3 results
Reduced Healthcare Resource Utilization in Patients With Chronic Insomnia 24 Months After Treatment With Digital CBT-I: A Matched-Control Study
- Felicia Forma, Tyler Knight, Rebecca Baik, Matthew Wallace, Dan Malone, Xiaorui Xiong, Fulton Velez, Frances Thorndike, Yuri Maricich
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- Journal:
- CNS Spectrums / Volume 28 / Issue 2 / April 2023
- Published online by Cambridge University Press:
- 14 April 2023, pp. 228-229
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Introduction
This analysis examined the impact of a digital therapeutic for treating chronic insomnia (currently marketed as Somryst®, at the time called Sleep Healthy Using The internet [SHUTi]) on healthcare resource use (HCRU) by comparing patients treated with the digital cognitive behavioral therapy for insomnia (dCBTi) to patients not treated with dCBTi, but with insomnia medications.
MethodsA retrospective observational study using health claims data was conducted in two cohorts across the United States: patients who registered for dCBTi (cases) between June 1, 2016 and October 31, 2018 (index date) vs. patients who did not register for dCBTi but initiated a second prescription for an insomnia medication in the same time period (controls). Observation period was 16–24 months. No other inclusion/exclusion criteria were used. Control patients were matched using a nearest neighbor within-caliper matching without replacement approach. Incidence rates for HCRU encounter type were calculated using a negative binomial model for both cohorts. Costs were estimated by multiplying HCRU by published average costs for each medical resource.
ResultsEvaluated were 248 cases (median age 56.5 years, 57.3% female, 52.4% treated with sleep-related medications) and 248 matched controls (median age 55.0 years, 56.0% female, 100.0% treated with sleep-related medications). Over the course of 24 months post-initiation, cases had significantly lower incidences of inpatient stays (55% lower, IRR: 0.45; 95% CI: 0.28–0.73; P=0.001), significantly fewer emergency department (ED) visits without inpatient admission (59% lower; IRR: 0.41; 95% CI: 0.27–0.63; P<0.001), and significantly fewer hospital outpatient visits (36% lower; IRR: 0.64; 95% CI: 0.49–0.82; P<0.001). There was also a trend for fewer ambulatory surgical center visits (23% lower; IRR: 0.77; 95% CI: 0.52–1.14; P=0.197) and fewer office visits (7% lower; IRR: 0.93; 95% CI: 0.81–1.07; P=0.302) with the use of SHUTi. Use of sleep medications was more than four times greater in controls vs. cases, with 9.6 (95% CI: 7.88–11.76) and 2.4 (95% CI: 1.91–2.95) prescriptions/patient, respectively (P<0.001). All-cause per-patient HCRU costs were $8,202 lower over 24 months for cases vs. controls, driven primarily by a lower incidence of hospitalizations (-$4,996 per patient) and hospital outpatient visits (-$2,003 per patient).
ConclusionsPatients with chronic insomnia who used a digital CBTi treatment had significant and durable real-world reductions in hospital inpatient stays, ED visits, hospital outpatient visits, and office visits compared to matched controls treated with medications.
FundingPear Therapeutics (US), Inc.
A systematic review of real-world healthcare resource use and costs of Clostridioides difficile infections
- Daniel C. Malone, Edward P. Armstrong, Dan Gratie, Sissi V. Pham, Alpesh Amin
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 3 / Issue 1 / 2023
- Published online by Cambridge University Press:
- 17 January 2023, e17
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Objective:
To conduct a systematic review of published real-world evidence describing the cost and healthcare resource use for Clostridiodes difficile infection (CDI) in the United States.
Methods:A systematic literature review was conducted searching for terms for CDI and healthcare costs. Titles of articles and abstracts were reviewed to identify those that met study criteria. Studies were evaluated to examine overall design and comparison groups in terms of healthcare resource use and cost for CDI.
Results:In total, 28 articles met the inclusion criteria. Moreover, 20 studies evaluated primary CDI or did not specify, and 8 studies1–8 evaluated both primary CDI and recurrent (rCDI). Data from Medicare were used in 6 studies. Nearly all studies used a comparison group, either controls without CDI (N = 20) or comparison between primary CDI and rCDI (N = 7). Two studies examined costs of rCDI by the number of recurrences. Overall, the burden of CDI is significant, with higher aggregate costs for patients with rCDI. Compared with non-CDI controls, hospital length of stay increased in patients with both primary and rCDI compared to patients without CDI. Patients with primary CDI cost healthcare systems $24,000 more than patients without CDI. Additionally, 2 studies that evaluated the impact of recurrence among those patients with an index case of CDI demonstrated significantly higher direct all-cause medical costs among those with rCDI compared to those without.
Conclusion:CDI, and particularly rCDI, is a costly condition with hospitalizations being the main cost driver.
11 - NETWORKS – The assessment of marine reserve networks: guidelines for ecological evaluation
- from Part IV - Scale-up of marine protected area systems
- Edited by Joachim Claudet, Centre National de la Recherche Scientifique (CNRS), Paris
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- Book:
- Marine Protected Areas
- Published online:
- 05 August 2012
- Print publication:
- 29 September 2011, pp 293-321
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Summary
Introduction
As marine ecosystems are plagued by an ever-increasing suite of threats including climate change, pollution, habitat degradation, and fisheries impacts (Roessig et al., 2004; Lotze et al., 2006; Jackson, 2008), there are now no ocean areas that are exempt from anthropogenic impacts (Halpern et al., 2008). In order to preserve marine biodiversity, ecosystem function, and the goods and services provided by resistant and/or resilient systems, marine reserves have been increasingly recommended as part of an ecosystem-based approach to management (Browman and Stergiou, 2004; Levin et al., 2009). Marine reserves are defined as “areas of the ocean completely protected from all extractive and destructive activities” (Lubchenco et al., 2003) and can be experimental controls for evaluating the impact of these activities on marine ecosystems. Growing scientific information has shown consistent increases in species density, biomass, size, and diversity in response to full protection inside reserves of varying sizes and ages located in diverse regions (Claudet et al., 2008; Lester et al., 2009; Molloy et al., 2009). However, most of these data are from individual marine reserves and therefore have inherently limited transferability to networks of marine reserves, which when properly designed can outperform single marine reserves for a variety of ecological, economic, and social management goals (Roberts et al., 2003; Almany et al., 2009; Gaines et al., 2010).
The concept of marine reserve networks grew out of a desire to achieve both conservation and fishery management goals by minimizing the potential negative economic, social, and cultural impacts of a single large reserve while still producing similar or even greater ecological and economic returns (Murray et al., 1999; Gaines et al., 2010). In addition, reserves networks can provide insurance by protecting areas across a region and spreading the risk that these sites may be impacted by localized catastrophes such as hurricanes or oil spills (Allison et al., 2003). The World Conservation Union's Marine Programme defines a network as “a collection of individual marine protected areas (MPAs) or reserves operating co-operatively and synergistically, at various spatial scales and with a range of protection levels that are designed to meet objectives that a single reserve cannot achieve” (IUCN–WCPA, 2008). However, general terms such as “co-operatively” and “synergistically” can have myriad meanings. Without a clear definition of a network, it becomes difficult to identify attainable management goals and design a process for evaluating whether the network achieves those goals. Besides, different management goals may in turn result in the need for different types of networks. The use of MPAs with varying protection levels together with no-take zones in multiple-zoning schemes adds another layer of complexity to network design and evaluation; however, partially protected areas are generally used to manage coastal uses and avoid conflicts (rather than for strict ecological purposes) and are therefore a function of the local social, economic, and cultural context. As we are here interested in the ecological effects of networks, for the purposes of this chapter, we focus on marine reserves because these areas are no-take and therefore offer greater ecological benefits than other types of MPAs that allow some forms of extraction (Lester and Halpern, 2008).