Electronic Theses and Dissertations

Identifier

1073

Date

2014

Document Type

Dissertation (Access Restricted)

Degree Name

Doctor of Philosophy

Major

Business Administration

Concentration

Economics

Committee Chair

Cyril F Chang

Committee Member

Albert Okunade

Committee Member

William T Smith

Committee Member

Andrew J Hussey

Abstract

The two essays in this dissertation draw on concepts from healthcare economics and pharmacoeconomics to examine the costs and outcomes which follow medication adherence with an interferon-beta in a multiple sclerosis population, and a personalized approach to therapy management in a rheumatoid arthritis population. The first essay demonstrates the positive impact of adherence with an interferon-beta therapy on multiple sclerosis relapses and healthcare resource utilization. This is the first study to use logistic general estimating equations (GEE) to analyze the impact of medication possession ratio (MPR) with an 85% cutoff point for interferon-beta on multiple sclerosis relapses; and to examine the relationship between medication adherence and inpatient hospitalizations, emergency room visits, and physician office visits. The second essay compares the cost-effectiveness of a personalized medicine (PSM) approach to biologic therapy management in a population of methotrexate-experienced rheumatoid arthritis (RA) patients with the usual (trial-and-error) therapy management approach. AMarkov process with a simulated cohort is used to model each therapy management approach over a three year time horizon. Incorporated in the model are costs associated with adverse events, and disease progression. This is the first study to quantify the potential cost savings and improved patient outcomes with a cost-effectiveness model for a novel biomarker essay test to measure biologic therapy response in RA. Additionally, this study highlights the potential benefits of personalized medicine by identifying a sub-group of individuals who can benefit from treatment, while minimizing the costs and safety risks from treating patients who will not benefit.

Comments

Data is provided by the student.

Library Comment

Dissertation or thesis originally submitted to the local University of Memphis Electronic Theses & dissertation (ETD) Repository.

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