Pharmacists and managed care professionals Activity Overview Alzheimer disease (AD) is the sixth ... more Pharmacists and managed care professionals Activity Overview Alzheimer disease (AD) is the sixth leading cause of death and the most common etiology for dementia. It causes a significant burden to the public health system, patients afflicted with it, and their caregivers. Continuing professional education will increase competency on AD, including the importance of early detection, patient and caregiver education, and the role of new therapeutic targets for the treatment of AD. Application of knowledge will improve clinical decision making, improve quality of life among patients and caregivers, optimize medication therapy, improve outcomes, and decrease costs associated with the treatment of AD.
from €1132 (lower bound) to €1199 (upper bound). The mean cost of atenolol per patient was €366. ... more from €1132 (lower bound) to €1199 (upper bound). The mean cost of atenolol per patient was €366. The mean costs of the cardiovascular events were respectively €1969 and €2261 for losartan and atenolol groups. Therefore, the total mean cost per patient ranged from €3101 to €3169 for the losartan group and was estimated €2627 for the atenolol group. CONCLUSION: The annual incremental cost for each patient treated with losartan ranged from €99 to €113. This additional cost is associated with a significant reduction in cardiovascular morbidity and mortality (especially stroke).
Rates of medication discontinuation reflect factors including effectiveness, tolerability, cost, ... more Rates of medication discontinuation reflect factors including effectiveness, tolerability, cost, and dosing frequency. Discontinuation data can be useful to physicians and health plan managers as they compare various glaucoma medications. To compare rates of discontinuation of therapy in patients initially prescribed monotherapy with a topical glaucoma medication. Members of a managed care plan who filled at least 1 prescription for latanoprost, timolol, or brimonidine during a 30-month period were eligible to participate in this study. Prescription refill records for all glaucoma agents used in the plan were extracted for the study period. Rates of discontinuation of initial glaucoma therapy were compared using Cox regression methods; Kaplan-Meier survival curves were generated. A total of 72,744 prescriptions were eligible, of which 48491 were for study drugs. Latanoprost was the most frequently dispensed therapy (accounting for 49.7% of study drugs), followed by timolol (30.6%), ...
In partnership with a large nonprofit healthcare insurer for the Mid-Atlantic region of the Unite... more In partnership with a large nonprofit healthcare insurer for the Mid-Atlantic region of the United States, we launched the first cancer clinical pathway in the United States in August 2008. Due to its early success with regard to savings and physician participation and compliance, a second-generation pathways program-the Oncology Medical Home-was piloted in 2011. This program offered a physician reimbursement model that shifted the source of revenue from drug reimbursement margin to professional charges for cognitive services (evaluation and management codes). We report our observations of the impact of that reimbursement model on physician prescribing behavior. This was a retrospective analysis. A select group of practices that participated in the first-generation pathways program were invited to voluntarily participate in the Oncology Medical Home and its cognitive weighted reimbursement design. A matched control group was chosen from the first-generation pathways participants. Co...
/ MANAGED CARE 35 way to reduce inappropriate utilization and waste in the health care system, co... more / MANAGED CARE 35 way to reduce inappropriate utilization and waste in the health care system, contain health care costs, and assure quality patient outcomes. The statement that follows highlights the expert panel presentations, discussions, and conclusions, and is intended to provide meaningful guidance to oncologists and other practicing physicians and to the payer community as they move forward to keep pace with new cancer diagnostics, biologic therapies, and disease management techniques to improve cancer care and achieve quality patient outcomes.
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NH... more This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology The study compared linezolid and vancomycin for the treatment of nosocomial pneumonia (NP) caused by methicillinresistant Staphylococcus aureus (MRSA). The linezolid regimen included linezolid 600 mg plus aztreonam every 12 hours (q12h), while the vancomycin regimen was vancomycin 1,000 mg plus aztreonam q12h. Type of intervention Treatment. Economic study type Cost-effectiveness analysis. Study population Patients were included in the study if it was likely that they had NP only and no other forms of non-NP. As there was no International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9CM) code that differentiated NP from community-acquired pneumonia, an algorithm was created to narrow the universe of patients with any diagnosis of pneumonia on admission to hospital, to a sample of patients who were most likely to have NP only. Admissions associated with a principal diagnosis of pneumonia were excluded, as were certain secondary diagnoses of pneumonia. Patients were excluded if their length of stay was less than 7 days or more than 21 days. Admissions for immunocompromised states and admissions of patients younger than 16 years of age were also excluded. Setting The setting was secondary care. The economic study was carried out in the mid-Atlantic region of the USA. Dates to which data relate The effectiveness data were taken from a study published in 2003. The dates to which the resources and prices related were not reported. Source of effectiveness data The effectiveness data were derived from a review of the literature. Modelling A decision-analytic model was used to compare the costs and effectiveness of linezolid and vancomycin.
Background: Hypertension is one of the most frequently diagnosed chronic medical conditions in th... more Background: Hypertension is one of the most frequently diagnosed chronic medical conditions in the United States and imposes a substantial financial and social burden on Americans. Objective: The aim of this study was to compare the cost of health care resources for hypertensive patients taking analgesics stratified by having controlled versus uncontrolled hypertension. Methods: This was a retrospective, database analysis of data for managed-care patients in Maryland and Washington, DC, recorded from February 1, 1999, to July 31, 2001. Hypertensive patients who were taking analgesics were stratified by their hypertension control status using a claims-based algorithm. Annualized costs and differences in annualized costs calculated for the periods before and after the initiation of analgesics were compared by patient hypertension control status. Results: Of the 9805 patients in the study (mean [SD] age, 49.8 [12.04] years), 2523 (25.73%) were categorized as having uncontrolled hypertension. The mean total annualized costs differed significantly between the controlled and uncontrolled hypertension groups by $2568 (P < 0.001). The annualized costs for emergencydepartment visits and hospitalizations for uncontrolled hypertensive patients exceeded those for controlled hypertensive patients by 9.3% and 28.0%, respectively. The differences between the postindex-and preindexperiod costs for health care resources were $1972 with controlled hypertension and $2961 with uncontrolled hypertension (P < 0.001). The results of linear regression, after adjustments were made for preindex costs and other covariates, indicated that patients with uncontrolled hypertension had significantly increased billed annualized costs (P < 0.001). Conclusions: These data suggest that the costs of health care resources were significantly higher for analgesic users with uncontrolled hypertension than for analgesic users with controlled hypertension. A considerable proportion of the cost differential was directly attributable to hypertension-related treatment care. (Clin Ther.
Pharmacists and managed care professionals Activity Overview ALS remains a devastating diagnosis ... more Pharmacists and managed care professionals Activity Overview ALS remains a devastating diagnosis that presages a rapid decline in motor functioning and often leads to death within 2 to 5 years. Two FDA-approved treatments are currently marketed that stem the decline temporarily, and guidelines strictly recommend these therapies be used and implemented into therapy as soon as possible. However, neither offer a cure and despite this progress, the disease ravages the ability of patients with ALS to function as they lose their ability to walk, swallow, sometimes think, and, eventually, breathe. With the advent of targeted therapies and growing knowledge about the disease, several discoveries are at last offering a glimpse into a more hopeful future for patients with this rare condition. It is imperative managed care professionals review the current treatment landscape and guidelines and the potential of emerging therapies to change the landscape.
Erectile dysfunction (ED) affects approximately 30 million men in the United States. The objectiv... more Erectile dysfunction (ED) affects approximately 30 million men in the United States. The objectives of this study were to (1) assess the cost and utilization of sildenafil citrate (Viagra), an oral therapeutic agent for ED, in a large managed care organization (MCO) with a quantity limit of 6 units per 30-day supply and (2) describe the incidence of comorbid conditions and the severity of cardiovascular disease in adult male users of sildenafil. Pharmacy claims for sildenafil were identified from an administrative database of claims with dates of service in calendar year 2001 for male members aged 18 years or older. Medical claims for MCO members who had sildenafil claims were used to identify comorbid diseases and categorize patients by degree of cardiovascular risk. High risk was defined as having at least 1 medical claim with a diagnosis of diabetes mellitus, ischemic heart disease, abdominal aortic aneurysm, or peripheral arterial disease, and medium risk was defined as not havi...
Expert Review of Pharmacoeconomics & Outcomes Research, 2002
Increasing standardization in pharmacoeconomics calls for systematic use of epidemiological measu... more Increasing standardization in pharmacoeconomics calls for systematic use of epidemiological measures, such as incidence and prevalence estimates. The implications are relevant to predicting illness events and costs and to formulary decision-making. The choice of method is determined by the purpose of the study and the nature of the disease. Prevalence-based costs are assigned to the years in which they occur-results are relevant for budget impact, cost control and in chronic conditions. In contrast, the incidence-based approach assigns the stream of costs to the year it starts. It requires knowledge of the disease course, survival rates and the impact of the illness on lifetime earnings. It is relevant for making decisions among alternative treatments, short-term cost-effectiveness and acute diseases.
Pharmacists and managed care professionals Activity Overview Alzheimer disease (AD) is the sixth ... more Pharmacists and managed care professionals Activity Overview Alzheimer disease (AD) is the sixth leading cause of death and the most common etiology for dementia. It causes a significant burden to the public health system, patients afflicted with it, and their caregivers. Continuing professional education will increase competency on AD, including the importance of early detection, patient and caregiver education, and the role of new therapeutic targets for the treatment of AD. Application of knowledge will improve clinical decision making, improve quality of life among patients and caregivers, optimize medication therapy, improve outcomes, and decrease costs associated with the treatment of AD.
from €1132 (lower bound) to €1199 (upper bound). The mean cost of atenolol per patient was €366. ... more from €1132 (lower bound) to €1199 (upper bound). The mean cost of atenolol per patient was €366. The mean costs of the cardiovascular events were respectively €1969 and €2261 for losartan and atenolol groups. Therefore, the total mean cost per patient ranged from €3101 to €3169 for the losartan group and was estimated €2627 for the atenolol group. CONCLUSION: The annual incremental cost for each patient treated with losartan ranged from €99 to €113. This additional cost is associated with a significant reduction in cardiovascular morbidity and mortality (especially stroke).
Rates of medication discontinuation reflect factors including effectiveness, tolerability, cost, ... more Rates of medication discontinuation reflect factors including effectiveness, tolerability, cost, and dosing frequency. Discontinuation data can be useful to physicians and health plan managers as they compare various glaucoma medications. To compare rates of discontinuation of therapy in patients initially prescribed monotherapy with a topical glaucoma medication. Members of a managed care plan who filled at least 1 prescription for latanoprost, timolol, or brimonidine during a 30-month period were eligible to participate in this study. Prescription refill records for all glaucoma agents used in the plan were extracted for the study period. Rates of discontinuation of initial glaucoma therapy were compared using Cox regression methods; Kaplan-Meier survival curves were generated. A total of 72,744 prescriptions were eligible, of which 48491 were for study drugs. Latanoprost was the most frequently dispensed therapy (accounting for 49.7% of study drugs), followed by timolol (30.6%), ...
In partnership with a large nonprofit healthcare insurer for the Mid-Atlantic region of the Unite... more In partnership with a large nonprofit healthcare insurer for the Mid-Atlantic region of the United States, we launched the first cancer clinical pathway in the United States in August 2008. Due to its early success with regard to savings and physician participation and compliance, a second-generation pathways program-the Oncology Medical Home-was piloted in 2011. This program offered a physician reimbursement model that shifted the source of revenue from drug reimbursement margin to professional charges for cognitive services (evaluation and management codes). We report our observations of the impact of that reimbursement model on physician prescribing behavior. This was a retrospective analysis. A select group of practices that participated in the first-generation pathways program were invited to voluntarily participate in the Oncology Medical Home and its cognitive weighted reimbursement design. A matched control group was chosen from the first-generation pathways participants. Co...
/ MANAGED CARE 35 way to reduce inappropriate utilization and waste in the health care system, co... more / MANAGED CARE 35 way to reduce inappropriate utilization and waste in the health care system, contain health care costs, and assure quality patient outcomes. The statement that follows highlights the expert panel presentations, discussions, and conclusions, and is intended to provide meaningful guidance to oncologists and other practicing physicians and to the payer community as they move forward to keep pace with new cancer diagnostics, biologic therapies, and disease management techniques to improve cancer care and achieve quality patient outcomes.
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NH... more This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology The study compared linezolid and vancomycin for the treatment of nosocomial pneumonia (NP) caused by methicillinresistant Staphylococcus aureus (MRSA). The linezolid regimen included linezolid 600 mg plus aztreonam every 12 hours (q12h), while the vancomycin regimen was vancomycin 1,000 mg plus aztreonam q12h. Type of intervention Treatment. Economic study type Cost-effectiveness analysis. Study population Patients were included in the study if it was likely that they had NP only and no other forms of non-NP. As there was no International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9CM) code that differentiated NP from community-acquired pneumonia, an algorithm was created to narrow the universe of patients with any diagnosis of pneumonia on admission to hospital, to a sample of patients who were most likely to have NP only. Admissions associated with a principal diagnosis of pneumonia were excluded, as were certain secondary diagnoses of pneumonia. Patients were excluded if their length of stay was less than 7 days or more than 21 days. Admissions for immunocompromised states and admissions of patients younger than 16 years of age were also excluded. Setting The setting was secondary care. The economic study was carried out in the mid-Atlantic region of the USA. Dates to which data relate The effectiveness data were taken from a study published in 2003. The dates to which the resources and prices related were not reported. Source of effectiveness data The effectiveness data were derived from a review of the literature. Modelling A decision-analytic model was used to compare the costs and effectiveness of linezolid and vancomycin.
Background: Hypertension is one of the most frequently diagnosed chronic medical conditions in th... more Background: Hypertension is one of the most frequently diagnosed chronic medical conditions in the United States and imposes a substantial financial and social burden on Americans. Objective: The aim of this study was to compare the cost of health care resources for hypertensive patients taking analgesics stratified by having controlled versus uncontrolled hypertension. Methods: This was a retrospective, database analysis of data for managed-care patients in Maryland and Washington, DC, recorded from February 1, 1999, to July 31, 2001. Hypertensive patients who were taking analgesics were stratified by their hypertension control status using a claims-based algorithm. Annualized costs and differences in annualized costs calculated for the periods before and after the initiation of analgesics were compared by patient hypertension control status. Results: Of the 9805 patients in the study (mean [SD] age, 49.8 [12.04] years), 2523 (25.73%) were categorized as having uncontrolled hypertension. The mean total annualized costs differed significantly between the controlled and uncontrolled hypertension groups by $2568 (P < 0.001). The annualized costs for emergencydepartment visits and hospitalizations for uncontrolled hypertensive patients exceeded those for controlled hypertensive patients by 9.3% and 28.0%, respectively. The differences between the postindex-and preindexperiod costs for health care resources were $1972 with controlled hypertension and $2961 with uncontrolled hypertension (P < 0.001). The results of linear regression, after adjustments were made for preindex costs and other covariates, indicated that patients with uncontrolled hypertension had significantly increased billed annualized costs (P < 0.001). Conclusions: These data suggest that the costs of health care resources were significantly higher for analgesic users with uncontrolled hypertension than for analgesic users with controlled hypertension. A considerable proportion of the cost differential was directly attributable to hypertension-related treatment care. (Clin Ther.
Pharmacists and managed care professionals Activity Overview ALS remains a devastating diagnosis ... more Pharmacists and managed care professionals Activity Overview ALS remains a devastating diagnosis that presages a rapid decline in motor functioning and often leads to death within 2 to 5 years. Two FDA-approved treatments are currently marketed that stem the decline temporarily, and guidelines strictly recommend these therapies be used and implemented into therapy as soon as possible. However, neither offer a cure and despite this progress, the disease ravages the ability of patients with ALS to function as they lose their ability to walk, swallow, sometimes think, and, eventually, breathe. With the advent of targeted therapies and growing knowledge about the disease, several discoveries are at last offering a glimpse into a more hopeful future for patients with this rare condition. It is imperative managed care professionals review the current treatment landscape and guidelines and the potential of emerging therapies to change the landscape.
Erectile dysfunction (ED) affects approximately 30 million men in the United States. The objectiv... more Erectile dysfunction (ED) affects approximately 30 million men in the United States. The objectives of this study were to (1) assess the cost and utilization of sildenafil citrate (Viagra), an oral therapeutic agent for ED, in a large managed care organization (MCO) with a quantity limit of 6 units per 30-day supply and (2) describe the incidence of comorbid conditions and the severity of cardiovascular disease in adult male users of sildenafil. Pharmacy claims for sildenafil were identified from an administrative database of claims with dates of service in calendar year 2001 for male members aged 18 years or older. Medical claims for MCO members who had sildenafil claims were used to identify comorbid diseases and categorize patients by degree of cardiovascular risk. High risk was defined as having at least 1 medical claim with a diagnosis of diabetes mellitus, ischemic heart disease, abdominal aortic aneurysm, or peripheral arterial disease, and medium risk was defined as not havi...
Expert Review of Pharmacoeconomics & Outcomes Research, 2002
Increasing standardization in pharmacoeconomics calls for systematic use of epidemiological measu... more Increasing standardization in pharmacoeconomics calls for systematic use of epidemiological measures, such as incidence and prevalence estimates. The implications are relevant to predicting illness events and costs and to formulary decision-making. The choice of method is determined by the purpose of the study and the nature of the disease. Prevalence-based costs are assigned to the years in which they occur-results are relevant for budget impact, cost control and in chronic conditions. In contrast, the incidence-based approach assigns the stream of costs to the year it starts. It requires knowledge of the disease course, survival rates and the impact of the illness on lifetime earnings. It is relevant for making decisions among alternative treatments, short-term cost-effectiveness and acute diseases.
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Papers by Winston Wong