Utilization of statins and aspirin among patients with diabetes and hyperlipidemia: Taiwan, 1998–2006

BackgroundThe proper use of statins and aspirin decrease the risk of coronary heart disease (CHD) among patients with diabetes (DM) and hyperlipidemia. The purpose of this study was to analyze the time trends and determinants of prescribing statins and aspirin among patients with DM and hyperlipidemia in medical practice in Taiwan.MethodsA cohort of 21,667 patients with DM and hyperlipidemia during the period from 1998 to 2006 was identified by using data of ambulatory care claims from Taiwan's National Health Insurance Database. The dataset was categorized into two equal calendar periods: Period 1 (September 1998–June 2002) and Period 2 (July 2002–April 2006). Multivariate logistic regression analyses were used to determine the independent determinants associated with receipt of lipid-lowering agents and aspirin among these patients.ResultsThere were significant increases in the prescribing of statins (OR 1.78; 95% CI 1.66?1.91) and aspirin (OR 1.47, 95% CI 1.50?1.59) in Period 2 as compared with Period 1. Nevertheless, 30% of patients with coexisting CHD neither received statins nor aspirin. Only 15% to 25% of DM patients with hyperlipidemia and CHD received the combined treatment with aspirin and statin. In multivariate logistic regression, we found that women received aspirin less frequently than men. Old patients (>45 years) with concomitant CHD were more likely to receive statins and aspirin.ConclusionDespite the increasing trend in the use of statins and aspirin in DM patients with hyperlipidemia in Taiwan, the improvements were at best modest, particularly for secondary prevention. Our data indicate the need for continued efforts to improve the utilization of these drugs in daily practice.     

Does the cost of care differ for patients with fee-for-service vs. capitation of payment? A case–control study in gastroenterology

Introduction

There is growing evidence to demonstrate overuse of medical resources in fee for service (FFS) payment models (in which physicians are reimbursed according to volume of care provided) compared to capitation payment models (in which physicians receive a fixed salary regardless of level of care provided). In this medical centre, patients with and without insurance are admitted through the same access point (emergency room) and cared for by the same physicians. Therefore, apart from insurance status, all other variables influencing delivery of care are similar for both patient groups. However, physician reimbursement differs for both groups: FFS for patients with private insurance (i.e. the admitting physician’s reimbursement escalates progressively with each day that the patient spends in hospital) and base salary irrespective of care provided for patients with universal insurance (capitation payment model). All admitting physicians are aware of the patient’s insurance status and the duration of hospitalization is at the discretion of the admitting physician. This study aimed to compare cost of care of patients with and without insurance admitted to a teaching hospital with a primary gastroenterology or hepatology (GIH) diagnosis.

Methods

All hospital inpatients admitted between January 2008 and December 2009 with a primary GI-related diagnosis related group (DRG) were identified. Patients were classified as uninsured (state-funded) or privately insured. Only DRGs with at least five patients in both the insured and uninsured patient groups were analyzed to ensure a precise estimate of inpatient costs. Patient level costing (PLC) was used to express the total cost of hospital care for each patient; PLC comprised a weighted daily bed cost plus cost of all medical services provided (e.g. radiology, pathology tests) calculated according to an activity-based costing approach, cost of medications were excluded. An overall mean cost of care per patient was calculated for both groups. All costs were discounted to 2009 values.

Results

In total, 630 patients were admitted with one of 11 GIH DRGs, 181 (29 %) with private insurance. Pooled mean cost of care was higher for uninsured (6,781 euros/patient) compared to insured patients (6,128 euros/patient). Apart from patients with ‘non-cirrhotic non-alcoholic liver disease (non-complex)’ in whom mean cost was higher for insured patients, there were no significant differences in mean cost of care nor mean patient age for insured and uninsured groups for any other diagnoses.

Conclusion

Inpatient hospital costs were equivalent for patients with and without private health insurance when care was provided in a single hospital. Provision of care for all patients in a common hospital setting regardless of health insurance status may reduce disparities in healthcare utilization.     

Association of Estrogen Receptor Gene Polymorphisms and Primary Biliary Cirrhosis in a Chinese Population: A Case–Control Study

Background:

Primary biliary cirrhosis (PBC) is a chronic and slowly progressive cholestatic liver disease characterized by destruction of the interlobular bile ducts and a striking female predominance. The aim of this study was to identify associations between estrogen receptor (ESR) gene polymorphisms with the risk of developing PBC and abnormal serum liver tests in a Chinese population.

Methods:

Thirty-six patients with PBC (case group) and 35 healthy individuals (control group) from the First Hospital of Jilin University were studied. Whole genomic DNA was extracted from all the participants. Three single-nucleotide polymorphisms (rs2234693, rs2228480, and rs3798577) from ESR1 and two (rs1256030 and rs1048315) from ESR2 were analyzed by a pyrosequencing method. Demographic data and liver biochemical data were collected.

Results:

Subjects with the T allele at ESR2 rs1256030 had 1.5 times higher risk of developing PBC than those with the C allele (odds ratio [OR] = 2.1277, 95% confidence interval [CI] = 1.1872–4.5517). Haplotypes TGC of ESR1 rs2234693, rs2228480, and rs3798577 were risk factors for having PBC. The C allele at ESR1 rs2234693 was associated with abnormal alkaline phosphatase (OR = 5.2469, 95% CI = 1.3704–20.0895) and gamma-glutamyl transferase (OR = 3.4286, 95% CI = 1.0083–13.6578) levels in PBC patients.

Conclusions:

ESR2 rs1256030 T allele may be a significant risk factor for the development of PBC. Screening for patients with gene polymorphisms may help to make early diagnoses in patients with PBC.     

Long-term efficacy of recombinant interferon alpha 2a in the treatment of chronic hepatitis C: a randomized prospective study comparing two dose schedules in Chinese patients.

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Menstrual irregularity,pregnancy outcomes,and birth outcomes in patients with systemic lupus erythematosus of childbearing age in China: a multicenter cross-sectional study

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Continuation,reduction, or withdrawal of tofacitinib in patients with rheumatoid arthritis achieving sustained disease control: a multicenter,open-label,randomized controlled trial

Background: Rheumatoid arthritis (RA), a chronic systemic autoimmune disease, is characterized by synovitis and progressive damage to the bone and cartilage of the joints, leading to disability and reduced quality of life. This study was a randomized clinical trial comparing the outcomes between withdrawal and dose reduction of tofacitinib in patients with RA who achieved sustained disease control.Methods: The study was designed as a multicenter, open-label, randomized controlled trial. Eligible...     

Resting heart rate control and prognosis in coronary artery disease patients with hypertension previously treated with bisoprolol: a sub-group analysis of the BISO-CAD study

Background: Resting heart rate (RHR) is considered as a strong predictor of total mortality and hospitalization due to heart failure in hypertension patients. Bisoprolol fumarate, a second-generation beta-adrenoreceptor blockers (β-blocker) is commonly prescribed drug to manage hypertension. The present study was to retrospectively evaluate changes in the average RHR and its association with cardiovascular outcomes in bisoprolol-treated coronary artery disease (CAD) patients from the CAD treated...     

Prevalence,risk factors,and survival associated with pulmonary hypertension and heart failure among patients with underlying coronary artery disease: a national prospective,multicenter registry study in China

Background: Coronary artery disease (CAD) is the commonest cause of heart failure (HF), whereas pulmonary hypertension (PH) has not been established or reported in this patient population. Therefore, we assessed the prevalence, risk factors, and survival in CAD-associated HF (CAD-HF) complicated with PH.Methods: Symptomatic CAD-HF patients were continuously enrolled in this prospective, multicenter registry study. Echocardiography, coronary arteriography, left and right heart catheterization (RH...