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Patients with chronic gout refractory to conventional urate-lowering therapy have high rates of flares and incidence of tophi, which impose a significant disease and potentially economic burden. This study examined healthcare resource use and costs stratified by disease burden. Adult patients diagnosed with gout (ICD-9-CM:274.xx) and having had ≥3 flares defined by clinical surrogates within a 12-month period were selected for the case cohort from the Thomson MarketScan databases (2003/Q3-2008/Q3). Only patients who had received allopurinol treatment and a diagnosis of tophi (ICD-9-CM:274.8x) at any time before the first flare (index date) or within 12 months postindex were included and were matched in a 1:1 ratio with control gout-free subjects. The comorbidity burden, healthcare resource use, and annual healthcare costs (2008 US$) in the 12-month postindex period were compared between both cohorts using regression models adjusted for demographic characteristic and stratified for patients with ≥6 flares. A total of 679 gout patients met the inclusion criteria for the study and had a higher prevalence of comorbidities than their matched controls. Gout cohort had a significantly higher incidence of emergency room, hospitalizations, outpatient visits, and other medical services than did their matched controls (all comparisons, uncorrected P < 0.01). After adjusting for baseline characteristics, the refractory gout cohort incurred an incremental total annual healthcare cost of $10,222 where 40% of the annual medical cost was for gout-related care compared with control cohort (P < 0.01). Patients with refractory gout have a significant economic burden compared with a gout-free population.

Crohn's disease (CD) is associated with substantial psychosocial burden and increased risks for mental health disorders. This retrospective cohort study compared the risks of developing anxiety disorders and depression and incidences of psychotropic medication use between young CD patients and matched CD-free controls.Medical claims, prescription drug claims, enrollment, and demographic data for patients18 years diagnosed with CD were obtained from the MarketScan database (1 January 2000-30 June 2006). Each CD patient was matched with five CD-free controls based on exact age, sex, and months of health plan enrollment. Incidence rates and risks of developing anxiety disorders and depression and psychotropic medication use in the 6 months after the index date were compared, as were risks of developing persistent anxiety or depression (receiving medical services related to a diagnosis of anxiety or depression or psychotropic therapy for1 year).After adjustment for patient characteristics, the risks of developing anxiety disorders (hazard ratio (HR) [95% confidence interval (CI);[equals;2.28 [1.65-3.17]) and depression (HR [95% CI;[equals;1.74 [1.35-2.25]) after CD diagnosis were significantly greater for the CD cohort (N=2,144) than for CD-free controls (N=10,720). Patients with CD also had greater risks of developing persistent anxiety and persistent depression (HR [95% CI;[equals;4.35 [2.22-8.50] and 2.75 [1.73-4.38], respectively).Compared with matched CD-free controls, young patients with CD had significantly greater risks of developing anxiety disorders and depression, were more likely to receive psychotropic treatments, and had significantly greater risks of developing persistent anxiety and depression.

Objectives: The primary objective was to investigate whether nonadherence to antiepileptic drugs (AEDs) is associated with increased mortality and the secondary objective to examine whether nonadherence increases the risk of serious clinical events, including emergency department (ED) visits, hospitalizations, motor vehicle accident (MVA) injuries, fractures, and head injuries. Methods: A retrospective open-cohort design was employed using Medicaid claims data from Florida, Iowa, and New Jersey from January 1997 through June 2006. Patients aged ≥18 years with ≥1 diagnosis of epilepsy by a neurologist and ≥2 AED pharmacy dispensings were selected. Medication possession ratio (MPR) was used to evaluate AED adherence on a quarterly basis with MPR ≥0.80 considered adherent and Results: The 33,658 study patients contributed 388,564 AED-treated quarters (26% nonadherent). Nonadherence was associated with an over threefold increased risk of mortality compared to adherence (hazard ratio = 3.32, 95% CI = 3.11–3.54) after multivariate adjustments. Time periods of nonadherence were also associated with a significantly higher incidence of ED visits (IRR = 1.50, 95% CI = 1.49–1.52), hospital admissions (IRR = 1.86, 95% CI = 1.84–1.88), MVA injuries (IRR = 2.08, 95% CI = 1.81–2.39), and fractures (IRR = 1.21, 95% CI = 1.18–1.23) than periods of adherence. Conclusion: These findings suggest that nonadherence to antiepileptic drugs can have serious or fatal consequences for patients with epilepsy.

Background: Antiarrhythmic drugs and warfarin (W) are often co-administered for atrial fibrillation/flutter (AF/AFL). Amiodarone (A) potentiates the anticoagulant effect of W, necessitating frequent INR monitoring and dose adjustment. We compared real-world treatment persistence in AF/AFL patients (pts) receiving W + A or W + another Class I/III antiarrhythmic drug (Other AAD). Methods: This retrospective cohort study identified AF/AFL pts ≥18 yrs with concurrent pharmacy claims (≥ 60 days' supply over first 90 days) for W and A or Other AAD from the Ingenix IMPACT database (1997-2009). Eligible pts had ≥1 claims with an AF/AFL diagnosis ≤6 months before starting concomitant W + A or W + Other AAD (‘index date’) and continuous pre- (≥6 months) and post-index (≥12 months) enrollment. Drug discontinuation (≥ 60-day gap between consecutive prescriptions) was recorded over 1 year from the index date. Pts were censored at first discontinuation of either drug (last day with supply before 60-day gap) or after 1 year. Times to drug discontinuation (either drug and W and AAD separately) were compared using Cox proportional hazards models. Results: 4,238 pts (mean age 66.5 yrs; 70% male; mean Charlson Comorbidity Index [CCI] 1.76) received W + A and 6,332 pts (mean age 61.9 yrs; 65% male; mean CCI 0.89) received W + Other AAD. Over 1-year post-index, the W + A cohort had higher rates of discontinuation of warfarin (51.7% vs 43.4%), AAD (53.1% vs 32.9%) or either drug (72.7% vs 58.3%) than the W + Other AAD cohort (all P P Treatment discontinuation rate - either drug 90 days 180 days 360 days Warfarin + Amiodarone 19.1% 48.5% 72.7% Warfarin + Other AAD 14.0% 36.6% 58.3% Conclusion: In real-world practice, AF/AFL pts are less persistent with W + A than with W + Other AAD combination therapy. The reasons for this difference remain to be established.