Background: Vertebral compression fractures (VCFs) can be treated by nonsurgical management or by minimally invasive surgical treatment including vertebroplasty and balloon kyphoplasty.

There are variable findings on the value of lumbar fusion for degenerative disc disease (DDD). Moreover, generally literature to date has focused on radiographic fusion rates, which may not translate into patient-centered outcomes.

While radiographic fusion and pain are commonly-reported outcomes in clinical studies of spinal fusion for degenerative disc disease (DDD), patient functioning is often the main goal of treatment. Given the increasing emphasis on patient-centered outcomes in comparative effectiveness research, we sought to examine the frequency and trends in reporting of functional outcomes in spinal fusion studies. A search of PubMed and Cochrane from July 2011, 1975 was conducted. Inclusion criteria included: English, abstract available, human subjects, ≥1 arm with lumbar fusion, pain/functional outcomes reported, minimum two years follow-up, adults with DDD including: spondylosis, spondylolisthesis, stenosis, disc herniation, degenerative scoliosis, standalone DDD, or discogenic back pain, all with mention of degeneration. Functional outcomes included the Oswestry Disability Index (ODI), SF36 Physical Component (PCS), and SF36 Physical Functioning (PF) Subscale. Results were stratified by study type (randomized control trial [RCT] vs. non-RCT) and publication year (2007-2011 versus before 2007). Out of 1526 titles and abstracts reviewed, 64 studies met study inclusion criteria with a median sample size of 51 and median age of 55. Thirty-seven (58%) of these were published between 2007 and 2011, with only 16 (25%) being RCTs. ODI was the most commonly reported patient centered outcome (N=48, 75% of studies), while SF36 scores were less commonly reported (n=11, 17% of studies). A higher proportion of RCTs reported functional outcomes compared to non-RCTs (ODI: 81% versus 73%; PCS or PF: 25% versus 15%). Thirteen studies (81%) from 2007-2011 reported ODI compared to 67% (N=18) of older studies. In published studies of spinal fusion surgery for DDD, we found an increasing use of functional outcomes measures, especially in randomized clinical trials, over the past five years. The reporting of such measures will greatly enhance opportunities to conduct meta-analyses of clinical trial results to inform decisions about comparative effectiveness.

Using a probabilistic model of the clinical and economic burden of rotavirus gastroenteritis (RVGE), we estimated the expected impact of vaccinating a US birth cohort with Rotarix in lieu of RotaTeq. Assuming full vaccination of all children, use of Rotarix – rather than RotaTeq – was estimated to reduce the total number of RVGE events by 5% and associated costs by 8%. On an overall basis, Rotarix would reduce costs by $77.2 million (95% CI $71.5–$86.5). Similar reductions with Rotarix were estimated to occur under an assumption of incomplete immunization of children.

s: Abstracts of Papers Accepted for Presentation at the Annual Meeting of the Society for Developmental and Behavioral Pediatrics: Poster Session, Sunday, September 17, 2006, 6: 00 p.m. - 7: 00 p.m.: Abstract # 42

Objective.-To investigate whether, among youth with attention-deficit/hyperactivity disorder (ADHD), stimulant treatment is associated with reduced emergency department (ED) use and medical costs.Methods.-We previously reviewed the complete and detailed school and medical records of all individuals born 1976-1982 in Rochester. Minn, to identify those who met criteria for ADHD between age 5 years and emigration from the area. Stimulant treatment (all start/stop dates, dosages) was also abstracted. This study followed birth cohort members with ADHD in provider-linked billing data from January 1, 1987 (billing data first available), to age 18 for outcomes: ED visits, ED costs, and medical costs. For each outcome, we analyzed associations with 1) any stimulants (yes/no), 2) proportion of follow-up time on stimulants, and 3) among those treated with stimulants, periods on versus off stimulants.Results.-Of 313 youth with ADHD, 231 (74%) received any stimulants; treatment duration ranged from 14 days to 11.8 years. Treated and untreated youth were similar with respect to median annual ED visits (0.5 vs 0.5) and medical costs ($661 vs $741) (P > .05); however, increasing proportion of follow-up on stimulants was associated with fewer ED visits (P=.02) and higher medical costs (P < .001). The 231 treated youth experienced an average of 3.7 periods on and off stimulants; while receiving stimulants, they exhibited fewer ED visits (P=.02), lower ED costs (P = .03), and higher medical costs (P < .001) compared with periods off stimulants.Conclusions.-Among youth with ADHD, extended stimulant treatment is associated with decreased ED visits and ED costs, but higher total medical costs.

While stimulant therapy has been shown to be effective in the treatment of attention-deficit/hyperactivity disorder (ADHD), there is less information concerning differences between alternative stimulant medications. The purpose of this study is to examine how different formulations of methylphenidate (MPH) affect treatment patterns and hospitalizations.

s: Abstracts of Papers Accepted for Presentation at the Annual Meeting of the Society for Developmental and Behavioral Pediatrics: Poster Session, Sunday, September 17, 2006, 6: 00 p.m. - 7: 00 p.m.: Abstract # 41

Objective: To compare the continuity of methylphenidate hydrochloride (MPH) therapy among youth Medicaid beneficiaries treated for attention-deficit/ hyperactivity disorder with immediate-release (IR) or extended-release (ER) MPH formulations.Method: An analysis was conducted of statewide California Medicaid claims (2000-2003) focusing on children and adolescents, ages 6 to 17 years, who started ER-MPH or IR-MPH treatment for attention-deficit/ hyperactivity disorder. The study cohorts were limited to youth who had not filled a prescription for MPHs, amphetamines, pemoline, or atomoxetine for 6 months preceding the index prescription and remained eligible for Medicaid benefits for the following 12 months. The study groups were compared with respect to background demographic traits and clinical characteristics. Mean and median duration of MPH treatment episodes were defined to terminate if a gap of 30 or more days occurred from the end of the last prescription supply to the start of the next prescription. Survival time ratios were used to assess treatment duration controlling for group differences in background characteristics.Results: As compared with patients initiating IR-MPH treatment, patients initiating ER-MPH treatment had a significantly longer mean estimated duration of treatment (ER-MPH, 140.3 days [95% confidence interval (CI), 136.3-144.4 days] vs IR-MPH, 103.4 days [95% CI, 101.3-103.4 days]). Similar results were found in analyses stratified by patient age, race/ethnicity, and sex. Controlling for group differences in age, sex, race/ ethnicity, coprescribed psychotropic medications, other treated mental disorders, case management, managed care participation, and seasonal effects, ER-MPH treatment initiation was associated with an average 37% longer duration of treatment than IR-MPH treatment (survival time ratio, 1.37 [95% CI, 1.32-1.42]). Among patients treated with ER-MPH, treatment initiation with an osmotic release oral system MPH (Concerta) was associated with significantly longer mean duration (147.2 days [95% CI, 142.6-151.7 days]) than treatment initiation with Metadate CD (controlled delivery) (113.0 days [95% CI, 100.9-125.1 days]) or Ritalin LA (long acting) (101.1 days [95% CI, 91.2-111.0 days]), respectively.Conclusions: Extended-release MPH formulations were associated with greater continuity of MPH treatment than IR formulations in the study population. Initial selection of an ER formulation may help to prolong continuity of MPH therapy among youth Medicaid beneficiaries with attention-deficit/hyperactivity disorder.

The Formal Observation of Concerta versUs Strattera (FOCUS) study was conducted to assess, in children with ADHD, treatment outcomes with Concerta [OROS methylphenidate (MPH)], a once-daily controlled-release medication, and Strattera, (atomoxetine), a selective noradrenaline reuptake inhibitor, Because of the lack of data in minority groups treated for ADHD, the present subgroup analysis was conducted to determine the effectiveness and tolerability of ADHD treatments in African-American patients who were randomized to OROS MPH (n=125) or atomoxetine (n=58) during the FOCUS study. At the end of the study, the mean dose of OROS MPH was 32.8 +/- 10.9 mg and that of atomoxetine was 1.1 +/- 0.4 mg/kg. The results demonstrated that both treatments were associated with significant improvements in ADHD symptoms from baseline; however, patients who received OROS MPH demonstrated significantly greater improvements in total ADHD symptoms, inattentiveness and global improvement. The incidence of adverse events was similar in both treatment groups. OROS MPH and atomoxetine are effective and tolerable in the treatment of African Americans with ADHD, and significantly greater treatment responses were observed in patients receiving OROS MPH compared with those receiving atomoxetine over three weeks. Additional studies are needed to evaluate treatment response in this population.