991,93 TAS and 23 twins matched to the ATR. Overall, 81.5% of the cohort members were identified. Conclusions: With these methods, we have been able to trace a possible address for a large portion of the original participants, with the electoral roll linkage being the most useful. Implications: It is possible to trace Australians for follow-up studies using electronic linkage, although without unique identifiers it is labour and resource intensive and requires matching to several databases. [source] Late gastrointestinal toxicity after radiation for prostate cancerCANCER, Issue 2 2006Sharon H. Giordano MD Abstract BACKGROUND. The current study was designed to determine rates and predictors of late, lower gastrointestinal toxicity after radiation therapy in a population-based cohort of older men with prostate cancer. METHODS. The study population consisted of men with localized or regional stage prostate cancer who were age ,66 years and were diagnosed between 1992 and 1999 who were identified in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Gastrointestinal diagnoses were ascertained through claims from 6 to 60 months after diagnosis. The relative rates of diagnoses in the radiation group versus the nonradiation group were used as a means of estimating toxicity from radiotherapy. Cox modeling was used to determine factors associated with gastrointestinal diagnoses. RESULTS. A total of 57,955 men were included, 24,130 of whom were treated with radiation therapy. Among patients with 5 years of follow-up, the rates of gastrointestinal diagnoses were 19.4% higher in irradiated patients than among patients who did not have local therapy. Hemorrhage was the most common diagnosis, and was increased by 18.9% among patients treated with radiation (39.6% of irradiated patients vs. comparison rates of 18.2% in patients treated with radical prostatectomy and 20.7% in patients with no local therapy). Diagnostic lower endoscopies were performed in an additional 20.9% of men (32.4% of men treated with radiation vs. 12.7% of men who underwent prostatectomy). In all, 4.4% of irradiated men were hospitalized with a gastrointestinal diagnosis versus comparison rates of 3.2% among men with no local therapy. In multivariate models, increasing patient age, hormonal therapy, comorbidity, diabetes, peripheral vascular disease, and hemorrhoids were all associated with gastrointestinal diagnoses consistent with toxicity, whereas tumor stage and grade were not predictors. CONCLUSIONS. Lower gastrointestinal toxicity after radiation therapy for prostate cancer continues for at least 5 years and may be more common than previously reported. Cancer 2006. © 2006 American Cancer Society. [source] | ||||||||||