Scholars@Duke
Anna Hung

Anna Hung

Assistant Professor in Population Health Sciences
Population Health Sciences
anna.hung@duke.edu
215 Morris Street, 2nd Floor, Durham, NC 27701

Selected Publications

Deprescribing in older adults with polypharmacy.

Journal Article BMJ · May 7, 2024 Polypharmacy is common in older adults and is associated with adverse drug events, cognitive and functional impairment, increased healthcare costs, and increased risk of frailty, falls, hospitalizations, and mortality. Many barriers exist to deprescribing, ... Full text Link to item Cite

Comprehensive Medication Review Completion Rates and Disparities After Medicare Star Rating Measure.

Journal Article JAMA health forum · May 2024 ImportanceComprehensive medication reviews (CMRs) are offered to qualifying US Medicare beneficiaries annually to optimize medication regimens and therapeutic outcomes. In 2016, Medicare adopted CMR completion as a Star Rating quality measure to e ... Full text Cite

Association Between a National Behavioral Weight Management Program and Veterans Affairs Health Expenditures.

Journal Article Med Care · April 1, 2024 OBJECTIVE: The association between participation in a behavioral weight intervention and health expenditures has not been well characterized. We compared Veterans Affairs (VA) expenditures of individuals participating in MOVE!, a VA behavioral weight loss ... Full text Link to item Cite

Patient Risk-Benefit Preferences for Transcatheter Versus Surgical Mitral Valve Repair.

Journal Article J Am Heart Assoc · March 19, 2024 BACKGROUND: Transcatheter edge-to-edge repair (TEER) of mitral regurgitation is less invasive than surgery but has greater 5-year mortality and reintervention risks, and leads to smaller improvements in physical functioning. The study objective was to quan ... Full text Link to item Cite

Real World Use of Anti-Obesity Medications and Weight Change in Veterans.

Journal Article J Gen Intern Med · March 2024 BACKGROUND: Anti-obesity medications (AOMs) can be initiated in conjunction with participation in the VA national behavioral weight management program, MOVE!, to help achieve clinically meaningful weight loss. OBJECTIVE: To compare weight change between Ve ... Full text Link to item Cite

A primer on brand-name prescription drug reimbursement in the United States

Journal Article Journal of Managed Care & Specialty Pharmacy · January 1, 2024 Full text Cite

Mapping potentially inappropriate medications in older adults using the Anatomical Therapeutic Chemical () classification system

Journal Article Journal of the American Geriatrics Society · January 2024 AbstractBackgroundPotentially inappropriate medications (PIMs) in older adults are medications in which risks often outweigh benefits and are suggested to be avoided. Worldwide, many disti ... Full text Cite

Differences in healthcare costs over 10 years following discharge from military service by weight trajectory.

Journal Article Obes Res Clin Pract · 2024 The prevalence of overweight and obesity among military personnel has increased substantially in the past two decades. Following military discharge many personnel can receive integrated health care from the Veterans Health Administration. Prior research re ... Full text Link to item Cite

Association between a national behavioral weight management program and real-world weight change.

Journal Article Obes Res Clin Pract · 2024 OBJECTIVE: In a national cohort of Veterans, weight change was compared between participants in a US Department of Veterans Affairs (VA) behavioral weight management program (MOVE!) and matched non-participants, and between high-intensity and low-intensity ... Full text Link to item Cite

Patient Preferences for Postmastectomy Breast Reconstruction.

Journal Article JAMA Surg · December 1, 2023 IMPORTANCE: Up to 40% of women experience dissatisfaction after breast reconstruction due to unexpected outcomes that are poorly aligned with personal preferences. Identifying what attributes patients value when considering surgery could improve shared dec ... Full text Link to item Cite

Bariatric Surgery and Suicide Risk in Patients With Obesity.

Journal Article Ann Surg · October 1, 2023 OBJECTIVE: In a large multisite cohort of Veterans who underwent Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy, we compared the 5-year suicidal ideation and attempt rates with matched nonsurgical controls. BACKGROUND: Bariatric surgery has si ... Full text Link to item Cite

Development and Validation of a Tool to Identify Patients Diagnosed With Castration-Resistant Prostate Cancer.

Journal Article JCO Clin Cancer Inform · September 2023 PURPOSE: Several novel therapies for castration-resistant prostate cancer (CRPC) have been approved with randomized phase III studies with continuing observational research either planned or ongoing. Accurately identifying patients with CRPC in electronic ... Full text Link to item Cite

Considering pharmacoequity when deprescribing potentially inappropriate medications

Journal Article Journal of the American Geriatrics Society · June 2023 This editorial comments on the article by Niznik et al. in this issue. ... Full text Cite

BMI Trends for Veterans Up to 10 Years After VA Enrollment Following Military Discharge.

Journal Article J Gen Intern Med · May 2023 BACKGROUND: Obesity (body mass index [BMI]≥30kg/m2) among US adults has tripled over the past 45 years, but it is unclear how this population-level weight change has occurred. OBJECTIVE: We sought to identify distinct long-term BMI trajectories and examine ... Full text Link to item Cite

Impact of list price changes on out-of-pocket costs and adherence in four high-rebate specialty drugs.

Journal Article PloS one · January 2023 BackgroundInsurers manage the cost of specialty medicines via rebates, however it is unclear if the savings are passed on to patients, and whether reducing rebates may lead to changes in patient out-of-pocket (OOP) costs and medication adherence. ... Full text Cite

Cost-Utility Analysis of a Medication Adherence-Enhancing Educational Intervention for Glaucoma.

Journal Article Ophthalmol Glaucoma · 2023 OBJECTIVE: To evaluate the cost utility of a glaucoma medication-enhancing intervention compared to standard of care over a lifetime from the United States Department of Veterans Affairs (VA) payer perspective. DESIGN: Model-based cost-utility analysis of ... Full text Link to item Cite

Tumor testing and treatment patterns in veterans with metastatic castration-resistant prostate cancer.

Journal Article Semin Oncol · 2023 INTRODUCTION: In 2016, the Department of Veterans Affairs (VA) and Prostate Cancer Foundation (PCF) began a partnership to improve access to testing. The primary objective of this analysis was to describe the use of tumor testing and treatment patterns in ... Full text Link to item Cite

Within-Trial Cost-Effectiveness of an Adherence-Enhancing Educational Intervention for Glaucoma.

Journal Article Am J Ophthalmol · December 2022 PURPOSE: To assess the within-trial cost-effectiveness of a behavioral intervention to improve glaucoma medication adherence. DESIGN: Prospective cost-effectiveness analysis of randomized, controlled trial data. METHODS: The study setting was a Veterans Af ... Full text Open Access Link to item Cite

Association of Transcatheter Aortic Valve Replacement Reimbursement, New Technology Add-on Payment, and Procedure Volumes With Embolic Protection Device Use.

Journal Article JAMA Cardiol · September 1, 2022 IMPORTANCE: In the setting of uncertain efficacy and additional, unreimbursed cost, use of an embolic protection device (EPD) during transcatheter aortic valve replacement (TAVR) has had variable uptake. The Centers for Medicare & Medicaid Services (CMS) i ... Full text Link to item Cite

COVID-19 vaccination intention and activation among health care system employees: A mixed methods study.

Journal Article Vaccine · August 19, 2022 BACKGROUND: Achieving high COVID-19 vaccination rates among employees is necessary to prevent outbreaks in health care settings. The goal of the study was to produce actionable and timely evidence about factors underlying the intention and decisions to obt ... Full text Open Access Link to item Cite

Potential Targets for Deprescribing in Medically Complex Older Adults with Suspected Cognitive Impairment.

Journal Article Geriatrics (Basel) · May 19, 2022 Deprescribing may be particularly beneficial in patients with medical complexity and suspected cognitive impairment (CI). We describe central nervous system (CNS) medication use and side effects in this population and explore the relationship between antic ... Full text Open Access Link to item Cite

Formulary tiers, medication cost sharing, and transparency in bronze and silver qualified health plans in 2014 vs 2018.

Journal Article J Manag Care Spec Pharm · October 2021 BACKGROUND: In 2014, qualified health plans sold in the Affordable Care Act (ACA) marketplaces were accused of providing drug coverage that was too restrictive and costly. After the change in administration in 2016, efforts to repeal portions of the ACA le ... Full text Link to item Cite

Heterogeneity in Parent Preferences for Peanut Desensitization Therapy.

Journal Article J Allergy Clin Immunol Pract · September 2021 BACKGROUND: Recently developed peanut desensitization treatment reduces the incidence of allergic reactions, the anxiety associated with the risk of accidental exposure, and the burden of precautionary behavior. Eliciting parent preferences for tradeoffs i ... Full text Link to item Cite

Chemoradiation treatment patterns among United States Veteran Health Administration patients with unresectable stage III non-small cell lung cancer.

Journal Article BMC Cancer · July 16, 2021 BACKGROUND: The Veterans Health Administration (VHA) is the largest integrated health care system in the United States (US). Among VHA patients, the rate of use of concurrent chemoradiation therapy (CCRT) among those with unresectable, stage III non-small ... Full text Link to item Cite

Physical Therapy Use, Costs, and Value for Latent Classes of Good vs Poor Outcome in Patients Who Catastrophize About Their Pain Prior to Knee Arthroplasty.

Journal Article Arch Phys Med Rehabil · July 2021 OBJECTIVE: To examine use, costs, and value of physical therapy (PT) among subgroups. DESIGN: We conducted an observational study of data from a randomized trial of a pain coping skills intervention. Good and poor outcome subgroups were determined based on ... Full text Link to item Cite

Impact of financial medication assistance on medication adherence: a systematic review.

Journal Article J Manag Care Spec Pharm · July 2021 BACKGROUND: The prevalence of financial medication assistance (FMA), including patient assistance programs, coupons/copayment cards, vouchers, discount cards, and programs/pharmacy services that help patients apply for such programs, has increased. The imp ... Full text Open Access Link to item Cite

Randomized controlled trial of an education-based intervention to improve medication adherence: Design considerations in the medication adherence in glaucoma to improve care study.

Journal Article Clin Trials · June 2021 BACKGROUND: Glaucoma treatment requires patients to follow daily, often times complex, eye drop regimens, but adherence is poor for many patients, putting them at risk for irreversible vision loss. A comprehensive approach is needed to address the challeng ... Full text Open Access Link to item Cite

Subgroups of High-Risk Veterans Affairs Patients Based on Social Determinants of Health Predict Risk of Future Hospitalization.

Journal Article Med Care · May 1, 2021 OBJECTIVE: Population segmentation has been recognized as a foundational step to help tailor interventions. Prior studies have predominantly identified subgroups based on diagnoses. In this study, we identify clinically coherent subgroups using social dete ... Full text Link to item Cite

EGFR mutation testing and TKI treatment patterns among veterans with stage III and IV non-small cell lung cancer.

Journal Article Cancer Treat Res Commun · 2021 BACKGROUND: Epidermal growth factor receptor (EGFR) mutation testing is recommended in metastatic non-small cell lung cancer (NSCLC). The objective of this study was to assess changes in EGFR mutation testing patterns and tyrosine kinase inhibitor (TKI) us ... Full text Link to item Cite

Prescribing rates and characteristics of recipients of tenofovir-containing regimens before and after market entry of tenofovir alafenamide.

Journal Article J Manag Care Spec Pharm · December 2020 BACKGROUND: Tenofovir alafenamide (TAF) is a new formulation of tenofovir disoproxil fumarate (TDF) that was approved in 2015. While clinical trial evidence suggests that TAF has more favorable outcomes related to kidney injury and loss of bone mineral den ... Full text Link to item Cite

Site engagement for multi-site clinical trials.

Journal Article Contemp Clin Trials Commun · September 2020 Multi-site clinical trials are essential within medical practice to help drive reliable and generalizable knowledge on advancing medical treatments. Although the success of multi-site trials is significantly dependent on local clinician and site research t ... Full text Link to item Cite

A data-driven examination of which patients follow trial protocol.

Journal Article Contemp Clin Trials Commun · September 2020 UNLABELLED: Protocol adherence in behavioral intervention clinical trials is critical to trial success. There is increasing interest in understanding which patients are more likely to adhere to trial protocols. The objective of this study was to demonstrat ... Full text Link to item Cite

Preclinical Alzheimer Disease Drug Development: Early Considerations Based on Phase 3 Clinical Trials.

Journal Article J Manag Care Spec Pharm · July 2020 The number of people in the United States living with Alzheimer disease (AD) is growing, resulting in significant clinical and economic impact. Substantial research investment has led to drug development in stages of AD before symptomatic dementia, such as ... Full text Link to item Cite

Cost-effectiveness of diabetes treatment sequences to inform step therapy policies.

Journal Article Am J Manag Care · March 1, 2020 OBJECTIVES: Cost-effectiveness estimates are useful to a health plan when they are specific to a utilization management policy question. To help inform a step therapy policy decision, this study assessed the 3-year cost-effectiveness of adding a sodium-glu ... Full text Link to item Cite

Risk Factors and Outcomes of Opioid Users with and Without Concurrent Benzodiazepine Use in the North Carolina Medicaid Population.

Journal Article J Manag Care Spec Pharm · February 2020 BACKGROUND: Concurrent use of opioids and benzodiazepines is associated with increased risk of opioid overdose and death. Clinical guidelines recommend against this practice and quality measures incentivize plans to minimize concurrent use. OBJECTIVE: To c ... Full text Link to item Cite

Ninety-day and one-year healthcare utilization and costs after knee arthroplasty.

Journal Article Osteoarthritis Cartilage · October 2019 OBJECTIVES: This study examined ninety-day and one-year postoperative healthcare utilization and costs following total knee arthroplasty (TKA) from the health sector and patient perspectives. DESIGN: This study relied on: 1) patient-reported medical resour ... Full text Link to item Cite

Validating a Budget Impact Model Using Payer Insight and Claims Data: A Framework and Case Study.

Journal Article J Manag Care Spec Pharm · August 2019 BACKGROUND: There is a paucity of studies validating budget impact models. The lack of such studies may contribute to the underuse of budget impact models by payers in formulary decision making. OBJECTIVE: To assess the face validity, internal verification ... Full text Link to item Cite

Modeling the Budgetary Impact of Payer Utilization Management Strategies: An Adapted Framework Based on Lessons Learned.

Journal Article J Manag Care Spec Pharm · August 2019 Historically, budget impact models have been used to demonstrate how a new drug or technology entering the market could influence payer budgets, with the hope of influencing coverage of the drug or technology. This article proposes the adaptation of a budg ... Full text Link to item Cite

A Primer for Managed Care Residents: How to Conduct Research Using Live Medical and Pharmacy Claims Data.

Journal Article J Manag Care Spec Pharm · May 2019 Managed care organizations are growing more sophisticated in their ability to analyze data. There are increasing numbers of data analysts at managed care organizations, as well as more types of real-time, or "live," data available. These data range from ph ... Full text Link to item Cite

Using a Budget Impact Model Framework to Evaluate Antidiabetic Formulary Changes and Utilization Management Tools.

Journal Article J Manag Care Spec Pharm · March 2019 BACKGROUND: Traditional budget impact models predict the financial consequences of a new drug entering the market. This study provides an example of applying the budget impact framework to a new research question of interest to managed care organizations-w ... Full text Link to item Cite

The possible harms of statins: What do product labels, patient package inserts, and pharmacy leaflets tell us?

Journal Article J Am Pharm Assoc (2003) · 2019 OBJECTIVES: To evaluate the degree to which health care professionals and patients receive consistent messages regarding the possible harms of statins. DESIGN: Cross-sectional study of prescribing information (PI), patient package inserts (PPIs), and pharm ... Full text Link to item Cite

A Systematic Review of U.S. Biosimilar Approvals: What Evidence Does the FDA Require and How Are Manufacturers Responding?

Journal Article J Manag Care Spec Pharm · December 2017 BACKGROUND: Biosimilars undergo an abbreviated licensure pathway called 351(k), which was created by the Biologics Price Competition and Innovation Act of 2009. This approval process is different from the 351(a) pathway for original biologic approval and, ... Full text Link to item Cite

What Are the Incentives for Medicare Prescription Drug Plans to Consider Long-Term Outcomes and Cost?

Journal Article J Manag Care Spec Pharm · July 2016 BACKGROUND: Medicare Prescription Drug Plans (PDPs) do not have incentives to consider long-term outcomes and costs associated with both medical and pharmacy benefits (LTOCMP) when making formulary decisions. OBJECTIVE: To identify existing quality measure ... Full text Link to item Cite

Patterns of Biologics Use Across Treatment Lines in Elderly (Age >65) Medicare Patients With Metastatic Colon Cancer.

Journal Article Oncologist · June 2016 BACKGROUND: We explored biologics receipt in metastatic colon cancer. METHODS: We used Surveillance, Epidemiology, and End Results-Medicare data of 4,545 elderly patients diagnosed with incident metastatic colon cancer from 2003 to 2009, treated with chemo ... Full text Link to item Cite

The effect of Medicare Advantage enrollment on mammographic screening.

Journal Article Am J Manag Care · February 1, 2016 OBJECTIVES: To compare the rates of mammographic screening and reasons for not receiving mammography between Medicare Advantage (MA) and Medicare fee-for-service (FFS) beneficiaries. STUDY DESIGN: Cross-sectional study. METHODS: Unadjusted rates of mammogr ... Link to item Cite

A review of how the quality of HIV clinical services has been evaluated or improved.

Journal Article Int J STD AIDS · June 2015 To examine approaches being used to evaluate and improve quality of HIV clinical services we searched the MEDLINE, Cochrane Library collection, EMBASE, Global Health, and Web of Science databases for articles and abstracts focused on evaluating or improvin ... Full text Link to item Cite

Clinical value of tapentadol extended-release in painful diabetic peripheral neuropathy.

Journal Article Expert Rev Clin Pharmacol · March 2014 Painful diabetic peripheral neuropathy is difficult to treat, partially because the underlying mechanism of pain is not fully understood. Various treatment guidelines recommend first-line agents, such as α2-δ ligands, serotonin-norepinephrine reuptake inhi ... Full text Link to item Cite

Relative effectiveness and safety of chemotherapy in elderly and nonelderly patients with stage III colon cancer: a systematic review.

Journal Article Oncologist · 2013 BACKGROUND: Chemotherapy effectiveness in clinical practice may differ from the efficacy demonstrated in clinical trials, particularly among populations underrepresented in clinical trials, such as elderly patients with cancer. This review aims to examine ... Full text Link to item Cite