Preventing Opioid Relapse: Cost-Effectiveness of Buprenorphine–Naloxone vs Extended-Release Naltrexone

MedicalResearch.com Interview with:

Sean M. Murphy, PhD Associate Professor of Research Director, CHERISH Consultation Service  Weill Cornell Medicine Department of Healthcare Policy & Research New York, NY 10065-8722

Dr. Murphy

Sean M. Murphy, PhD
Associate Professor of Research
Director, CHERISH Consultation Service
Weill Cornell Medicine
Department of Healthcare Policy & Research
New York, NY 10065-8722

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: A recent eight-site US randomized effectiveness trial compared buprenorphine-naloxone to extended-release naltrexone to prevent opioid-use relapse. Participants were recruited from inpatient detoxification or short-term residential treatment programs.

Current treatment protocols require persons initiating extended-release naltrexone, but not buprenorphine-naloxone, be fully detoxified from opioids. Both medications were effective at treating opioid use disorder with regard to time abstinent from opioid use and health-related quality-of-life; however, the higher cost of extended-release naltrexone and additional costs associated with detoxification prior to administering this medication, resulted in buprenorphine-naloxone being the better value to the healthcare sector, among patients who require detoxification before initiating extended-release naltrexone.

The economic value of extended-release naltrexone, compared to buprenorphine-naloxone, became more attractive after accounting for additional costs to society (participant time and travel, criminal activity, workforce productivity), and among persons who were successfully initiated on treatment. 

MedicalResearch.com: What should readers take away from your report?

Response: Because the economic value of extended-release naltrexone compared to buprenorphine-naloxone increased among persons who were successfully initiated on treatment, identifying persons who are most likely to achieve superior outcomes on extended-release naltrexone in advance would be a preferred to offering this medication to everyone. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: Narrowing the cost gap by identifying the best possible patients for each medication, lowering the cost of extended-release naltrexone, and shortening or eliminating the induction period could improve its relative economic value, thereby increasing its attractiveness to payers and allowing more people to access either alternative according to their clinical needs and preferences.

Thus, I would really like to see additional research on treatment models that could achieve these objectives. I am also eager to see comparative effectiveness and economic evaluations of extended-release naltrexone compared to extended-release buprenorphine products. 

Citation:

Murphy SM, McCollister KE, Leff JA, Yang X, Jeng PJ, Lee JD, et al. Cost-Effectiveness of Buprenorphine–Naloxone Versus Extended-Release Naltrexone to Prevent Opioid Relapse. Ann Intern Med. [Epub ahead of print ] doi: 10.7326/M18-0227

Dec 18, 2018 @ 12:50 am

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Healthcare Costs in Patients with Cancer Rise with Increasing Risk of Venous Thromboembolism

MedicalResearch.com Interview with:

Paul Burton MD, PhD, FACC Vice President, Medical Affairs Internal Medicine Janssen Scientific Affairs, LLC.

Dr. Burton

Paul Burton MD, PhD, FACC
Vice President, Medical Affairs
Internal Medicine
Janssen Scientific Affairs, LLC.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Despite being largely preventable, venous thromboembolism (VTE) is the second leading cause of death in people with cancer. The risk of VTE is five times greater in people with cancer than those without cancer, and that risk is magnified in those receiving certain types of chemotherapy, in the newly diagnosed and in those with more advanced, metastatic disease. This 6,194-patient study examined economic burden associated with VTE, and found patients newly diagnosed with cancer who are at a higher risk of a VTE had significantly higher all-cause and VTE-related health care costs compared to patients with a lower risk of VTE. Continue reading

CLL: Overall Treatment Savings With Ibrutinib (Imbruvica) Despite Higher Prescription Costs

MedicalResearch.com Interview with:

Dr. Sundaram

Murali Sundaram, MBA, Ph.D.
Director of Real World Value and Evidence
Oncology, Janssen

MedicalResearch.com: What is the background for this study?

Response: Ibrutinib is a novel Bruton’s tyrosine kinase (BTK) inhibitor approved for the treatment of patients with newly diagnosed chronic lymphocytic leukemia (CLL).

Ibrutinib is administered orally while standard of care (CD20 monoclonal antibody-based chemoimmunotherapy [CIT]) is administered intravenously. This difference in route of administration impacts what type of benefit covers these treatments (i.e., pharmacy benefit for oral ibrutinib and medical benefit for intravenous CIT).

Previous studies evaluating the costs burden of patients treated with ibrutinib versus CIT did not include the full spectrum of real-world healthcare costs.

Continue reading

Use of Biosimilar Growth Factor Increases in Supportive Cancer Care

MedicalResearch.com Interview with:

Abiy Agiro, PHD HealthCore Inc Wilmington, Delaware

Dr. Agiro

Abiy Agiro, PHD
HealthCore Inc
Wilmington, Delaware 

MedicalResearch.com: What is the background for this study?

Response: Biosimilar approval pathway, authorized in 2010 by the Biologics Price Competition and Innovation Act as part of the Affordable Care Act, aims to increase adoption of biosimilar products and generate significant cost savings to payers and patients alike. Biosimilar filgrastim, used to prevent febrile neutropenia, is one of the first biosimilars to be approved in the United States. A large scale, post-approval real-world analysis was needed that compares biosimilar filgrastim to the original drug for safety and efficacy.

Continue reading

Poor Health Insurance Literacy Linked to Avoidance of Health Care Services

MedicalResearch.com Interview with:
Renuka Tipirneni, MD, MSc Assistant Professor Holder of the Grace H. Elta MD Department of Internal Medicine Early Career Endowment Award 2019-2024 University of Michigan Department of Internal Medicine, Divisions of General Medicine and Hospital Medicine, and Institute for Healthcare Policy & Innovation Ann Arbor, MI 48109Renuka Tipirneni, MD, MSc
Assistant Professor
Holder of the Grace H. Elta MD Department of Internal Medicine Early Career Endowment Award 2019-2024
University of Michigan Department of Internal Medicine
Divisions of General Medicine and Hospital Medicine, and
Institute for Healthcare Policy & Innovation
Ann Arbor, MI 48109

MedicalResearch.com: What is the background for this study? What are the main findings?

Response:  Navigating health insurance and health care choices is challenging and requires significant health insurance literacy (knowledge and application of health insurance concepts). We looked at the association between U.S. adults’ health insurance literacy and avoidance of health care services due to perceived cost.

We found that 30% of people we surveyed reported delayed or foregone care because of perceived cost, and that those with lower health insurance literacy reported significantly greater avoidance of both preventive and nonpreventive health care services.

Continue reading

Untreated Hearing Loss: Higher Health Care Costs, More ER Visits and Readmissions

MedicalResearch.com Interview with:

Nicholas S. Reed, AuD Assistant Professor | Department of Otolaryngology-Head/Neck Surgery Core Faculty  | Cochlear Center for Hearing and Public Health Johns Hopkins University School of Medicine Johns Hopkins University Bloomberg School of Public Health

Nicholas Reed AuD

Nicholas S. Reed, AuD
Assistant Professor | Department of Otolaryngology-Head/Neck Surgery
Core Faculty  | Cochlear Center for Hearing and Public Health
Johns Hopkins University School of Medicine
Johns Hopkins University Bloomberg School of Public Health

MedicalResearch.com: What is the background for this study?

 

Response: This study was a true team effort. It was funded by AARP and AARP Services, INC and the research was a collaboration of representatives from Johns Hopkins University, OptumLabs, University of California – San Francisco, and AARP Services, INC. Given all of the resent research on downstream effects of hearing loss on important health outcomes such as cognitive decline, falls, and dementia, the aim was to explore how persons with hearing loss interacted with the healthcare system in terms of cost and utilization.

MedicalResearch.com: What are the main findings? 

Response: Over a 10 year period, untreated hearing loss (hearing aid users were excluded from this study as they are difficult to capture in the claims database) was associated with higher healthcare spending and utilization. Specifically, over 10 years, persons with untreated hearing loss spent 46.5% more, on average, on healthcare (to the tune of approximately $22000 more) than those without evidence of hearing loss. Furthermore, persons with untreated hearing loss had 44% and 17% higher risk for 30-day readmission and emergency department visit, respectively.

Similar relationships were seen across other measures where persons with untreated hearing loss were more likely to be hospitalized and spent longer in the hospital compared to those without evidence of hearing loss.  Continue reading

Even in Intensive Care, Health Care Costs Are Factor For Both Patients and Clinicians

MedicalResearch.com Interview with:

Deborah D. Gordon, MBA Mossavar-Rahmani Center for Business and Government Harvard Kennedy School Cambridge, Massachusetts

Deborah  Gordon

Deborah D. Gordon, MBA
Mossavar-Rahmani Center for Business and Government
Harvard Kennedy School
Cambridge, Massachusetts

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Against the backdrop of rising health care costs, and the increasing share of those costs that consumers bear, studies show people are interested in finding health care cost information and engaging with their providers on issues of cost.

We were interested in learning to what extent, if any, discussion or consideration of cost would be documented in electronic health records.

Using machine learning techniques to extract data from unstructured notes, we examined 46,146 narrative clinical notes from ICU admissions. We found that approximately 4% of admissions had at least one note with financially relevant content. That financial content included documentation of cost as a barrier to adhering to treatment prior to admission, and as a consideration in treatment and discharge planning.    Continue reading

Medicaid Expansion Linked To Lower Death Rates for Kidney Failure Patients

MedicalResearch.com Interview with:
"Plugged into dialysis" by Dan is licensed under CC BY 2.0Amal Trivedi, MD, MPH

Associate Professor of Health Services, Policy and Practice
Associate Professor of Medicine
Brown University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Affordable Care Act Medicaid expansion gave states the option to expand coverage to low-income adults. Prior research has reported that these expansions have been associated with increased coverage, improved access to care, and in some studies better self-rated health. To date the impact of Medicaid expansion on mortality rates, particularly for persons with serious chronic illness, remains unknown.

Our study found an association between Medicaid expansion and lower death rates for patients with end-stage renal disease in the first year after initiating dialysis.  Specifically, we found an absolute reduction in 1-year mortality in expansion states of -0.6 percentage points, which represents a 9% relative reduction in 1-year mortality.      Continue reading

More Than Half of Physician Guideline Authors for Expensive Medications Have Undeclared Conflicts of Interest

MedicalResearch.com Interview with:

Samir C. Grover MD, MEd, FRCPC Division of Gastroenterology Program Director Division of Gastroenterology Education Program  University of Toronto

Dr. Grover

Samir C. Grover MD, MEd, FRCPC
Division of Gastroenterology Program Director
Division of Gastroenterology Education Program
University of Toronto

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We know that physician-industry interactions are commonplace. Because of this, there has been a movement to make the presence of these relationships more transparent. For clinical practice guidelines, this is especially important as these documents are meant to be objectively created, evidence based, and intended to guide clinical practice.

The standard in the US come from the National Academy of Medicine report, “Clinical Practice Guidelines We Can Trust”, which suggests that guideline chairs should be free of conflicts of interest, less than half of the guideline committee should have conflicts, and that guideline panel members should declare conflicts transparently.

Other studies, however, have shown that some guidelines don’t adhere to this advice and have committee members who don’t disclose all conflicts. We thought to look at this topic among medications that generate the most revenue, hypothesizing that undeclared conflicts would be especially prevalent in this setting.

We found that, among 18 guidelines from 10 high revenue medications written by 160 authors, more than (57%) had a financial conflict of interest, meaning they received payments from pharmaceutical companies that make or market medications recommended in that guideline. About a quarter of authors also received, and didn’t disclose payments from one of these companies. Almost all the guidelines did not adhere to National Academy of Medicine standards.

Continue reading

Amphetamine-Related Hospitalizations Skyrocket Costing $2 Billion per Year

MedicalResearch.com Interview with:

Tyler Winkelman MD, MSc   Clinician-Investigator Division of General Internal Medicine, Hennepin Healthcare Center for Patient and Provider Experience, Hennepin Healthcare Research Institute Assistant Professor Departments of Medicine & Pediatrics University of Minnesota 

Dr. Winkelman

Tyler Winkelman MD, MSc  
Clinician-Investigator
Division of General Internal Medicine, Hennepin Healthcare
Center for Patient and Provider Experience, Hennepin Healthcare Research Institute
Assistant Professor
Departments of Medicine & Pediatrics
University of Minnesota 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Trends in amphetamine use are mixed across data sources. We sought to identify trends in serious, problematic amphetamine use by analyzing a national sample of hospitalizations.

Amphetamine-related hospitalizations increased over 270% between 2008 and 2015. By 2015, amphetamine-related hospitalizations were responsible for $2 billion in hospital costs. While opioid-related hospitalizations were more common, amphetamine-related hospitalizations increased to a much larger degree. After accounting for population growth, amphetamine hospitalizations grew 245% between 2008 and 2015, whereas opioid-related hospitalizations increased 46%. Amphetamine-related hospitalizations were more likely to be covered by Medicaid and be in the western United States compared with other hospitalizations. In-hospital mortality was 29% higher among amphetamine-related hospitalizations compared with other hospitalizations. 

Continue reading

High Deductible Plans Hit Chronically Ill Low-Income Patients Hardest

MedicalResearch.com Interview with:

Salam Abdus, PhD Division of Research and Modeling, Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality Department of Health and Human Services Rockville, Maryland

Dr. Abdus

Salam Abdus, PhD
Division of Research and Modeling,
Center for Financing, Access, and Cost Trends,
Agency for Healthcare Research and Quality
Department of Health and Human Services
Rockville, Maryland

MedicalResearch.com: What is the background for this study? What are the main findings? 


Response:
High deductible health plans are more prevalent than ever.

Previous research showed that adults in low-income families or with chronic conditions are more likely to face high financial burdens when they are enrolled in high-deductible health plans, compared to adults in higher income families or healthier adults.

In this study we examined the financial burden of high-deductible health plans among adults who are both low income and chronically ill. We used AHRQ’s Medical Expenditure Panel Survey Household Component (MEPS-HC) data from 2011 to 2015 to study the prevalence of high out-of-pocket health care spending burden of high deductible health plans among adults enrolled in employer-sponsored insurance. We included family out-of-pocket spending on premiums and health care services.

We found that among adults who had family income below 250% of Federal Poverty Level (FPL), had multiple chronic conditions, and were enrolled in high-deductible health plans, almost half (46.9%) had financial family out-of-pocket health care burden exceeding 20 percent of family disposable income.

Continue reading

Most Health Care Costs Associated With Osteoporotic Fractures Occur in First Year

MedicalResearch.com Interview with:

Kandice A. Kapinos, Ph.D. Economist Professor RAND Corporation Pardee RAND Graduate School 

Dr. Kapinos

Kandice A. Kapinos, Ph.D.
Economist
Professor
RAND Corporation
Pardee RAND Graduate School 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: The economic burden of osteoporotic fractures is substantial with studies estimating the annual healthcare cost burden between $10 to 17 billion. Although estimates from individual studies vary, most studies assessing costs after a fracture only explore up to twelve months following a fracture. There is little investigation of how fracture patients’ costs evolve over a longer post-fracture period.

As osteoporotic fractures are one of the most common causes of disability among older adults and can translate into greater medical costs, we focused on studying Medicare beneficiaries. In fact, previous research has suggested that most of the increase in Medicare spending over time can be explained from costs associated with treating higher risk Medicare beneficiaries.

Our objective in this study was to compare health care costs over a 3-year period of those who experienced a fracture to those who did not among a sample of Medicare beneficiaries who were at an increased risk of having a fracture.

Consistent with previous studies, we found a significant increase in expenditures in the year immediately following a fracture relative to controls: almost $14,000 higher for fractures relative to controls. However, at 2 and 3-years post-fracture, there were no significant differences in the change in expenditures between fracture cases and controls. We note that these findings may be different for beneficiaries living in skilled nursing facilities or other non-community-based settings.

Continue reading

How Much Do Clinical Trials For New Medications Really Cost?

MedicalResearch.com Interview with:

Thomas J Moore Senior Scientist Institute for Safe Medication Practices Lecturer, Department of Epidemiology and Biostatistics The George Washington University Milken Institute of Public Health Alexandria, VA 22314

Thomas J Moore

Thomas J Moore AB
Senior Scientist Institute for Safe Medication Practices
Lecturer, Department of Epidemiology and Biostatistics
The George Washington University
Milken Institute of Public Health
Alexandria, VA 22314

MedicalResearch.com: What is the background for this study? What are the main findings?

  • The study provides realistic cost estimates of pivotal clinical trials that establish drug benefits to support FDA approval of 59 new drugs released for marketing in 2015-2016.
  • The median estimated cost was just $19 million, with half of the 138 trials studied clustered between $12 million and $33 million.
  • The highest cost trials–with estimates up to $345 million–were for new drugs that were similar to drugs already available and already proven in treating serious illnesses. 

Continue reading

Who Has the Highest Rate of Readmission After Hospital Discharge?

MedicalResearch.com Interview with:
"patient in hospital bed with nursing staff gathered around" by Penn State is licensed under CC BY-NC-ND 2.0Andrea Gruneir, PhD
Department of Family Medicine
University of Alberta
Edmonton, AB Canada

MedicalResearch.com: What is the background for this study?

Response: Hospital readmissions – when a patient is discharged from hospital but then returns to hospital in a short period of time – are known to be a problem, both for the patients and for the larger health system. Hospital readmissions have received considerable attention and there have been a number of initiatives to try to reduce them, but with mixed success. Older adults are among the most vulnerable group for hospital readmission. Older adults are also the largest users of continuing care services, such as home care and long-term care homes (also known as nursing homes). Yet, few large studies have really considered how older adults with different pathways through hospital compare on the risk of hospital readmission.

In our study, we take a population-level approach and use health administrative data to create a large cohort of older adults who were hospitalized in Ontario between 2008 and 2015. For each of the 701,527 patients in our study, we identified where they received care before the hospitalization (in the community or in long-term care) and where they received care after discharge (in the community, in the community with home care, or in long-term care).  Continue reading

Medicare Spends Hundreds of Millions Annually to Treat Precancerous Skin Lesions

MedicalResearch.com Interview with:
“Actinic Keratosis” by Ed Uthman is licensed under CC BY 2.0Howa Yeung, MD
Assistant Professor of Dermatology
Emory University School of Medicine
Atlanta, GA 30322 

MedicalResearch.com: What is the background for this study? Would you briefly explain what is meant by actinic keratoses?

Response: Actinic keratoses are common precancerous skin lesions caused by sun exposure. Because actinic keratoses may develop into skin cancers such as squamous cell carcinoma and basal cell carcinoma, they are often treated by various destructive methods. We used Medicare Part B billing claims to estimate the number and cost of treated actinic keratoses from 2007 to 2015.

MedicalResearch.com: What are the main findings? 

Response: While the number of Medicare Part B beneficiaries increased only moderately, the number of actinic keratoses treated by destruction rose from 29.7 million in 2007 to 35.6 million in 2015. Medicare paid an average annual amount of $413.1 million for actinic keratosis destruction from 2007 to 2015. Independently billing non-physician clinicians, including advanced practice registered nurses and physician assistants, are treating an increasing proportion of actinic keratosis, peaking at 13.5% in 2015.

MedicalResearch.com: What should readers take away from your report?

Response: Readers should understand that the burden of actinic keratosis treatment is increasing in the Medicare population. There is also an increasing proportion of actinic keratoses being treated by advanced practice registered nurses and physician assistants.  Continue reading

Access to Treatment for Head/Neck Cancer Patients Improved with Medicaid Expansion

MedicalResearch.com Interview with:

Richard B. Cannon, MD Division of Otolaryngology–Head and Neck Surgery School of Medicine University of Utah, Salt Lake City 

Dr. Cannon

Richard B. Cannon, MD
Division of Otolaryngology–Head and Neck Surgery
School of Medicine
University of Utah, Salt Lake City 

MedicalResearch.com: What is the background for this study? What are the main findings?

 Response: The Patient Protection and Affordable Care Act (ACA) is a nationwide effort to reduce the number of uninsured individuals in the United States and increase access to health care. This legislation is commonly debated and objective data is needed to evaluate its impact.  As a head and neck cancer surgeon, I sought to evaluate how the ACA had specifically influenced my patients.  Main findings below:    

MedicalResearch.com: What should readers take away from your report?

Response: This population-based study found an increase in the percentage of patients enrolled in Medicaid and private insurance and a large decrease in the rates of uninsured patients after implementation of the Patient Protection and Affordable Care Act (ACA).  This change was only seen in states that adopted the Medicaid expansion in 2014. The decrease in the rate of uninsured patients was significant, 6.2% before versus 3.0% after. Patients who were uninsured prior to the Patient Protection and Affordable Care Act had poorer survival outcomes.

Continue reading

Scribes Can Reduce Documentation Burden for Primary Care Physicians, But Cost is High

MedicalResearch.com Interview with:

Richard W. Grant MD MPH Research Scientist III, Kaiser Permanente Division of Resarch Adjunct Associate Professor, UCSF Dept Biostatistics & Epidemiology Director, Kaiser Permanente Delivery Science Fellowship Program Co-Director, NIDDK Diabetes Translational Research post-doctoral training program

Dr. Grant

Richard W. Grant MD MPH
Research Scientist III, Kaiser Permanente Division of Resarch
Adjunct Associate Professor, UCSF Dept Biostatistics & Epidemiology
Director, Kaiser Permanente Delivery Science Fellowship Program
Co-Director, NIDDK Diabetes Translational Research post-doctoral training program

MedicalResearch.com: What is the background for this study?

Response: Primary care in the United States is in a state of crisis, with fewer trainees entering the field and more current primary care doctors leaving due to professional burnout. Changes in the practice of primary care, including the many burdens related to EHR documentation, has been identified as a major source of physician burnout. There are ongoing efforts to reduce physician burnout by improving the work environment. One innovation has been the use of medical scribes in the exam room who are trained to enter narrative notes based on the patient-provider interview. To date, there have only been a handful of small studies that have looked at the impact of medical scribes on the provider’s experience of providing care.

Continue reading

Increase In Measles in Italy Linked to Austerity Measures

MedicalResearch.com Interview with:

Measles

Veronica Toffolutti PhD
Research Fellow in Health Economics
Bocconi University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Austerity has been linked to several health damaging effects such as suicides, increase in unmet needs, disease outbreaks that affect vulnerable peoples such as malaria in Greece, HIV in Greece and Romania during the current economic crises or in the earlier economic crisis cuts in public health expenditure have been linked with diphtheria and TB.

Europe is experiencing declining vaccination rates and resurgences in measles incidence rates. Italy appears to be particularly affected reporting the second largest number, second to Romania, of infection in Europe in 2017. Starting from the point that the primary reason for the outbreak in the decline in the measles vaccination we test the hypothesis that large budget reductions in public health spending were also a contributing factor.

Using data on 20 Italian regions for the period 2000-2014 we found that each 1% reduction in the real per capita public health expenditure was associated with a decrease of 0.5 percentage points (95% CI: 0.36-0.65 percentage points) in MMR coverage, after adjusting for time and regional-specific time-trends.  Continue reading

Medicare’s Bundled Payment Program–Does it Change Hospital Volume or Case Mix?

MedicalResearch.com Interview with:

Amol Navathe, MD, PhD Assistant Professor, Health Policy and Medicine Perelman School of Medicine Penn Leonard Davis Institute of Health Economics

Dr. Navathe

Amol Navathe, MD, PhD
Assistant Professor, Health Policy and Medicine
Perelman School of Medicine
Penn Leonard Davis Institute of Health Economics

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Medicare’s voluntary Bundled Payments for Care Improvement (BPCI) initiative for lower extremity joint replacement (LEJR) surgery has been associated with reduced episode spending and stable-to-improved quality. However, BPCI may create unintended effects by prompting participating hospitals to increase the overall volume of episodes covered by Medicare. This could potentially eliminate Medicare-related savings or prompt hospitals to shift case mix to lower-risk patients.

Among the Medicare beneficiaries who underwent LEJR, BPCI participation was not significantly associated with a change in market-level volume (difference-in-differences estimate . In non-BPCI markets, the mean quarterly market volume increased 3.8% from 3.8 episodes per 1000 beneficiaries before BPCI to 3.9 episodes per 1000 beneficiaries after BPCI was launched. In BPCI markets, the mean quarterly market volume increased 4.4% from 3.6 episodes per 1000 beneficiaries before BPCI to 3.8 episodes per 1000 beneficiaries after BPCI was launched.

The adjusted difference-in-differences estimate between the market types was 0.32%. Among 20 demographic, socioeconomic, clinical, and utilization factors, BPCI participation was associated with changes in hospital-level case mix for only one factor, prior skilled nursing facility use in BPCI vs. non-BPCI markets.  Continue reading

What Happens When Pay for Performance Incentives Are Withdrawn?

MedicalResearch.com Interview with:

Prof-Bruce Guthrie Head of Population Health Sciences Division Professor of Primary Care Medicine and Honorary Consultant NHS Fife

Prof. Guthrie

Prof. Bruce Guthrie PhD
Head of Population Health Sciences Division
Professor of Primary Care Medicine and Honorary Consultant NHS Fife 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The UK Quality and Outcomes Framework (QOF)) is a primary care pay for performance programme (P4P) implemented in 2004. QOF was and still is the largest healthcare P4P programme in the world, initially having ~150 indicators and accounting for ~20% of practice income. QOF has been reduced in scale and scope over time, with 40 indicators retired in 2014. It was abolished in Scotland in 2016 and is due to be further reformed in England. There is some evidence that P4P (and QOF itself) is associated with modest improvements in quality when introduced, but little evidence about what happens when financial incentives are withdrawn.

Our study examined what happened when incentives were withdrawn in 2014 for 12 indicators where there is good before and after data. There were immediate reductions in documented quality of care, which were similar in size to improvements observed when incentives were introduced. These reductions were small to modest (~10%) for indicators relating to care that is already systematically delivered (eg routine diabetes, hypertension and cardiovascular disease) and large for indicators which has historically been less systematically delivered (eg lifestyle advice).

Continue reading

Medicaid Expansion May Increase Access to Birth Control and Family Planning Services

MedicalResearch.com Interview with:

Michelle H. Moniz, MD, MSc Assistant Professor Department of Obstetrics and Gynecology Ann Arbor, MI 48109-2800

Dr. Moniz

Michelle H. Moniz, MD, MSc
Assistant Professor
Department of Obstetrics and Gynecology
Ann Arbor, MI 48109-2800

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We wanted to examine whether Medicaid expansion in Michigan was associated with improved access to birth control/family planning services in our state.  We conducted a survey of enrollees in the Michigan Medicaid expansion program (called “Healthy Michigan Plan”).

We found that 1 in 3 women of reproductive age reported improved access to birth control/family planning services after joining HMP.  Women who were younger, who were uninsured prior to joining HMP, and those who had recently seen a primary care clinician were most likely to report improved access.  Continue reading

Robotic Surgery More Expensive But May Not Have Better Outcomes Than Traditional Surgery

MedicalResearch.com Interview with:
A robotically assisted surgical system: WikipediaChris Childers, M.D.

Division of General Surgery
David Geffen School of Medicine at UCLA
10833 Le Conte Ave., CHS 72-247
Los Angeles, CA 90095

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The robotic surgical approach has gained significant traction in the U.S. market despite mixed opinions regarding its clinical benefit. A few recent randomized trials have suggested there may be no clinical benefit of the robotic approach for some surgical procedures over the more traditional open or laparoscopic (“minimally-invasive”) approaches.

Previous studies have also suggested the robotic approach is very expensive, but until our study, there was no benchmark for the true costs (to the hospital) of using the robotic platform.

Our study analyzed financial statements from the main supplier of robotic technology. We found that the use of robotic surgery has increased exponentially over the past decade from approximately 136 thousand procedures in 2008 to 877 thousand procedures in 2017. The majority of these procedures were performed in the United States. While most people think of the robotic approach in urologic and perhaps gynecologic surgery, the fastest growing segment has been general surgery, for procedures such as colorectal resections, hernia repairs and gallbladder removals. In total, over 3 billion dollars was spent by hospitals to acquire and use robotic platforms in 2017 with 2.3 billion dollars in the United States. This equates to nearly $3,600 per procedure performed.

Continue reading

Oncologist-Authors Often Do Not Fully Disclose Financial Relationships with Pharmaceutical Companies

MedicalResearch.com Interview with:

MedicalResearch.com Interview with: Cole Wayant Oklahoma State University Center for Health Sciences ‐ Analytical and Institutional Research Tulsa, OK MedicalResearch.com: What is the background for this study? What are the main findings? Response: New FDA-approved oncology drugs are essential to oncology practice. These drugs may immediately change clinical care by offering better treatments for common, lethal forms of cancer. But, new FDA-approved oncology drugs are expensive and have been shown to have variable efficacy. Given the importance of new FDA-approved oncology drugs to patients and physicians, the trials that underpin the FDA-approval of these drugs must be free from bias and transparent. Therefore, we investigated the financial relationships between oncologist-authors of clinical trials that underpin FDA-approvals. MedicalResearch.com: What should readers take away from your report? Response: The key takeaway from our study is that oncologist-authors often do not fully disclose their financial relationships with pharmaceutical companies. Financial disclosures are important for the reasons of transparency and trust between physicians and other stakeholders, such as patients. Disclosing conflicts of interest helps readers interpret the findings of a research study, especially given the fact that drug companies finance their own drug trials. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: In the future, beyond recommending that authors fully disclose all financial relationships with the sponsor of the trial, I recommend that journals use the Open Payments Database to verify the accuracy and completeness of author disclosure statements. Doing so is a small first step toward mitigating the potential for financial bias in the oncology literature.” Disclosures: I do not have anything else to add. None of the authors have conflicts of interest - financial or otherwise. Citation: Financial Conflicts of Interest Among Oncologist Authors of Reports of Clinical Drug Trials  <span class="last-modified-timestamp">Aug 30, 2018 @ 5:06 pm</span> The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

Cole Wayant

Cole Wayant BS
Oklahoma State University Center for Health Sciences ‐ Analytical and Institutional Research
Tulsa, OK

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: New FDA-approved oncology drugs are essential to oncology practice. These drugs may immediately change clinical care by offering better treatments for common, lethal forms of cancer.

But, new FDA-approved oncology drugs are expensive and have been shown to have variable efficacy. Given the importance of new FDA-approved oncology drugs to patients and physicians, the trials that underpin the FDA-approval of these drugs must be free from bias and transparent. Therefore, we investigated the financial relationships between oncologist-authors of clinical trials that underpin FDA-approvals. 

MedicalResearch.com: What should readers take away from your report?

Response: The key takeaway from our study is that oncologist-authors often do not fully disclose their financial relationships with pharmaceutical companies. Financial disclosures are important for the reasons of transparency and trust between physicians and other stakeholders, such as patients. Disclosing conflicts of interest helps readers interpret the findings of a research study, especially given the fact that drug companies finance their own drug trials.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: In the future, beyond recommending that authors fully disclose all financial relationships with the sponsor of the trial, I recommend that journals use the Open Payments Database to verify the accuracy and completeness of author disclosure statements. Doing so is a small first step toward mitigating the potential for financial bias in the oncology literature.” 

Disclosures: I do not have anything else to add. None of the authors have conflicts of interest – financial or otherwise.

Citation:

Wayant C, Turner E, Meyer C, Sinnett P, Vassar M. Financial Conflicts of Interest Among Oncologist Authors of Reports of Clinical Drug Trials. JAMA Oncol. Published online August 30, 2018. doi:10.1001/jamaoncol.2018.3738

Aug 30, 2018 @ 5:06 pm

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Combination Brand Name Drugs Cost Medicare Millions More Than Separate Generic Pills

MedicalResearch.com Interview with:

Chana A. Sacks, MD, MPH Program On Regulation, Therapeutics, And Law (PORTAL) Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women’s Hospital

Dr. Sacks

Chana A. Sacks, MD, MPH
Program On Regulation, Therapeutics, And Law (PORTAL)
Division of Pharmacoepidemiology and Pharmacoeconomics
Brigham and Women’s Hospital

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Combination pills combine multiple medications into a single dosage form. There have been case reports in recent years of high prices for certain brand-name combination drugs – even those that are made up of generic medications.

Our study looks at this phenomenon in a systematic way using recently released Medicare spending data. We evaluated 29 combination drugs and found that approximately $925 million dollars could potentially have been saved in 2016 alone had generic constituents been prescribed as individual pills instead of using the combination products.

For example, Medicare reported spending more than $20 per dose of the combination pill Duexis, more than 70 times the price of its two over-the-counter constituent medications, famotidine and ibuprofen.

The findings in this study held true even for brand-name combination products that have generic versions of the combination pill. For example, Medicare reported spending more than $14 for each dose of brand-name Percocet for more than 4,000 patients, despite the existence of a generic combination oxycodone/acetaminophen product. Continue reading

Low Risk Prostate Cancer Imaging More Common Outside of VA Hospitals

MedicalResearch.com Interview with:

Danil V. Makarov, MD, MHS Department of Urology and Department of Population Health New York University Langone School of Medicine VA New York Harbor Healthcare System, Robert F. Wagner Graduate School of Public Service Cancer Institute, New York University School of Medicine, New York

Dr. Makarov

Danil V. Makarov, MD, MHS
Department of Urology and
Department of Population Health
New York University Langone School of Medicine
VA New York Harbor Healthcare System,
Robert F. Wagner Graduate School of Public Service
Cancer Institute, New York University School of Medicine, New York

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Reducing prostate cancer staging imaging for men with low-risk disease is an important national priority to improve widespread guideline-concordant practice, as determined by the National Comprehensive Cancer Network guidelines. It appears that prostate cancer imaging rates vary by several factors, including health care setting. Within Veterans Health Administration (VHA), physicians receive no financial incentive to provide more services. Outside VHA, the fee-for-service model used in Medicare may encourage provision of more healthcare services due to direct physician reimbursement.

In our study, we compared these health systems by investigating the association between prostate cancer imaging rates and a VA vs fee-for-service health care setting. We used novel methods to directly compare Veterans, Medicare Recipients, and Veterans that chose to receive care from both the VA at private facilities using Medicare insurance through the Choice Act with regard to rates of guideline-discordant imaging for prostate cancer.

We found that Medicare beneficiaries were significantly more likely to receive guideline-discordant prostate cancer imaging than men treated only in VA.

Moreover, we found that men with low-risk prostate cancer patients in the VA-only group had the lowest likelihood of guideline-discordant imaging, those in the VA and Medicare group had the next highest likelihood of guideline-discordant imaging (in the middle), and those in the Medicare-only group had the highest likelihood of guideline-discordant imaging.  Continue reading