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6. Comparative effectiveness of single versus multiple tablet antiretroviral therapy regimens in clinical HIV practice

Author

Drozd, Daniel R, Saag, Michael S, Westfall, Andrew O, Mathews, William Chris, Haubrich, Richard, Boswell, Stephen L, Cole, Stephen R, Porter, Donna, Kitahata, Mari M, Juday, Timothy, and Rosenblatt, Lisa

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, HIV/AIDS, Comparative Effectiveness Research, Prevention, Adult, Anti-Retroviral Agents, Female, HIV Infections, Humans, Male, Middle Aged, Treatment Outcome, ART, atripla, comparative effectiveness, HIV, single tablet regimen, CFAR Network of Integrated Clinical Systems
Abstract

We determined risk of virologic failure (VF) in individuals initiating tenofovir/emtricitabine/efavirenz as single versus multiple tablet regimens (MTR). We found no significant difference in the risk of VF, though did observe a trend toward more VF and M184 V mutations among persons initiating MTR. Temporal trends in care may have confounded results.

Published
2017

9. Benzodiazepine Usage, Healthcare Resource Utilization, and Costs Among Older Adults Treated with Common Insomnia Medications: A Retrospective Cohort Study

Author

Wickwire,Emerson M, Juday,Timothy R, Gor,Deval, Amari,Diana T, and Frech,Feride H

Subjects
ClinicoEconomics and Outcomes Research
Abstract

Emerson M Wickwire,1,2 Timothy R Juday,3 Deval Gor,4 Diana T Amari,4 Feride H Frech3 1Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; 2Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA; 3Health Economics & Outcomes Research, US Medical Affairs, Eisai Inc., Nutley, NJ, USA; 4Real-World Evidence, Genesis Research, Hoboken, NJ, USACorrespondence: Timothy R Juday, Health Economics & Outcomes Research, US Medical Affairs, Eisai Inc, 200 Metro Blvd, Nutley, NJ, 07710, USA, Tel +1-551-502-2116, Email timothy_juday@eisai.comBackground: Benzodiazepines are commonly prescribed for insomnia management but are often associated with negative safety outcomes such as falls and abuse, particularly among older adults.Objective: The purpose of this real-world study was to compare the impact of benzodiazepines, low-dose trazodone, and zolpidem immediate release (IR) on healthcare resource utilization (HCRU), and costs among older adults (age ≥ 65 years) with insomnia in the US.Methods: Using the IBM MarketScan Medicare Supplemental Database, older adults with > 1 physician-assigned diagnosis of insomnia and treated with benzodiazepines were matched 1:1 on age, sex, and index-date to individuals treated with trazodone, and separately matched 1:1 on age and sex, to individuals treated with zolpidem immediate release (IR). Between-groups differences were analyzed using general linear models (GLMs) that controlled for multiple confounders.Results: Significant between-groups differences in HCRU and costs were observed such that relative to zolpidem IR and separately relative to low-dose trazodone, benzodiazepines were consistently associated with worsened outcomes.Conclusion: These findings build upon and extend prior knowledge on the negative impact of benzodiazepines and suggest directions for future research.Keywords: benzodiazepine, trazodone, zolpidem, elderly, insomnia, healthcare resource utilization, cost

Published
2023

11. Incremental health care resource use and costs among adult patients with depression and treated for insomnia with zolpidem, trazodone, or benzodiazepines

Author

Wickwire, Emerson M., Amari, Diana T., Juday, Timothy R., Frech, Feride, Gor, Deval, and Malhotra, Manoj

Subjects
Adult, Male, Depression, Health Care Costs, General Medicine, Middle Aged, Medicare, United States, Zolpidem, Benzodiazepines, Sleep Initiation and Maintenance Disorders, Trazodone, Humans, Female, Delivery of Health Care, Aged, Retrospective Studies
Abstract

To quantify health care resource utilization (HCRU) and costs associated with insomnia treated with commonly prescribed insomnia medications among patients with depression. A retrospective cohort study was conducted using IBM MarketScan Commercial and Medicare Supplemental Databases to identify adults with: (1) ≥1 ICD-9/ICD-10 code for depression; (2) ≥1 commonly prescribed medication for insomnia (zolpidem immediate release [IR], zolpidem extended release [ER], trazodone, or benzodiazepines); and (3) ≥12 months of eligibility before and after initiating insomnia medication. A 1:1 age- and sex-matched control cohort with depression but without sleep-related disorders was identified. Adjusted HCRU and costs were compared using generalized linear models. A total of 21,027 patients (mean age = 48.3 years, 69.5% female) with depression and treated insomnia (D + TI; 1.9% zolpidem ER, 32.0% zolpidem IR, 50.0% trazodone, 16.1% benzodiazepines) were matched to controls. Although mean number of inpatient visits were similar (0.1 for both), relative to controls, D + TI had a higher mean number of ED (0.2 vs 0.1, p p p Relative to controls with depression but without sleep disorders, overall, health care costs for adults with D + TI were 2.2-fold higher; costs and HCRU varied by insomnia medication. Further study of the impact of newer insomnia treatments on patient outcomes in depression and comorbid insomnia is warranted.

Published
2022

18. A School-Based Program to Improve Life Skills and to Prevent HIV Infection in Multicultural Transgendered Youth in Hawai'i

Author

Bopp, P. Jayne, Juday, Timothy R., and Charters, Cloudia W.

Abstract

Chrysalis is a weekly after-school drop-in group on O'ahu high school campuses for transgendered and questioning youth. Nine Chrysalis members, nine demographically matched TG youth, and five key informants participated in a study to evaluate program effectiveness in improving life skills and preventing HIV infection. Chrysalis members scored better than comparison group members in school participation, educational and career goals, self-esteem, friends and peer support, family, physical safety, sex reassignment surgery, alcohol and drug use, and safer sex self-efficacy. Chrysalis members and key informants cited positive adult TG role models and peer support as key factors in the program's success. (Contains 3 tables and 2 notes.)

Published
2004
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28. Challenges and opportunities in insomnia disorder.

Author

Roach, Meaghan, Juday, Timothy, Tuly, Rifat, Chou, Jacquelyn W., Jena, Anupam B., and Doghramji, Paul P.

Subjects
*INSOMNIA, *TREATMENT effectiveness, *COMORBIDITY, *SLEEP disorders, *LITERATURE reviews
Abstract

Insomnia disorder is a prevalent, often unrecognized condition that affects millions. This clinical disorder is characterized by difficulty initiating or maintaining sleep over a sustained period. In fact, insomnia disorder affects much more than sleep; it increases the risk of developing serious medical and psychiatric comorbidities and can exacerbate existing conditions. The association between insomnia disorder and serious medical and psychiatric comorbidities are complex and directionality is not yet fully understood. There remain gaps in the treatment landscape for insomnia disorder. We performed a narrative review of the published literature to identify challenges, unmet needs, and burden associated with insomnia disorder. In this article, we describe the substantial burden that insomnia disorder poses on patients, the healthcare system, and society in the US. This article explores the factors attributable to this burden including limited provider knowledge, inadequate treatment options, and unknown long-term impacts of off-label treatments. Several recommendations are proposed to address these challenges and improve patient outcomes through efforts to: (1) establish the societal value of treatment; (2) improve the clinical understanding of insomnia disorder; and (3) prioritize development of and access to effective treatments that do not pose addiction potential or tolerability issues. [ABSTRACT FROM AUTHOR]

Published
2021
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36. Comparative Value of Four Measures of Retention in Expert Care in Predicting Clinical Outcomes and Health Care Utilization in HIV Patients

Author

Reveles, Kelly R., primary, Juday, Timothy R., additional, Labreche, Matthew J., additional, Mortensen, Eric M., additional, Koeller, Jim M., additional, Seekins, Daniel, additional, Oramasionwu, Christine U., additional, Bollinger, Mary, additional, Copeland, Laurel A., additional, Jones, Xavier, additional, and Frei, Christopher R., additional

Published
2015
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48. The Impact of State AIDS Drug Assistance Policies on Clinical and Economic Outcomes of People With HIV.

Author

Snider, Julia Thornton, Goldman, Dana P., Rosenblatt, Lisa, Seekins, Daniel, Juday, Timothy, Sanchez, Yuri, Wu, Yanyu, Peneva, Desi, and Romley, John A.

Subjects
AIDS treatment, DRUG control, MEDICAL economics, HIV infections, THERAPEUTICS, ANTIRETROVIRAL agents, QUALITY of life, HEALTH policy, PUBLIC welfare, ANTI-HIV agents, PUBLIC welfare statistics, HEALTH services accessibility, POVERTY, STATE governments, RETROSPECTIVE studies, ECONOMICS
Abstract

We investigated the effect of changes to state AIDS Drug Assistance Programs (ADAP) policies, which govern access to antiretroviral therapy (ART), on clinical and economic outcomes among low-income people living with HIV/AIDS. Retrospective analyses of ART access were conducted on state ADAP policies, using data from ADAP Monitoring Reports and Kaiser Family Foundation from 2006 to 2010. We found stricter eligibility requirements reduce the number of HIV-positive individuals with ART access through ADAP, and decreased ART use increases mortality by 2.67 quality-adjusted life years (QALYs) per beneficiary. If the ADAP income eligibility cutoff were decreased by 50 percentage points in each state, 4,626 individuals would lose ART access nationwide. Based on a $22,143 cost/QALY, this policy would save $274 million in health care expenditures (2012 dollars), but result in 12,352 QALYs lost, valued at $1.2 billion. Therefore, states should exercise caution in restricting programs that increase ART access for low-income people living with HIV/AIDS. [ABSTRACT FROM AUTHOR]

Published
2016
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