Journal of Medical Economics
ISSN: 1369-6998 (Print) 1941-837X (Online) Journal homepage: http://www.tandfonline.com/loi/ijme20
Reply: Essential need for research in hepatitis C Neeta Tandon, Luis A. Balart, François Laliberté, Dominic Pilon, Patrick Lefebvre, Guillaume Germain & Avinash Prabhakar To cite this article: Neeta Tandon, Luis A. Balart, François Laliberté, Dominic Pilon, Patrick Lefebvre, Guillaume Germain & Avinash Prabhakar (2015) Reply: Essential need for research in hepatitis C, Journal of Medical Economics, 18:7, 514-515 To link to this article: http://dx.doi.org/10.3111/13696998.2015.1017504
Accepted author version posted online: 05 Mar 2015. Published online: 24 Apr 2015. Submit your article to this journal
Article views: 42
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ijme20 Download by: [University of Florida]
Date: 05 November 2015, At: 19:00
Journal of Medical Economics 1369-6998 doi:10.3111/13696998.2015.1017504
Vol. 18, No. 7, 2015, 514–515
Article 0016/1017504 All rights reserved: reproduction in whole or part not permitted
Letter to the Editor Reply: Essential need for research in hepatitis C
Neeta Tandon Downloaded by [University of Florida] at 19:00 05 November 2015
Janssen Scientific Affairs, LLC, Titusville, NJ, USA
Luis A. Balart Tulane University Health Sciences Center, New Orleans, LA, USA
Franc¸ois Laliberte´ Dominic Pilon Patrick Lefebvre Guillaume Germain Groupe d’analyse, Lte´e, Montre´al, QC, Canada
Avinash Prabhakar Janssen Scientific Affairs, LLC, Titusville, NJ, USA Address for correspondence: Neeta Tandon, Director, Health Economics & Outcomes Research – VIROLOGY, 1125 TrentonHarbourton Road, Titusville, NJ 08560, USA. Tel: 609-730-7880; [email protected] Accepted: 6 February 2015; published online: 24 April 2015 Citation: J Med Econ 2015; 18:514–5
514
Letter to the Editor Tandon et al.
Dear Editor, We have read the letter by J. S. McCombs1 and appreciate the comments. Our study compared during post therapy (on average 3–4 years) healthcare costs of patients who completed vs discontinued interferon therapy during the first 36–48 weeks of follow-up. To address his first comment regarding how savings attributed to completed therapy compared to costs, we have included a table with the overall healthcare costs during a revised observation period, which now includes the first 48 weeks post therapy initiation, stratified by hospitalizations, outpatient visits, ER visits and pharmacy costs (Table 1). In Table 1, we show that, after a mean follow-up of 1665 and 1514 days for patients who completed vs discontinued interferon therapy, respectively, the mean (SD) total healthcare costs per patient per year were $21,910 (28,734) vs $22,187 (34,518), with a non-significant adjusted cost difference of $923 in favor of incomplete therapy patients (p ¼ 0.4945). These findings suggest that the higher costs of therapy for patients who completed vs those who discontinued interferon therapy during the first 48 weeks post therapy initiation were offset by their lower healthcare resource utilization after 3–4 years. McCombs’ second comment is related to the high overall exposure to therapy of non-completers and sensitivities that could have been conducted on the adherence measure that was used to define patients who completed vs discontinued interferon therapy. In our study, interferon users were categorized according to their adherence to therapy, as defined by a persistence to therapy measure (i.e., no gap of 30 days or more between two refills) during the first 36 weeks of treatment. As mentioned by McCombs, the non-completers average was 391 days of exposure, suggesting that many non-completers likely started and stopped therapy multiple times. This is also what is suggested by the persistent therapy duration measure reported in Table 2 of our original manuscript, since non-completers had, on average, only 108 days of persistent therapy duration. We agree that the significant exposure to treatment by non-completers may have had an impact on their healthcare costs and likely reduced their costs and narrowed the difference in healthcare costs over the post-treatment period. The results presented in Table 1 of this letter provide some hindsight on the impact adherence to therapy has on healthcare costs, but sensitivities on adherence measures (e.g., using the proportion of days covered measure) to assess their impact was beyond the scope of the original study. Regarding McCombs’ third comment that recent studies (including ours) did not study the predictors of treatment initiation or treatment response, we agree that it would be a very interesting topic that warrants future research, but it was again beyond the scope of the study on post therapy healthcare costs.
www.informahealthcare.com/jme ! 2015 Informa UK Ltd
Journal of Medical Economics
Volume 18, Number 7
July 2015
Table 1. Comparison of PPPY healthcare cost between beneficiaries in the complete vs discontinued HCV therapy cohorts including the first 48 weeks post therapy initiation.a
Downloaded by [University of Florida] at 19:00 05 November 2015
PPPY healthcare costs (US $2012)
Number of patients, n Observation period, days, mean (SD) All-cause healthcare costs, mean (SD) Hospitalizations ER visits Outpatient visits Pharmacy dispensing CHC-related healthcare costs, mean (SD) Hospitalizations ER visits Outpatient visits Pharmacy dispensingc Interferon dispensing
Complete therapy cohort
1066 1665 (1021) $21,910 (28,734) $3262 (13,447) $230 (593) $5344 (15,815) $13,074 (11,535) $11,128 (12,709) $1005 (8089) $3 (39) $690 (1234) $9430 (8849) $5841 (5348)
Discontinued therapy cohort
1014 1514 (982) $22,187 (34,518) $6237 (24,078) $328 (1173) $6090 (10,498) $9533 (11,805) $9215 (18,214) $2556 (16,149) $4 (34) $745 (1285) $5910 (7586) $3507 (3732)
Complete vs discontinued therapy cohort Unadjusted cost difference
Adjusted cost differenceb [95% CI]
p Value
$277 $2974 $98 $746 $3541 $1913 $1551 $0 $55 $3520 $2334
$923 [1730; 3517] $2639 [4492; 1004] $89 [159; 29] $518 [1528; 520] $4169 [3375; 4990] $2426 [1030; 3703] $1504 [2788; 325] $0 [3; 3] $28 [145; 78] $3958 [3484; 4431] $2598 [2307; 2894]
0.4945 50.0001 0.0040 0.3103 50.0001 50.0001 0.0100 0.7888 0.6346 50.0001 50.0001
PPPY, per patient per year; SD, standard deviation; CHC, chronic hepatitis C; CI, confidence interval; ER, emergency room. a The number of patients in the complete vs discontinued therapy cohorts reported are slightly higher than those reported in the manuscript since patients with 36–48 weeks of observation post therapy initiation, but no post therapy follow-up (due to end of insurance coverage or end of data availability [March 2012]) were also included, while in the manuscript only patients with at least 48 weeks post therapy initiation were included. b Adjusted cost differences were obtained using ordinary least-squares regressions, adjusting for baseline characteristics including age, gender, type of beneficiary, geographic region, payer type, year of index date, Quan-Charlson comorbidity index and healthcare costs. Confidence intervals (95% CI) were calculated using a non-parametric bootstrap with 999 replications. c CHC-related pharmacy dispensing costs were identified with NDC codes for any of these medicated treatments: peginterferon alfa-2a or alfa-2b, interferon alfa-2a or alfa-2b, or interferon alfacon-1, ribavirin, telaprevir and boceprevir.
We are very grateful for the time McCombs took to review our manuscript and the opportunity to provide more information on our study findings.
! 2015 Informa UK Ltd www.informahealthcare.com/jme
References 1. Tandon N, Balart LA, Laliberte´ F, et al. Impact of completing chronic hepatitis C (CHC) treatment on post-therapy healthcare cost. J Med Econ 2014;17:862-71
Letter to the Editor Tandon et al.
515
ISSN: 1369-6998 (Print) 1941-837X (Online) Journal homepage: http://www.tandfonline.com/loi/ijme20
Reply: Essential need for research in hepatitis C Neeta Tandon, Luis A. Balart, François Laliberté, Dominic Pilon, Patrick Lefebvre, Guillaume Germain & Avinash Prabhakar To cite this article: Neeta Tandon, Luis A. Balart, François Laliberté, Dominic Pilon, Patrick Lefebvre, Guillaume Germain & Avinash Prabhakar (2015) Reply: Essential need for research in hepatitis C, Journal of Medical Economics, 18:7, 514-515 To link to this article: http://dx.doi.org/10.3111/13696998.2015.1017504
Accepted author version posted online: 05 Mar 2015. Published online: 24 Apr 2015. Submit your article to this journal
Article views: 42
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ijme20 Download by: [University of Florida]
Date: 05 November 2015, At: 19:00
Journal of Medical Economics 1369-6998 doi:10.3111/13696998.2015.1017504
Vol. 18, No. 7, 2015, 514–515
Article 0016/1017504 All rights reserved: reproduction in whole or part not permitted
Letter to the Editor Reply: Essential need for research in hepatitis C
Neeta Tandon Downloaded by [University of Florida] at 19:00 05 November 2015
Janssen Scientific Affairs, LLC, Titusville, NJ, USA
Luis A. Balart Tulane University Health Sciences Center, New Orleans, LA, USA
Franc¸ois Laliberte´ Dominic Pilon Patrick Lefebvre Guillaume Germain Groupe d’analyse, Lte´e, Montre´al, QC, Canada
Avinash Prabhakar Janssen Scientific Affairs, LLC, Titusville, NJ, USA Address for correspondence: Neeta Tandon, Director, Health Economics & Outcomes Research – VIROLOGY, 1125 TrentonHarbourton Road, Titusville, NJ 08560, USA. Tel: 609-730-7880; [email protected] Accepted: 6 February 2015; published online: 24 April 2015 Citation: J Med Econ 2015; 18:514–5
514
Letter to the Editor Tandon et al.
Dear Editor, We have read the letter by J. S. McCombs1 and appreciate the comments. Our study compared during post therapy (on average 3–4 years) healthcare costs of patients who completed vs discontinued interferon therapy during the first 36–48 weeks of follow-up. To address his first comment regarding how savings attributed to completed therapy compared to costs, we have included a table with the overall healthcare costs during a revised observation period, which now includes the first 48 weeks post therapy initiation, stratified by hospitalizations, outpatient visits, ER visits and pharmacy costs (Table 1). In Table 1, we show that, after a mean follow-up of 1665 and 1514 days for patients who completed vs discontinued interferon therapy, respectively, the mean (SD) total healthcare costs per patient per year were $21,910 (28,734) vs $22,187 (34,518), with a non-significant adjusted cost difference of $923 in favor of incomplete therapy patients (p ¼ 0.4945). These findings suggest that the higher costs of therapy for patients who completed vs those who discontinued interferon therapy during the first 48 weeks post therapy initiation were offset by their lower healthcare resource utilization after 3–4 years. McCombs’ second comment is related to the high overall exposure to therapy of non-completers and sensitivities that could have been conducted on the adherence measure that was used to define patients who completed vs discontinued interferon therapy. In our study, interferon users were categorized according to their adherence to therapy, as defined by a persistence to therapy measure (i.e., no gap of 30 days or more between two refills) during the first 36 weeks of treatment. As mentioned by McCombs, the non-completers average was 391 days of exposure, suggesting that many non-completers likely started and stopped therapy multiple times. This is also what is suggested by the persistent therapy duration measure reported in Table 2 of our original manuscript, since non-completers had, on average, only 108 days of persistent therapy duration. We agree that the significant exposure to treatment by non-completers may have had an impact on their healthcare costs and likely reduced their costs and narrowed the difference in healthcare costs over the post-treatment period. The results presented in Table 1 of this letter provide some hindsight on the impact adherence to therapy has on healthcare costs, but sensitivities on adherence measures (e.g., using the proportion of days covered measure) to assess their impact was beyond the scope of the original study. Regarding McCombs’ third comment that recent studies (including ours) did not study the predictors of treatment initiation or treatment response, we agree that it would be a very interesting topic that warrants future research, but it was again beyond the scope of the study on post therapy healthcare costs.
www.informahealthcare.com/jme ! 2015 Informa UK Ltd
Journal of Medical Economics
Volume 18, Number 7
July 2015
Table 1. Comparison of PPPY healthcare cost between beneficiaries in the complete vs discontinued HCV therapy cohorts including the first 48 weeks post therapy initiation.a
Downloaded by [University of Florida] at 19:00 05 November 2015
PPPY healthcare costs (US $2012)
Number of patients, n Observation period, days, mean (SD) All-cause healthcare costs, mean (SD) Hospitalizations ER visits Outpatient visits Pharmacy dispensing CHC-related healthcare costs, mean (SD) Hospitalizations ER visits Outpatient visits Pharmacy dispensingc Interferon dispensing
Complete therapy cohort
1066 1665 (1021) $21,910 (28,734) $3262 (13,447) $230 (593) $5344 (15,815) $13,074 (11,535) $11,128 (12,709) $1005 (8089) $3 (39) $690 (1234) $9430 (8849) $5841 (5348)
Discontinued therapy cohort
1014 1514 (982) $22,187 (34,518) $6237 (24,078) $328 (1173) $6090 (10,498) $9533 (11,805) $9215 (18,214) $2556 (16,149) $4 (34) $745 (1285) $5910 (7586) $3507 (3732)
Complete vs discontinued therapy cohort Unadjusted cost difference
Adjusted cost differenceb [95% CI]
p Value
$277 $2974 $98 $746 $3541 $1913 $1551 $0 $55 $3520 $2334
$923 [1730; 3517] $2639 [4492; 1004] $89 [159; 29] $518 [1528; 520] $4169 [3375; 4990] $2426 [1030; 3703] $1504 [2788; 325] $0 [3; 3] $28 [145; 78] $3958 [3484; 4431] $2598 [2307; 2894]
0.4945 50.0001 0.0040 0.3103 50.0001 50.0001 0.0100 0.7888 0.6346 50.0001 50.0001
PPPY, per patient per year; SD, standard deviation; CHC, chronic hepatitis C; CI, confidence interval; ER, emergency room. a The number of patients in the complete vs discontinued therapy cohorts reported are slightly higher than those reported in the manuscript since patients with 36–48 weeks of observation post therapy initiation, but no post therapy follow-up (due to end of insurance coverage or end of data availability [March 2012]) were also included, while in the manuscript only patients with at least 48 weeks post therapy initiation were included. b Adjusted cost differences were obtained using ordinary least-squares regressions, adjusting for baseline characteristics including age, gender, type of beneficiary, geographic region, payer type, year of index date, Quan-Charlson comorbidity index and healthcare costs. Confidence intervals (95% CI) were calculated using a non-parametric bootstrap with 999 replications. c CHC-related pharmacy dispensing costs were identified with NDC codes for any of these medicated treatments: peginterferon alfa-2a or alfa-2b, interferon alfa-2a or alfa-2b, or interferon alfacon-1, ribavirin, telaprevir and boceprevir.
We are very grateful for the time McCombs took to review our manuscript and the opportunity to provide more information on our study findings.
! 2015 Informa UK Ltd www.informahealthcare.com/jme
References 1. Tandon N, Balart LA, Laliberte´ F, et al. Impact of completing chronic hepatitis C (CHC) treatment on post-therapy healthcare cost. J Med Econ 2014;17:862-71
Letter to the Editor Tandon et al.
515
