End-stage renal disease-associated managed care costs among patients with and without diabetes.

OBJECTIVE: To examine the direct costs of care before and after onset of end-stage renal disease (ESRD) for patients with and without diabetes based on analyses of retrospective healthcare claims data. RESEARCH DESIGN AND METHODS: Patients with onset of ESRD between January 1998 though June 2002 were identified based on use of dialysis, renal transplantation, or other ESRD-related services. Continuous health plan enrollment > or =12 months before and > or =1 month after ESRD onset was required. The costs calculated include both observed and adjusted estimates; the latter were calculated using generalized linear models, controlling for demographic and clinical characteristics, "onset" period, and duration of follow-up. Analyses focus on the diabetic ESRD patient and include a comparison with ESRD patients without diabetes. RESULTS: The study included 2,020 patients with diabetes and 2,170 without diabetes; 63% of patients were >50 years of age. Average costs were relatively stable before ESRD ($1,535 to $4,357 for diabetes, $1,082 to $2,447 for no diabetes) but more than doubled in the month preceding onset ($9,152 and $8,211, respectively). Postonset, average monthly per-patient costs escalated sharply in the 1st month ($26,507 and $26,789), declined steadily through month 6, and remained flat but elevated thereafter. Adjusted annual costs per patient pre- and postonset of ESRD were significantly higher for diabetes (P <0.0001); annual costs were 69% ($38,041 vs. $22,538) and 79% ($96,014 vs. $53,653) higher pre- and postonset, respectively. CONCLUSIONS: The economic burden of ESRD in the year after onset is substantial, particularly among patients with diabetes.

Clinical and economic impact of glatiramer acetate versus beta interferon therapy among patients with multiple sclerosis in a managed care population.

OBJECTIVE: To examine the outcomes of use of glatiramer acetate (GA) versus beta interferons-1a (intramuscular) (1A) and -1b (1B) in patients with multiple sclerosis (MS) in a managed care setting. METHODS: Data were obtained from a national retrospective claims database from January 1996 to June 2001. Patients were followed from the first prescription for immunomodulatory therapy until plan disenrollment or end of study time frame. The incidence of all relapses (defined as hospitalization for MS or ambulatory visit followed by use of systemic corticosteroids) as well as utilization and costs of MS-related care were examined for each group. Data were adjusted for variable follow-up using survival techniques. RESULTS: A total of 8,457 patients receiving immunomodulatory therapy were included in the study cohort; follow-up averaged 17.3 months. Three quarters of patients were female; the mean age was 42.2 years. The risk of relapse (defined as number of new cases) at one year was significantly increased for the beta interferons relative to GA (hazard rates: 1.15 and 1.51 for 1A and 1B, respectively, P<0.01). Mean (+/- SD) costs of care also were reduced among GA patients ($9,522 [+/- $9,706] versus $9,957 [+/- $9,083] and $10,185 [+/- $9,526] for 1A and 1B, respectively). These findings persisted in multivariate analyses, controlling for differences in demographic characteristics and propensity scores for immunomodulatory therapy. CONCLUSIONS: Glatiramer acetate is associated with reductions in the incidence of relapse and costs of care relative to the beta interferons among this large group of managed care patients with MS.