Osteoporotic fracture trends in a population of US managed care enrollees from 2007 to 2017.

This study expands on previous findings that hip fracture rates may no longer be declining. We found that age- and sex-adjusted fracture rates in the US plateaued or increased through mid-2017 in a population of commercially insured and Medicare Advantage health plan enrollees, in contrast to a decline from 2007 to 2013. INTRODUCTION: The purpose of this study was to evaluate fracture trends in US commercial and Medicare Advantage health plan members aged ≥ 50 years between 2007 and 2017. METHODS: Retrospective analysis of the Optum Research Database from January 1, 2007, to May 31, 2017. RESULTS: Of 1,841,263 patients identified with an index fracture, 930,690 were case-qualifying and included in this analysis. The overall age- and sex-adjusted fracture rate decreased from 14.67/1000 person-years (py) in 2007 to 11.79/1000 py in 2013, followed by a plateau for the next 3 years and then an increase to 12.50/1000 py in mid-2017. In females aged ≥ 65 years, fracture rates declined from 27.49/1000 py in 2007 to 22.08/1000 py in 2013, then increased to 24.92/1000 py in mid-2017. Likewise, fracture rates in males aged ≥ 65 years declined from 2007 (12.00/1000 py) to 2013 (10.72/1000 py), then increased to 12.04/1000 py in mid-2017. The age- and sex-adjusted fracture rates for most fracture sites declined from 2007 to 2013 by 3.7% per year (P = 0.310). CONCLUSIONS: Following a consistent decline in fracture rate from 2007 to 2013, trends from 2014 to 2017 indicate fracture rates are no longer declining and, for some fracture types, rates are rising.

Differences in survival for patients with metastatic colorectal cancer by lines of treatment received and stage at original diagnosis.

OBJECTIVE: Few published studies have examined survival rates for patients with metastatic colorectal cancer (mCRC) by number of lines of treatment received or stage at diagnosis. This study aims to evaluate survival and numbers of lines of treatment in USA mCRC managed care patients. METHODS: To evaluate the impact of chemotherapy/biological on survival of patients with mCRC, adults with a diagnosis of CRC between 1 January 2005 and 31 May 2010 were identified from the Oncology Management registry. Registry data included stage and diagnosis date. Patients with stage IV CRC at original diagnosis or development of metastasis were included. Linked healthcare claims from a large USA database were used to identify lines of treatment after metastasis and patient characteristics. The patient population was enrolled in a commercial health insurance programme, with 10% of patients > 65 years of age. Patients were categorised by lines of treatment received (0, 1, 2, 3+) and stage at original diagnosis (0-3, 4, unknown). Survival following metastasis was evaluated using Cox proportional hazards models controlling for lines of treatment, disease stage, and other patient characteristics. RESULTS: Study population included commercially insured adult patients, ≥ 18 years of age (n = 598, mean age 54, 56% male), 16% of which did not receive chemotherapy/biological therapy after becoming metastatic, and 33% received only 1 line of treatment. Average follow-up was 653 days, and 19% of patients died during the study period. Mean unadjusted length of follow-up was 516, 511, 627 and 930 days for patients who received 0, 1, 2 and 3+ lines of treatment, respectively. In the Cox proportional hazards model, geographical region was the only variable significantly associated with survival (p < 0.05). CONCLUSION: Lines of treatment received and stage at original diagnosis were not statistically significantly associated with survival after metastasis development.

Evaluation of hospitalization and follow-up care costs among patients hospitalized with ACS treated with a stent and clopidogrel.

OBJECTIVE: This retrospective claims study was performed to evaluate the initial and subsequent healthcare costs in patients with acute coronary syndrome (ACS) who had been treated with stent placement and clopidogrel following discharge from the hospital. METHOD AND RESULTS: This was a retrospective, administrative claims-based analysis from a large, geographically diverse US managed care plan affiliated with i3 Innovus. Study subjects were commercially insured enrollees, aged > or = 18, who were hospitalized for ACS between 1 January 2000 and 31 December 2004 with a stent placed, and had at least one filled prescription for clopidogrel within 7 days of discharge from the index hospitalization. Of the 9135 subjects included in the cost analysis, 2241 subjects experienced a subsequent event. On average, subjects with a second event incurred $32,495 more in medical costs over 2 years and $39,742 more in medical costs over 3 years versus those who did not have a second event. Excluding ischemic hospitalizations, subjects with a second event incurred $7257 and $9724 more in medical costs than patients without a second event during the 2 and 3 years following discharge from the index hospitalization, respectively. CONCLUSIONS: Significant cost increases were observed among patients who had a subsequent hospitalization for an ischemic event compared to those without a subsequent hospitalization. Cost increases were still present after excluding costs of the ischemic hospitalizations. The findings of this study must be considered within the limitations of database analysis as claims data are collected for the purpose of payment and not research.