Medicaid Patients May Not Have Access to IVIG for Autoimmune Blistering Diseases

MedicalResearch.com Interview with:
Kyle T. Amber, MD

Department of Dermatology
UC Irvine Health
Irvine, CA 92697-2400 

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

Response: The use of IVIg has been shown in randomized controlled trials to be safe and highly effective in the treatment of both pemphigus and bullous pemphigoid. Despite its efficacy, its cost remains a deterrent to its use. Cost studies in the United States point towards IVIg being an overall cost-saving therapy in the treatment of  Autoimmune Blistering Diseases when compared to traditional immunosuppressive treatment due to the decrease in associated infections, complications, and hospitalizations.

Continue reading

Financial Distress Common Among Cancer Patients, Especially Underinsured

MedicalResearch.com Interview with:

Dr. Fumiko Chino, MD Duke Radiation Oncology Duke School of Medicine

Dr. Chino

Dr. Fumiko Chino, MD
Duke Radiation Oncology
Duke School of Medicine

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

Response: The financial burden of cancer treatment is a growing concern. Out-of-pocket expenses are higher for patients with cancer than for those who have other chronic illnesses. Fifty percent of elderly cancer patients spend at least 10% of their income on treatment-related out-of-pocket expenses. Additionally, high financial burden is associated with both increased risk of poor psychological well-being and worse health-related quality of life. A cancer diagnosis has been shown to be an independent risk factor for declaring personal bankruptcy, and cancer patients who declare personal bankruptcy are at greater risk for mortality. These potentially harmful outcomes resulting from financial burden have been recognized as the financial toxicity of cancer therapy, analogous to the more commonly considered physical toxicity.

We conducted an IRB approved study of financial distress and cost expectations among patients with cancer presenting for anti-cancer therapy. In this cross-sectional, survey based study of 300 patients, over one third of patients reported higher than expected financial burden. Cancer patients with highest financial distress are underinsured, paying nearly 1/3 of income in cancer-related costs. In adjusted analysis, experiencing higher than expected financial burden was associated with high/overwhelming financial distress (OR 4.78; 95% CI 2.02-11.32; p<0.01) and with decreased willingness to pay for cancer care (OR 0.48, 95% CI 0.25-0.95, p=0.03).

Continue reading

Patients With Social Risks Are More Expensive and Require Greater Medicaid Resources

MedicalResearch.com Interview with:

Dr-arlene-S-Ash.jpg

Dr. Ash

Arlene S. Ash, PhD
Department of Quantitative Health Sciences
University of Massachusetts Medical School
Worcester 

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

Response: State Medicaid programs (and other health care purchasers) often contract with several managed care organizations, each of which agrees to address all health care needs for some of their beneficiaries. Suppose a Medicaid program has $5000 to spend, on average, for each of its 1 million beneficiaries. How much should they pay health plan “A” for the particular 100,000 beneficiaries it enrolls? If some group, such as those who are homeless, is much more expensive to care for than the payment, plans that try to provide good care for many such people will go broke. We describe the model now used by MassHealth to ensure that plans get more money for enrolling patients with greater medical and social needs. In this medical-social model, about 10% of total dollars is allocated by factors other than the medical-morbidity risk score.

Continue reading

Even After Rebates, Use of PCSK9 Inhibitor Would Still Cost Over $5 Million To Prevent One Stroke

MedicalResearch.com Interview with:

Inmaculada Hernandez, PharmD, PhD Assistant Professor of Pharmacy and Therapeutics University of Pittsburgh School of Pharmacy Pittsburgh, PA 1526

Dr. Hernandez

Inmaculada Hernandez, PharmD, PhD
Assistant Professor of Pharmacy and Therapeutics
University of Pittsburgh School of Pharmacy
Pittsburgh, PA 1526

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

Response: A few months ago, the results of the FOURIER trial were published. This trial was the first one to evaluate the efficacy of PCSK9 inhibitors in the prevention of cardiovascular events, since the approval of these agents was based on trials that evaluated their efficacy in reducing levels of LDL-C. The results of the FOURIER trial did not meet the expectations generated by prior studies that had simulated how much the risk of cardiovascular events should decrease based on the observed reduction in LDL-C levels. A few hours after the publication of the results of the FOURIER trial, Amgen (evolocumab´s manufacturer) announced that it would be willing to engage in contracts where the cost of evolocumab would be refunded for those patients who suffer a heart attack or a stroke while using the drug.

Continue reading

Disruptions In Medicaid Coverage For Depression Linked To Increased ER Visits

MedicalResearch.com Interview with:
Xu Ji PhD Candidate
Emory University
Department of Health Policy and Management
Rollins School of Public Health
Emory University
Atlanta, GA

What is the background for this study? What are the main findings?

Response: Gaps in Medicaid coverage (sometimes called “churning”) can disrupt ongoing outpatient care needed to manage chronic conditions, such as depression, and trigger use of emergency care. This study examined how disruptions in Medicaid coverage impacted acute care use—specifically emergency department visits and hospital stays—in nearly 140,000 adults treated for major depression.

We found that those with disruptions in Medicaid coverage were more likely to have emergency department visits and longer hospital stays when they went back on Medicaid compared to those with continuous coverage.

We also found that disruptions in Medicaid coverage occurred less frequently for Medicaid enrollees with depression in states requiring only yearly recertification (i.e., more streamlined re-enrollment procedures) than those in states that required recertification every six months or more frequently (i.e., more stringent procedures). Eligibility recertification usually requires enrollees to visit the social welfare office to provide income or other documentation to prove eligibility. Failure to complete the recertification process would drop enrollees out of Medicaid.
Continue reading

Changes in Hospital Inpatient Stays Over Ten Years: Less Cardiac Care, More Mental Health and Sepsis Admissions

MedicalResearch.com Interview with:
Ruirui Sun, Service Fellow, Economist
Center for Delivery, Organization and Markets
Agency for Healthcare Research and Quality

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

Response: Hospital inpatient care has experienced changes due to factors such as population growth, rising of prevalence of chronic disease and efforts to reduce unnecessary hospitalizations. We generated information from the National Hospital Utilization and Costs path on Fast Stats (https://www.hcup-us.ahrq.gov/faststats/landing.jsp ), to present the trends on national hospitalization and costs from 2005 to 2014, as well as the most common diagnoses among inpatient stays over the 10-year period.

MedicalResearch.com: What are the main findings?

  • Between 2005 and 2014, the inflation-adjusted mean cost per inpatient stay increased by 12.7 percent, from $9,500 to $10,900.
  • Inflation-adjusted cost per stay for patients covered by private insurance or Medicaid increased 16-18 percent. Cost per stay for Medicare-covered patients and the uninsured changed minimally.
  • The rate of inpatient stays decreased the most among patients in the highest income quartiles (15-20 percent decrease).
  • The proportion of Medicaid-covered inpatient stays increased by 15.7 percent, whereas the proportion paid by private insurance and that were uninsured decreased by 12.5 and 13.0 percent, respectively.
  • Mental health/substance use accounted for nearly 6 percent of all inpatient stays in 2014, up 20.1 percent from 2005.
  • Between 2005 and 2014, septicemia and osteoarthritis became two of the five most common reasons for inpatient stays. Septicemia hospital stays almost tripled.
  • Nonspecific chest pain and coronary atherosclerosis decreased by more than 60 percent from 2005 to 2014, falling off the list of top 10 reasons for hospitalization. 

Continue reading

Higher Cost Sharing For Mental Health Services Could Increase Downstream Costs

MedicalResearch.com Interview with:

Bastian Ravesteijn PhD Department of Health Care Policy Harvard Medical School

Dr. Ravesteijn

Bastian Ravesteijn PhD
Department of Health Care Policy
Harvard Medical School 

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

Response: We find that higher out-of-pocket costs for mental health care could have the unintended consequence of increasing the use of acute and involuntary mental health care among those suffering from the most debilitating disorders. Continue reading

EKGs of Low Risk Patients Remain Common and Associated With More Cardiac Testing

MedicalResearch.com Interview with:
Sacha Bhatia, MD, MBA, FRCPC
Scientist, Women’s College Research Institute
Director, Women’s College Hospital Institute for Health System Solutions and Virtual Care
Cardiologist, Women’s College Hospital and University Health Network
Canada

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

Response: The USPSTF recommends against screening with resting electrocardiography (ECG) for the prediction of coronary heart disease (CHD) events in asymptomatic adults at low risk for CHD events. We conducted a retrospective cohort study of the frequency of resting ECGs in low risk patients within 30 days of an annual health exam. We found that 21.5% of low risk patients in Ontario, Canada had a ECG, with significant variation among primary care physicians (1.8% to 76.1%). Moreover, low risk patients who had a ECG were five times more likely to receive another cardiac test or cardiology consultation than those that did not receive an ECG. At one year the rate of mortality, cardiac hospitalizations and revascularization was <0.5% in each group.

Continue reading

Supply and Demand for Diabetes Prevention Programs

MedicalResearch.com Interview with:

Maria L. Alva, DPhil Economist RTI International -  Research Triangle Institute

Dr. Alva

Maria L. Alva, DPhil
Economist
RTI International –  Research Triangle Institute

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

Response: We have strong evidence from trials of structured lifestyle intervention programs (e.g. the Diabetes Prevention Program (DPP)) showing that half of new diabetes cases could be avoided if persons with prediabetes changed their lifestyle habits to lose a modest amount of body weight. Moreover, the DPP has been successfully translated into cost-effective community-based prevention interventions, but nationally, these evidence-based interventions (EBIs) are not being used sufficiently. To scale up the implementation of diabetes prevention EBIs, we need to address the challenges of getting organizations to adopt EBIs, and community members to enroll.

Because cost is a primary barrier we wanted to understand what was the perceived value and demand for diabetes prevention programs in NC. And in particular, the role that community health workers and technology could play in program delivery, from the perspectives of both potential recipients (adults at high risk or diagnosed with prediabetes) and decision-makers in healthcare/public health delivery.

Continue reading

Moral Hazard Encourages Consumers To Choose More Expensive Treatment Options

MedicalResearch.com Interview with:

Nitin Mehta PhD Associate Professor in Marketing Rotman School

Dr. Mehta

Nitin Mehta PhD
Associate Professor in Marketing
Rotman School

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

Response: The focus of this paper is an investigation of the increase in health care costs associated with chronic disease in the context of consumers enrolled in employer sponsored insurance plans. Chronic illnesses – including conditions such as heart disease, cancer, hypertension, rheumatoid arthritis, respiratory diseases, diabetes, and kidney disease – account for nearly 75 percent of health care expenditures in the U.S. Treatments vary widely in terms of cost and impact: expensive “frontier” treatments provide the best outcome for only the seriously ill, while cheaper, established treatments prove effective for most other patients. As an example, the annual cost to an insurer for “biologics” – novel genetically modified protein drugs – is upwards of $20,000, while the more established drug – methotrexate – costs only $1,000 a year.

We investigate whether a part of the increase in healthcare costs stems from consumers opting for the more expensive treatments even when the lesser expensive treatments may have worked well. To do so, we examined data from a health insurer in the United States on the insurance plan and treatment options for 3,000 chronically ill patients over a three year period.

Continue reading