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  • The Effects of Calcitonin Gene-Related Peptide Inhibitors on Migraine Days, Healthcare Use, and Workplace Productivity: A Markov Model Approach

    Migraine is a debilitating condition in which painful headaches occur frequently.  Treatments for migraines, such as acute care treatment and preventive therapy, can help migraine sufferers manage their pain and reduce their frequency. However, there have been few recent improvements in the market for preventive migraine therapies.  Calcitonin gene-related peptide (CGRP) inhibitors are a new class of preventive migraine drugs that may address the need for new, effective treatments for migraines.

    In this study, we estimate the value of CGRP inhibitor treatment for chronic and episodic migraine sufferers. We used a Markov model framework with four primary outcomes: (1) migraine days; (2) acute care drug treatment days; (3) number of physician and emergency room visits; and (4) workplace productivity.  We considered the impact of CGRP inhibitors on patients who are not currently on preventive therapy because existing non-CGRP inhibitor treatments are ineffective or intolerable for these patients.

    Use of CGRP inhibitors was on average associated with fewer migraine days per year (-18.68/-29.20 for EM/CM), fewer triptan uses per year (-3.21/-5.04), more physician visits for migraine per year (1.03/1.02), fewer ER visits per year (-0.06/-0.10), higher probability of full-time (0.03/0.02) and part-time employment (0.01/0.00), fewer lost productive hours per year (-39.69/-21.31), and less indirect cost per year (-$20,327/-$11,176). Effects were generally greater for individuals with higher response to the drugs and varied by age and sex.

    If all migraine sufferers not on preventive medicine used CGRP inhibitors, we estimate national indirect cost savings of $390 billion for EM and $6 billion for CM over 10 years, as well as national reductions in migraine days per year of 358 million for EM and 16 million for CM.

    Links: Report

    Services : Health Economics & Outcomes Research Expertise:

    Migraine is a debilitating condition in which painful headaches occur frequently.  Treatments for migraines, such as acute care treatment and preventive therapy, can help migraine sufferers manage their pain and reduce their frequency. However, there have been few recent improvements in the market for preventive migraine therapies.  Calcitonin gene-related peptide (CGRP) inhibitors are a new

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  • Quality Measure Development and Assessment for Ambulatory Surgery Centers

    KNG Health provides statistical support to The Ambulatory Surgery Center Quality Collaboration (ASC QC) to evaluate quality measures proposed for inclusion in CMS’ ASC Quality Reporting Program.  KNG Health has conducted statistical evaluation of select measures in terms of reliability, validity, feasibility, and interpretability based on data collected through pilot testing.  As part of its quality measure work for ASC QC, KNG Health has also developed a data collection tool for measure reliability testing, which included automation and consistency checks to minimize data entry error.  In addition, KNG Health has analyzed data from Culture of Patient Safety Survey data from ambulatory surgery centers and developed both facility-level and organizational-level reports that use data visualization tools to illustrate analysis results.

    Services : Program Evaluation and Monitoring Expertise:

    KNG Health provides statistical support to The Ambulatory Surgery Center Quality Collaboration (ASC QC) to evaluate quality measures proposed for inclusion in CMS’ ASC Quality Reporting Program.  KNG Health has conducted statistical evaluation of select measures in terms of reliability, validity, feasibility, and interpretability based on data collected through pilot testing.  As part of its

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  • Comparative Outcome and Market Analyses for Long Term Acute Care Hospitals

    KNG Health was contracted by a long-term care hospital (LTCH) to conduct a series of studies to better understand (1) the value of care provided by the hospital to patients in its market area; (2) the value it provides to short term acute care hospitals, and (3) referral patterns in its market.  To address these objectives, KNG Health conducted a series of studies using Medicare claims data.  In the first study, we compared mortality, readmissions, discharge to community, and Medicare spending per beneficiary between patients treated in the client’s LTCH to similar patients treated in other LTCHs and skilled nursing facilities (SNFs) in the same market area.  We used propensity score matching to construct a comparison group of patients who have similar clinical characteristics to the population of the LTCH examined.  In the second study, we conducted a market analysis that identifies the referral patterns among patient discharged from short-term acute care hospitals in the LTCH’s market area.  This analysis revealed the LTCH’s market share among cases that fulfill LTCH patient criteria as well as the share of cases that are referred to other providers.  The analysis was conducted for cases that fulfilled LTCH patient criteria, and the results were presented separately by MS-DRG.  In the third study, we predict cost savings that short-term acute care hospitals can experience by transferring their cases to the LTCH earlier.  We estimate a predictive model of average hospital costs and use the model’s results to predict cost savings under different counterfactual scenarios regarding length of stay.  The findings are incorporated into an interactive Excel tool that allows the user to identify predictions for different MS-DRGs and length of stays.

    Services : Health Economics & Outcomes Research Expertise: , ,

    KNG Health was contracted by a long-term care hospital (LTCH) to conduct a series of studies to better understand (1) the value of care provided by the hospital to patients in its market area; (2) the value it provides to short term acute care hospitals, and (3) referral patterns in its market.  To address these

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  • The Effectiveness of Glucarpidase in Treating Methotrexate Toxicity: A Retrospective Study

    KNG Health conducted a retrospective cohort study of Medicare beneficiaries to examine the effectiveness of glucarpidase in cancer patients.  Glucarpidase is a drug that is used to treat toxicity that can be caused by methotrexate, an anticancer and immunosuppressive agent.  We used Medicare claims data to compare the outcomes between cancer patients treated with glucarpidase and similar patients treated with dialysis.  In constructing the comparison group, we identified patients who are likely to be candidates for glucarpidase based on clinical indicators in the Medicare claims data.  Further risk adjustment was conducted using Elixhauser comorbidities and inverse probability of treatment weighting estimation.  Outcomes examined included length of stay in hospital, number of days in intensive care unit, mortality, and readmission rate.  The findings are presented in a research manuscript, which is currently under review at a peer-reviewed journal.

    Services : Health Economics & Outcomes Research Expertise: ,

    KNG Health conducted a retrospective cohort study of Medicare beneficiaries to examine the effectiveness of glucarpidase in cancer patients.  Glucarpidase is a drug that is used to treat toxicity that can be caused by methotrexate, an anticancer and immunosuppressive agent.  We used Medicare claims data to compare the outcomes between cancer patients treated with glucarpidase

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  • Comparison of Patients Treated in Hospital Outpatient Departments and Independent Physician Offices

    KNG Health is conducting a study to compare patients treated in hospital outpatient departments (HOPDs) and those treated in independent physician offices in terms of patient and visit characteristics.  The findings of the study will be used to inform the policy debate on whether payments to HOPDs and independent physician offices should be site neutral.  The study comprises of three sections.  First, we examine how patient populations treated in HOPDs and independent physician offices differ in terms of demographics, socioeconomic status, illness severity, and medical complexity.  Second, we examine differences in how the types of services and provider specialties differ between HOPDs and independent physician offices.  Third, we examine how patient and visit characteristics have changed over time in the two settings.  The data come from Medicare Inpatient, Outpatient, and Carrier Limited Data Sets for 5% of the Medicare beneficiaries.  The study is funded by the American Hospital Association.  KNG Health conducted an earlier version of this study limited to the cancer patient population in 2014.

    Services : Health Economics & Outcomes Research Expertise: , ,

    KNG Health is conducting a study to compare patients treated in hospital outpatient departments (HOPDs) and those treated in independent physician offices in terms of patient and visit characteristics.  The findings of the study will be used to inform the policy debate on whether payments to HOPDs and independent physician offices should be site neutral. 

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  • Assessing the Value of Home Health Care

    KNG Health has partnered with Excel Health to conduct an assessment of the value that home health care brings to Medicare beneficiaries discharged from a short-term acute care hospital.  About 30% of Medicare beneficiaries discharged from short-term acute care hospitals with instructions to receive home health care do not receive home health care.  The study exploits this variation in home health adherence among beneficiaries discharged with home health instructions to examine the effect of home health care on patient outcomes and Medicare expenditures.  Specifically, it examines hospital readmissions, mortality, Emergency Department visits, and Medicare spending over a 180-day post-acute care episode between beneficiaries who are adherent and those who are non-adherent with their instructions to receive home health care.  The data come from Medicare Inpatient, Outpatient, and Carrier Files available on the Virtual Research Data Center.  The outcome comparison is conducted using a risk adjustment model that accounts for differences in patient severity and medical complexity between the two patient groups.  The preliminary findings from the study were presented at a keynote session of the 2018 Elevating Home National Leadership Conference.

    Links: 2018 Elevating Home National Leadership Conference, Home Health Care News

    Services : Health Economics & Outcomes Research Expertise: , ,

    KNG Health has partnered with Excel Health to conduct an assessment of the value that home health care brings to Medicare beneficiaries discharged from a short-term acute care hospital.  About 30% of Medicare beneficiaries discharged from short-term acute care hospitals with instructions to receive home health care do not receive home health care.  The study

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