Crude and age–standardized pregnancy rates per 1,000 person-year of females aged 13–19 years, overall and according to mental disorder type.

These are peer-reviewed supplementary materials for the article 'Evaluation of inpatient and emergency department healthcare resource utilization and costs pre- and post-nusinersen for the treatment of spinal muscular atrophy using United States claims' published in the Journal of Comparative Effectiveness Research.Supplementary Figure 1: Mean (SD) number of inpatient admissions per patient in individuals with SMA in the 12 months before and after nusinersen treatment. Mean (SD) number of days spent in hospital per patient in individuals with SMA in the 12 months before and after nusinersen treatment.Supplementary Figure 2: Mean (SD) ED visits and costs per patient in individuals with SMA in the 12 months before and after nusinersen treatment.Supplementary Table 1: Patient baseline characteristics of cohorts aligned with steps of patient selection criteria (who were ultimately excluded) in comparison to final cohort.Aim: Nusinersen, administered by intrathecal injection at a dose of 12 mg, is indicated across all ages for the treatment of spinal muscular atrophy (SMA). Evidence on real-world healthcare resource use (HRU) and costs among patients taking nusinersen remains limited. This study aimed to evaluate real-world HRU and costs associated with nusinersen use through US claims databases. Patients & methods: Using the Merative™ MarketScan R ? Research Databases, patients with SMA receiving nusinersen were identified from commercial (January 2017 to June 2020) and Medicaid claims (January 2017 to December 2019). Those likely to have complete information on the date of nusinersen initiation and continuous enrollment 12 months pre- and post-index (first record of nusinersen treatment) were retained. Number and costs (US$ 2020) of inpatient admissions and emergency department (ED) visits, unrelated to nusinersen administration, were evaluated for 12 months pre- and post-nusinersen initiation and stratified by age: pediatric (

Access to highly specialized interventional oncology procedures such as transarterial chemoembolization (TACE) and radioembolization (TARE) may be limited in non-metropolitan areas of the United States. This study characterizes the distribution of these procedures across regions by metropolitan status through utilization of a large commercial healthcare claims database (Truven Merative Marketscan). Patients with a diagnosis of primary hepatocellular carcinoma (HCC) (n= 41,280) were categorized into those who received TACE (n = 1,780) or TARE (n = 1,179). Chi-squared tests of association were utilized to analyze regional data. Statistical analyses showed significant differences between most regional comparisons with most patients receiving these procedures originating from metropolitan areas overall. Though limited to TACE and TARE, this study reveals a disparate distribution of TACE and TARE utilization across regions with preference towards metropolitan over non-metropolitan areas, which may represent a barrier for access to care for nonmetropolitan patients, though this remains to be studied.

Food allergies impose a large clinical and financial burden on patients and the health care system. However, little is known about the factors associated with health care resource use and costs. The aim of this study was to investigate health care resource use and costs in individuals with food allergies utilizing health care in the United States. We conducted a retrospective analysis of insurance claims data from the Merative MarketScan Research Databases (indexed from 1 January 2015 to 30 June 2022). All-cause and food allergy-related health care resource use, direct medical, and out-of-pocket costs for medical services were estimated for 12 months post-index using International Classification of Diseases [ICD] codes. Of 355,520 individuals with food allergies continuously enrolled in a health insurance plan for ≥12 months pre- and post-index, 17% had a food allergy-related emergency department visit and 0.9% were hospitalized. The top patient characteristic associated with all-cause and food allergy-related hospitalizations, all-cause costs, and food allergy-related outpatient visit costs was a Charlson Comorbidity Index score of ≥2. Food allergy-related direct medical and out-of-pocket costs were high among patients with a food allergy-related visit. Out-of-pocket cost per patient per year for outpatient visits, emergency department visits, and hospitalizations had an estimated mean of $1631 for patients with food allergy-related visits, which is ∼11% of the total costs for these services ($14,395 per patient per year). Study limitations are primarily related to the nature of claims databases, including generalizability and reliance on ICD codes. Nevertheless, MarketScan databases provide robust patient-level insights into health care resource use and costs from a large, commercially insured patient population. The health care resource use of patients with food allergies imposes a burden on both the health care system and on patients and their families, especially if patients had comorbidities. Some people with food allergies might need extra visits to the doctor or hospital to manage allergic reactions to food, and these visits add to the cost of medical services for both families and for health care providers. Using records of health insurance claims, we looked into the factors affecting medical visits and costs in people with food allergies in the United States. For people with food allergies, having additional medical conditions (measured using the Charleson Comorbidity Index) were linked with extra medical visits and costs. Out-of-pocket costs were high for people who visited a doctor or hospital for their food allergies (costing each person more than $1,600 per year). The total medical cost of food allergy-related care was $14,395 per person per year, paid for by families and health care providers. Our findings might help to better manage and treat people with food allergies and reduce medical costs.

These are peer-reviewed supplementary materials for the article 'Resource utilization and economic outcomes following repetitive transcranial magnetic stimulation for treatment-resistant depression: a retrospective observational analysis' published in the Journal of Comparative Effectiveness Research.Supplementary table 1: Minimum, Median and Maximum Healthcare Costs for Patient Cohort Aim: We investigated the impact of repetitive transcranial magnetic stimulation (rTMS) for treatmentresistant depression on healthcare resource utilization as well as commercial and Medicare Fee-for-Service payer costs. Materials & methods: We conducted a retrospective observational analysis of claims data using Medicare Fee-for-Service datasets and commercial (Merative MarketScan Research Databases) datasets from 1 January 2021 to 30 September 2023. We identified two cohorts, a cohort that received rTMS and a cohort not treated with rTMS over an 18-month period. We used propensity score matching to balance the baseline characteristics of the cohorts, and we calculated the total cost of care based on payer allowed amounts from Merative MarketScan Research Databases and Standard Analytical Files. Results: Relative to the non-TMS cohort, the rTMS cohort incurred 37% more hospital outpatient visits (14.00 vs 10.21; p ≤ 0.0001) with 7% higher outpatient cost ($8946 vs $8363; p = 0.3400). Simultaneously, the rTMS cohort incurred 24% fewer inpatient admissions (0.25 vs 0.33; p = 0.0003) with 19% lower inpatient admission costs ($5666 vs $6978; p = 0.0392), 48% fewer emergency room visits (0.27 vs 0.53; p ≤ 0.0001) with 34% lower emergency room costs ($322 vs $487; p ≤ 0.0001), and $893 less in episode of care costs. Conclusion: This study suggests that patientswho receive rTMS for treatment-resistant depression required fewer high acuity hospital visits and incurred less expensive episode-of-care costs compared with patients who do not receive rTMS. From this perspective, rTMS is an investment that returns health and economic dividends through fewer high acuity hospital visits.

BackgroundChronic atrophic gastritis (CAG) is a precancerous condition of the gastric mucosa which predisposes to non-cardia gastric cancer (NCGC). The risk for NCGC following diagnosis with CAG has not been described robustly in the United States.MethodsWe used a commercial claims database (Marketscan, Merative LP) covering over 150 million privately-insured Americans aged 18–64 to create a cohort of individuals diagnosed with CAG. We then followed these individuals for the development of NCGC or to the time of their last clinical encounter. Demographic and clinical characteristics were captured through administrative coding schema, and linked to metropolitan statistical area measures of socioeconomic status. Individual race and ethnicity were not available for this analysis.FindingsWe analyzed data on 107,835 individuals and recorded 355,591 person-years (p-y) of follow-up. The crude overall incidence of NCGC was 98 per 100,000 p-y. In the fully-adjusted multivariable proportional hazards model, age ≥ 50 (HR 2.20, 95% CI 1.44–3.36), anemia (HR 5.09, 95% CI 3.46–7.50), former or current smoking (HR 1.42, 95% CI 1.11–1.81) and family history (HR 1.44, 95% CI 1.05–1.99) were individual-level factors associated with increased risk.ConclusionsWe present one of the first estimates of NCGC risk following CAG diagnosis in an American population, and highlight risk factors for cancer progression. These data may help to guide future risk prevention strategies, such as endoscopic surveillance, in the United States.

Pregnancy is a condition of broad interest across many medical and health services research domains, but one not easily identified in healthcare claims data. Our objective was to establish an algorithm to identify pregnant women and their pregnancies in claims data. We identified pregnancy-related diagnosis, procedure, and diagnosis-related group codes, accounting for the transition to International Statistical Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) diagnosis and procedure codes, in health encounter reporting on 10/1/2015. We selected women in Merative MarketScan commercial databases aged 15–49 years with pregnancy-related claims, and their infants, during 2008–2019. Pregnancies, pregnancy outcomes, and gestational ages were assigned using the constellation of service dates, code types, pregnancy outcomes, and linkage to infant records. We describe pregnancy outcomes and gestational ages, as well as maternal age, census region, and health plan type. In a sensitivity analysis, we compared our algorithm-assigned date of last menstrual period (LMP) to fertility procedure-based LMP (date of procedure + 14 days) among women with embryo transfer or insemination procedures. Among 5,812,699 identified pregnancies, most (77.9%) were livebirths, followed by spontaneous abortions (16.2%); 3,274,353 (72.2%) livebirths could be linked to infants. Most pregnancies were among women 25–34 years (59.1%), living in the South (39.1%) and Midwest (22.4%), with large employer-sponsored insurance (52.0%). Outcome distributions were similar across ICD-9 and ICD-10 eras, with some variation in gestational age distribution observed. Sensitivity analyses supported our algorithm’s framework; algorithm- and fertility procedure-derived LMP estimates were within a week of each other (mean difference: -4 days [IQR: -13 to 6 days]; n = 107,870). We have developed an algorithm to identify pregnancies, their gestational age, and outcomes, across ICD-9 and ICD-10 eras using administrative data. This algorithm may be useful to reproductive health researchers investigating a broad range of pregnancy and infant outcomes.

These are peer-reviewed supplementary materials for the article 'TComparison of real-world healthcare resource utilization and costs among patients with hereditary angioedema on lanadelumab or berotralstat long-term prophylaxis' published in the Journal of Comparative Effectiveness Research.Table S1: Patient attritionTable S2: Baseline clinical characteristicsTable S3: Baseline all-cause healthcare utilizationSupplementary figure 1Supplementary figure 2Supplementary table and figure legendsAim: Hereditary angioedema (HAE) is a rare and chronic genetic condition. Lanadelumab and berotralstat, two plasma kallikrein inhibitors, have both been approved for long-term prophylaxis in patients with HAE; however, real-world data comparing costs and healthcare resource utilization (HCRU) are lacking. Materials & methods: This retrospective study used administrative healthcare insurance claims data (Merative™ MarketScan R ? Commercial, Medicare and Early View Research Databases; 1 July 2017–31 July 2023) to identify patients with HAE who initiated lanadelumab or berotralstat and were persistent for ≥18 months or 6 months, respectively. Sex, baseline healthcare costs and baseline number of ondemand treatment/short-term prophylaxis medication claims were used to calculate covariate balancing propensity scores for inverse probability of treatment weighting. Following weighting, outcomes during the 6-month follow-up period in patients receiving berotralstat were compared with those during months 0–6, 7–12 and 13–18 in lanadelumab-treated patients. Results: Fifty-seven lanadelumab- and 32 berotralstat-treated patients were included. After weighting, more berotralstat-treated patients had an all-cause inpatient admission (berotralstat, 9.4%; lanadelumab, months 0–6, 4.0%, 7–12, 1.8%, months 13–18, 2.0%) and emergency room visit (berotralstat, 21.9%; lanadelumab, months 0–6, 14.0%, 7–12, 8.0%, months 13–18, 17.9%). Total HAE treatment costs were similar during months 0–6 (lanadelumab, $377,326 vs berotralstat, $373,010), but decreased in months 7–12 ($319,967) and 13–18 ($283,241) of lanadelumab. On-demand treatment/short-term prophylaxis costs were lower for lanadelumab across the three follow-up periods than for berotralstat during months 0–6 (berotralstat, $60,451; lanadelumab, months 0–6, $46,336, months 7–12, $37,578, months 13–18, $23,968). The proportion of lanadelumabtreated patients who reduced dosing frequency was 24.8% during months 7–12 and 21.6% during months 13–18. Conclusion: Patients with HAE initiating lanadelumab versus berotralstat may require less ondemand and supportive HAE treatments and incur lower treatment-related and total healthcare costs. The ability to reduce lanadelumab dosing frequency after an attack-free period may be key in treatment selection, given the combination of cost savings and lower healthcare resource utilization.

Although the efficacy of mepolizumab in reducing exacerbations and oral corticosteroid (OCS) use in severe asthma is well-established, real-world long-term effectiveness data are limited. This study evaluated the real-world impact of mepolizumab treatment in patients with severe asthma over a 4-year follow-up period. This was a retrospective cohort study of patients with asthma initiating mepolizumab (index date: first claim, November 2015–September 2019) using the Merative MarketScan Commercial and Medicare Databases. Outcomes included asthma exacerbations, OCS use, and exacerbation-related healthcare resource utilization (HCRU) and costs, assessed 12-months pre-index (baseline) and annually during the 4-year follow-up period. Among 189 eligible patients, mean asthma exacerbation rate (AER) declined progressively from baseline during follow-up: AER decreased by 53.8% at Year 1 and 73.8% by Year 4 (p 

These are peer-reviewed supplementary materials for the article 'Economic burden of complicated ureteral stent removal in patients with kidney stone disease in the USA' published in the Journal of Comparative Effectiveness Research.Supplementary Table 1: Patient Characteristics – Propensity-Score MatchingAim: To examine the medical costs of simple versus complicated ureteral stent removal. Materials & methods: We included adults with kidney stones undergoing simple or complicated cystoscopy-based stent removal (CBSR) post ureteroscopy from the 2014 to 2018 Merative™ MarketScan Commercial Database. The medical costs of patients with complicated and simple CBSR were compared. Results: Among 16,682 patients, 2.8% had complicated CBSR. Medical costs for patients with complicated CBSR were higher than for simple CBSR ($2182 [USD] vs $1162; p < 0.0001). Increased stenting time, increased age, southern US geography and encrusted stent diagnoses were significantly associated with complicated CBSR. Conclusion: Complicated ureteral stent removal doubled the medical costs associated with CBSR. Ureteral stents with anti-encrustation qualities may reduce the need for complicated CBSR and associated costs.

Aim: To examine the medical costs of simple versus complicated ureteral stent removal. Materials & methods: We included adults with kidney stones undergoing simple or complicated cystoscopy-based stent removal (CBSR) post ureteroscopy from the 2014 to 2018 Merative™ MarketScan R ? Commercial Database. The medical costs of patients with complicated and simple CBSR were compared. Results: Among 16,682 patients, 2.8% had complicated CBSR. Medical costs for patients with complicated CBSR were higher than for simple CBSR ($2182 [USD] vs $1162; p < 0.0001). Increased stenting time, increased age, southern US geography and encrusted stent diagnoses were significantly associatedwith complicated CBSR. Conclusion: Complicated ureteral stent removal doubled the medical costs associated with CBSR. Ureteral stents with anti-encrustation qualities may reduce the need for complicated CBSR and associated costs.