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The effectiveness of a pharmacist-led telephone intervention directed at providers or members was examined in this randomized study. Pharmacist calls to members did not improve osteoporosis management over member and provider mail and fax notifications. Greater impact was demonstrated by performing a pharmacist call intervention with providers rather than with members.

Background Examining drug exposure is essential to pharmacovigilance, especially for bisphosphonate (BP) therapy. Objective This study examines differences in four measures of oral BP exposure: treatment discontinuation, adherence, persistence, and non-persistence. Methods Among women aged ≥50 years who initiated oral BP therapy during 2002–2007 with at least three years of health plan membership follow-up, discontinuation was defined by evidence of no further treatment during the study observation period. Among those with at least two filled BP prescriptions during the study period, adherence was calculated for each year of follow-up using the proportion of days covered, modified to allow for stockpiling of prescription/refills overlap ≤30 days supply (mPDC). Persistence was quantified by treatment duration, allowing a gap of up to 60 days between prescription/refill days covered. Non-persistence was quantified by the periods without drug outside this allowable gap. Multivariable logistic regression was used to compare age and race groups and the relationships of early adherence (adherence during the first year) with subsequent adherence. Results Among 48,390 women initiating oral BP therapy and followed for three years, 26.7% discontinued in Year 1 and 14.7% of the remaining 35,456 women discontinued in Year 2. Discontinuation rates were slightly higher (29.4%, p<0.001) for women age ≥75 years and somewhat lower (21.1%, p<0.001) for Asian women. During the first year, 60.4% achieved a mPDC of ≥75%, with demographic differences in adherence similar to that seen for treatment discontinuation. Over the three years, the median mPDC levels for BP therapy were 86%, 84% and 85% in Years 1, 2 and 3, respectively for those receiving treatment. Cumulative persistence was 2.3 years (median, IQR 1.0–3.0) overall and slightly greater for Asian versus white women and lower for older women. There were 18,174 (42.9%) women with at least one period of non-persistence during three years follow-up in excess of the 60 day allowable gap between prescription/refills (median cumulative non-persistence 0.65, IQR 0.30–1.25 years). Women with mPDC ≥75% during the first year had a 12-fold and 6-fold increased odds of mPDC ≥75% during Year 2 and Year 3, respectively. Conclusions Bisphosphonate discontinuation rates are highest for women during the first year. Among those continuing treatment in subsequent years, adherence rates were relatively stable. Persistence and adherence varied slightly by age and was somewhat higher in Asians, contributing to differences in cumulative bisphosphonate exposure. We also found evidence that optimal adherence in the first year was highly predictive of optimal adherence in the subsequent one to two years. Hence, subgroups of patients receiving oral bisphosphonate drugs may require different levels of support and monitoring to maximize treatment benefit, especially based on early patterns of use.

Surgeon case volume had positive impacts on procedural, financial, and clinical outcomes and this finding may be used to improve hospital's quality of care.

Introduction: Cancer care costs escalated with the introduction of novel therapies. Therefore, cancer-related Cost Utility Analyses (CUAs) are used to guide policy makers. Since numerous methods (criteria) exist to evaluate CUAs, we compared these criteria between CUAs of solid tumors and those of hematological malignancies. Methods:A systemic MEDLINE search of English-language publications between 2001 and 2012 was performed. Strict inclusion criteria were limited to CUAs examining one single intervention and one single study comparator. Standard data of 66 variables, based on the Drummond criteria, were collected to review each CUA for clarity, completeness, and health economic methodological quality.Results: Among 8,515 screened papers on Pubmed, 177 cancer-related CUAs (2%) were eligible. Solid tumors and hematological malignancies CUAs constituted 161(91%) and 16(9%). Among the standardized methods for evaluating CUAs, those of solid tumors reported more frequently the presentation of cost-effectiveness acceptability curve (p=0.02) and the use of threshold value to interpret study results (p=0.024) than those of hematological malignancies. Further, CUAs of solid tumors were more frequently multicenter-based (p=0.014); however, CUAs of hematological malignancies listed differential quality adjusted life year separately more frequently (p=0.02). Outcomes of CUAs of solid tumors were more frequently reported as significant (p=0.014). Conclusions:CUAs of solid tumors abided more frequently with the standardized methods (criteria) than those of hematological malignancies, which may be due in part to their multiple study sites. CUAs of hematological malignancies may warrant more methodological standardization and incorporate more study sites. MethodsA systemic MEDLINE search by the keywords: CUAs and cancer of English-language manuscripts published between 2001 and 2012 was performed. Eligibility criteria consisted of including only CUAs that examined one single intervention and one single study comparator. For example, adding rituximab to fludarabine and cyclophosphamide for the treatment of previously untreated chronic lymphocytic leukemia [15]. Exclusion criteria included CUAs that examined more than one intervention, more than one comparator or more than one study population or type of malignancy. The study population was not limited by age; therefore, CUAs examining children, adult or geriatric populations were included.