Addiction, Author Interviews, Cost of Health Care / 17.03.2017

MedicalResearch.com Interview with: [caption id="attachment_33049" align="alignleft" width="125"]Hefei Wen, PhD Assistant Professor, Department of Health Management & Policy University of Kentucky College of Public Health Dr.Hefei Wen[/caption] Hefei Wen, PhD Assistant Professor, Department of Health Management & Policy University of Kentucky College of Public Health MedicalResearch.com: What is the background for this study? What are the main findings? Response: Buprenorphine has been proven effective in treating opioid use disorder. However, the high cost of buprenorphine and the limited prescribing capacity may restrict access to this effective medication-assisted treatment (MAT) for opioid use disorder. We found a 70% increase in Medicaid-covered buprenorphine prescriptions and a 50% increase in buprenorphine spending associated with the implementation of Medicaid expansions in 26 states during 2014. Physician prescribing capacity was also associated with increased buprenorphine prescriptions and spending.
Allergies, Author Interviews, Cost of Health Care, Pediatrics / 17.03.2017

MedicalResearch.com Interview with: Lavanya Diwakar, FRCPath Honorary consultant in immunology Queen Elizabeth Hospital, Birmingham, and Research fellow in health economic University of Birmingham Birmingham UK MedicalResearch.com: What is the background for this study? Response: The rate of anaphylaxis (serious, potentially life threatening manifestation of allergy) has increased in the last decade. There have been some reports from other countries about an increase in the number of adrenaline autoinjectors being prescribed in children, but this has not been systematically examined in the UK. We looked at a database of patient records from over 500 general practices, THIN (the Health Improvement Network), between 2000 and 2012. We found nearly 24,000 children who had been identified as being at risk of anaphylaxis by General Practitioners and prescribed epipens.
AHRQ, Author Interviews, Cost of Health Care / 15.03.2017

MedicalResearch.com Interview with: Anita Soni, PhD, MBA Survey Analyst/Statistician Agency for Healthcare Research and Quality Rockville, MD MedicalResearch.com: What is the background for this study? Response: This statistical brief uses the data from the Medical Expenditure Panel Survey (MEPS), which is a nationally representative survey of the U.S. civilian noninstitutionalized population that collects data on the demographic characteristics, health conditions, health status, use of medical care services, charges and payments, access to care, satisfaction with care, health insurance coverage, income, and employment of Americans. This brief focuses on adults 18 and older who received some medical care in 2014. Persons who have multiple chronic conditions—those who were treated for two or more conditions considered to be chronic during 2014 -- are compared to those who, while they had medical care, reported use associated with only one or no chronic conditions. 
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA / 13.03.2017

MedicalResearch.com Interview with: Yusuke Tsugawa, research associate Department of Health Policy and Management Harvard T H Chan School of Public Division of General Internal Medicine and Primary Care Brigham and Women’s Hospital, Boston, MA      MedicalResearch.com: What is the background for this study? What are the main findings? Response: It is well known that health spending varies substantially across geographical regions, and yet regions that spend more on health care dot not achieve better health outcomes. These findings has led to many to conclude that at least 20% of U.S. health care spending could be reduced without compromising quality of care. However, while physicians play a critical role in health care decision making, little is known as to how much health care spending varies between physicians, and its implications for patient outcomes. In this study, we found that the variation in spending across physicians is slightly larger than the variation across hospitals. More importantly, higher spending by physicians did not lead to lower patient mortality or readmission rates, within the same hospital.
Author Interviews, Cost of Health Care, Diabetes / 07.03.2017

MedicalResearch.com Interview with: [caption id="attachment_32757" align="alignleft" width="118"]Maria L. Alva, DPhil Public Health Economics Program RTI International 701 13 Street, NW, Suite 750 Washington, DC 20005 Dr. Maria Alva[/caption] Maria L. Alva, DPhil Public Health Economics Program RTI International 701 13 Street, NW, Suite 750 Washington, DC 20005  MedicalResearch.com: What is the background for this study? What are the main findings? Response:  Diabetes affects more than 25 percent of Americans over 65. The estimated economic cost of diagnosed diabetes is $245 billion a year. In spite of this we have almost no evidence of the impact of programs geared to stave off the cost of diabetes. The Y-USA received a Health Care Innovation Award of $11.8 million from the Centers for Medicare & Medicaid Services to offer a diabetes prevention program to individuals 65 and over with prediabetes. The goal of the Y-USA model is to get participants to lose 5 percent or more of their body weight and gradually increase their physical activity to 150 minutes per week.  The program lasts a year. The curriculum comprises sixteen weekly core sessions about healthy eating, exercise and motivation followed by eight monthly maintenance sessions. Epidemiological data from other studies have shown that the risk of diabetes increases with increased levels of BMI. There is mounting evidence that it is possible to prevent or delay diabetes through life-style intervention. It is unclear, however, whether weight-loss interventions can yield reductions in medical spending. The objective of our analysis was to establish whether the -USA Diabetes Prevention Program reduces health care spending and utilization among fee-for-service Medicare beneficiaries.
Author Interviews, Cost of Health Care, Hearing Loss / 07.03.2017

MedicalResearch.com Interview with: [caption id="attachment_32744" align="alignleft" width="182"]Larry Humes, PhD, CCC-A Department of Speech and Hearing Sciences Indiana University Bloomington Dr. Larry Humes[/caption] Larry Humes, PhD, CCC-A Department of Speech and Hearing Sciences Indiana University Bloomington MedicalResearch.com: What is the background for this study? What are the main findings? Response: About 40% of adults over the age of 60 have significant hearing loss, yet only about 20% of these older Americans seek help and eventually purchase hearing aids.  There have been several national calls for improvements in the accessibility and affordability of hearing health care for adults, especially older adults, including a 2015 report by the President’s Council of Advisors in Science and Technology and a 2016 report by the National Academies of Science, Engineering and Medicine.  One strategy in common to both of these recent reports is to make hearing aids available directly to the consumer via over-the-counter service delivery. This study was a double-blind placebo-controlled randomized clinical trial investigating two different service-delivery approaches, best-practices and over-the-counter, and two different purchase prices for the hearing aids ($600/pair, $3600/pair).  For the most part, purchase price had no influence on outcomes.  Hearing aids delivered via the best-practices service-delivery model were confirmed to be efficacious, but almost identical positive outcomes were obtained via the over-the-counter service-delivery approach.
Author Interviews, Cost of Health Care / 07.03.2017

MedicalResearch.com Interview with: [caption id="attachment_32691" align="alignleft" width="140"]Genevieve Kanter, PhD Assistant Professor Department of Health Management and Policy Drexel University Dornsife School of Public Health Philadelphia, PA Dr. Kanter[/caption] Genevieve Kanter, PhD Assistant Professor Department of Health Management and Policy Drexel University Dornsife School of Public Health Philadelphia, PA  MedicalResearch.com: What is the background for this study? What are the main findings? Response: We were interested in the exposure of patients to doctors who accept industry payments. Previous research on physician payments has focused on the percentage of doctors who accepted payments, but these estimates can give a partial or misleading picture of the reach of industry payments in relation to the typical patient. No studies had previously taken a population-based approach to estimate the reach of industry payments. We conducted a nationally representative survey of 3542 Americans. We asked respondents about their awareness of industry payments and if they knew whether their own doctor had received an industry payment. We also asked them to identify the doctor they had visited most frequently in the previous 12 months and linked this information to Open Payments, a government website that reports payments made to doctors by prescription drug and device manufacturers. We found that 65%, or almost two-thirds, of patients had seen--in the past 12 months--a physician who had received an industry payment. For some specialties, patient contact with doctors who had industry contact was much higher; 77% of patients who saw an obstetrician/gynecologist visited a doctor who had accepted payments, and 85% of patients who saw an orthopedic surgeon visited a doctor who had accepted payments. At the same time, very few people knew whether their own doctor had received payments; only 5% of respondents reported knowing whether their doctor had received an industry payment.
Author Interviews, Cost of Health Care / 06.03.2017

MedicalResearch.com Interview with: Dr. LeaAnne DeRigne Associate Professor School of Social Work Florida Atlantic University Boca Raton, FL 33431 MedicalResearch.com: What is the background for this study? What are the main findings? Response: “Compared to 22 similarly developed countries, the United States is the only one that does not mandate employers to provide paid sick leave benefits or include paid sick leave in a universal social insurance plan,” said LeaAnne DeRigne, Ph.D., lead author and an associate professor in the School of Social Work within FAU’s College for Design and Social Inquiry. For the study, DeRigne and collaborators used cross-sectional data from a sample of 13,545 adults aged 18-64 with current paid employment from the 2015 National Health Interview Survey (NHIS). They examined the relationship between having paid sick leave and obtaining eight preventive care services: blood pressure check; cholesterol check; fasting blood sugar check; getting a flu shot; being seen by a medical doctor or health care provider; getting a Pap test (females only); getting a mammogram (females only); and getting tested for colon cancer. The analysis controlled for demographic and other important predictor variables including gender, marital status, education, race/ethnicity, full time work, insurance coverage, health status, limiting health conditions, family income, age, and family size.
Asthma, Author Interviews, Cost of Health Care, Pediatrics / 04.03.2017

MedicalResearch.com Interview with: [caption id="attachment_32645" align="alignleft" width="132"]Patrick W. Sullivan, Ph.D. Professor Regis University School of Pharmacy Denver, CO 80221 Dr. Sullivan[/caption] Patrick W. Sullivan, Ph.D. Professor Regis University School of Pharmacy Denver, CO 80221 MedicalResearch.com: What is the background for this study? Response: Asthma is one of the most common chronic disorders among children. It affects 7.1 million children in the U.S. Of these, 4.1 million children suffered an asthma attack in 2011. An asthma attack is an acute period of extreme difficulty breathing. It can be life threatening and is always very frightening for children. Because asthma can be dangerous and frightening, it ends up costing a lot because patients need to go the doctor, hospital or take medications to try to control it. Asthma also has a negative effect on the patient’s health and outlook about their health – both mentally and physically. Previous studies have focused on adults with asthma and have found that it is very expensive – it costs $18 billion in the U.S. to manage adults with asthma. Those studies also showed that adults with asthma have lower quality of life. However, there is not a lot of good evidence on the burden of asthma in children. This study was designed to quantify the cost and mental and physical health of children with asthma in the U.S.
Author Interviews, Cost of Health Care, Primary Care / 28.02.2017

MedicalResearch.com Interview with: [caption id="attachment_32467" align="alignleft" width="192"]Molly Candon, PhD Fellow Leonard Davis Institute of Health Economics, The Wharton School Center for Mental Health Policy and Services Research, Perelman School of Medicine University of Pennsylvania Dr. Molly Candon[/caption] Molly Candon, PhD Fellow Leonard Davis Institute of Health Economics, The Wharton School Center for Mental Health Policy and Services Research, Perelman School of Medicine University of Pennsylvania MedicalResearch.com: What is the background for this study? What are the main findings? Response: Primary care practices are less likely to schedule appointments with Medicaid patients compared to the privately insured, largely due to lower reimbursement rates for providers. Given the gap in access, concerns have been raised that Medicaid enrollees may struggle to translate their coverage into care. Despite the substantial increase in demand for care resulting from provisions in the Affordable Care Act (ACA), our 10-state audit study recently published in JAMA Internal Medicine finds that primary care appointment availability for new patients with Medicaid increased 5.4 percentage points between 2012 and 2016, while appointment availability for patients with private coverage did not change. Over the same time period, both Medicaid patients and the privately insured experienced slight increases in wait times.
Author Interviews, Cost of Health Care, Heart Disease, JAMA / 17.02.2017

MedicalResearch.com Interview with: [caption id="attachment_32148" align="alignleft" width="142"]James E. Udelson, MD Chief, Division of Cardiology Director, Nuclear Cardiology Laboratory Professor, Tufts University School of Medicine Dr. James Udelson[/caption] James E. Udelson, MD Chief, Division of Cardiology Director, Nuclear Cardiology Laboratory Professor, Tufts University School of Medicine   MedicalResearch.com: What is the background for this study? What are the main findings? Response: There are millions of stress tests done every year in the United States and many of them are normal,” said James Udelson, MD, Chief of the Division of Cardiology at Tufts Medical Center and the senior investigator on the study. “We thought that if we could predict the outcome of these tests by using information we already had from the patient before the test, we could potentially save the health care system money and save our patients time and worry.”   We were able to get a strong prediction of the possibility of having entirely normal testing and no clinical events such as a heart attack, by developing a risk prediction tool using ten clinical variables that are commonly available to a physician during an evaluation”
AHA Journals, Author Interviews, Cost of Health Care, Geriatrics, Heart Disease / 15.02.2017

MedicalResearch.com Interview with: [caption id="attachment_32066" align="alignleft" width="200"]Olga Khavjou RTI International Olga Khavjou[/caption] Olga Khavjou RTI International MedicalResearch.com: What is the background for this study? What are the main findings? Response: Cardiovascular disease (CVD) is the leading cause of death in the United States and is one of the costliest chronic diseases. As the population ages, CVD costs are expected to increase substantially. To improve cardiovascular health and control health care costs, we must understand future prevalence and costs of CVD. In 2015, 41.5% (more than 100 million people) of the U.S population was estimated to have some form of CVD. By 2035, the number of people with CVD is projected to increase to over 130 million people, representing a 30% increase in the number of people with CVD over the next 20 years. Between 2015 and 2035, real total direct medical costs of CVD are projected to more than double from $318 billion to $749 billion and real indirect costs (due to productivity losses) are projected to increase from $237 billion to $368 billion. Total costs (medical and indirect) are projected to more than double from $555 billion in 2015 to $1.1 trillion in 2035.
Author Interviews, Brain Injury, Cost of Health Care, CT Scanning, Electronic Records, Emergency Care, Kaiser Permanente / 25.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31510" align="alignleft" width="156"]Adam L. Sharp MD MS Research Scientist/Emergency Physician Kaiser Permanente Southern California Kaiser Permanente Research Department of Research & Evaluation Pasadena, CA 91101 Dr. Adam Sharp[/caption] Adam L. Sharp MD MS Research Scientist/Emergency Physician Kaiser Permanente Southern California Kaiser Permanente Research Department of Research & Evaluation Pasadena, CA 91101 MedicalResearch.com: What is the background for this study? Response: Millions of head computed tomography (CT) scans are ordered annually in U.S. emergency Departments (EDs), but the extent of avoidable imaging is poorly defined. Ensuring appropriate use is important to ensure patient outcomes and limited resources are optimized. A large number of stake holders have highlighted the need to reduce “unnecessary” CT scanning as part of their recommendations for the Choosing Wisely campaign. However, despite calls for improved stewardship, the extent of avoidable CT use among adults with minor trauma in community EDs is not known. The Canadian CT Head Rule (CCHR) is perhaps the most studied of many validated decision instruments designed to assist providers in evaluating patients with minor head trauma. This study aims to describe the scope of overuse of CT imaging by ED providers in cases where application of the CCHR could have avoided imaging. Secondarily, we sought to describe the extent to which avoidable CTs, if averted, would have resulted in “missed” intracranial hemorrhages requiring a neurosurgical intervention.
Author Interviews, BMJ, Cost of Health Care, Kidney Disease / 23.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31437" align="alignleft" width="134"]Talar W. Markossian PhD MPH Assistant Professor of Health Policy Loyola University Chicago 2160 S. First Ave, CTRE 554 Maywood, IL 60153 Dr. Talar Markossian[/caption] Talar W. Markossian PhD MPH Assistant Professor of Health Policy Loyola University Chicago 2160 S. First Ave, CTRE 554 Maywood, IL 60153 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Approximately 10% of U.S. adults currently have non-dialysis dependent chronic kidney disease (CKD), while dialysis dependent CKD accounts for only 0.5% of the U.S. population. The escalation in healthcare expenditures associated with CKD starts prior to requirement for dialysis, and treatment costs escalate as non-dialysis dependent CKD progresses. We examined the total healthcare expenditures including out-of-pocket costs for non-dialysis dependent and compared these expenditures with those incurred for cancer and stroke in the U.S. adult population. After adjusting for demographics and comorbidities, the adjusted difference in total direct healthcare expenditures was $4746 (95% CI $1775-$7718) for CKD, $8608 (95% CI $6167-$11,049) for cancer and $5992 (95% CI $4208-$7775) for stroke vs. group without CKD, cancer or stroke. Adjusted difference in out-of-pocket healthcare expenditures was highest for adults with CKD ($760; 95% CI 0-$1745) and was larger than difference noted for cancer ($419; 95% CI 158–679) or stroke ($246; 95% CI 87–406) relative to group without CKD, cancer or stroke.
Author Interviews, Colon Cancer, Cost of Health Care, Medicare / 23.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31434" align="alignleft" width="200"]Nengliang “Aaron” Yao PhD Assistant professor Department of Public Health Sciences University of Virginia Dr. Nengliang Yao[/caption] Nengliang “Aaron” Yao PhD Assistant professor Department of Public Health Sciences University of Virginia MedicalResearch.com: What is the background for this study? What are the main findings? Response: The ACA made several changes in Medicare that could increase the use of cancer screening and thus lead to more early cancer diagnoses. This includes waiving patient cost-sharing for screening, waiving patient cost-sharing for one wellness visit per year, and paying bonuses to physicians for doing more work in a primary care setting. We studied how effective those changes were in facilitating more early diagnoses of breast and colorectal cancers. We found that the changes had no effect on early breast cancer diagnoses (likely because costs and other access barriers for mammograms were already low), but increased the number of early colorectal cancer diagnoses by 8 percent.
Author Interviews, CDC, Cost of Health Care, Opiods / 19.01.2017

MedicalResearch.com Interview with: Dora Lin, MHS Sr. Research Assistant Johns Hopkins Bloomberg School of Public Health Center for Drug Safety and Effectiveness Baltimore, MD 21205  MedicalResearch.com: What is the background for this study? What are the main findings? Response: In response to the opioid epidemic and growing number of overdose deaths each year, the CDC released draft guidelines to improve the safe use of opioids in primary care. The draft guidelines were open to public comment, and many organizations, ranging from professional societies to consumer advocates to local governmental organizations, submitted comments regarding the guidelines. We examined the levels of support or non-support for the draft guidelines among the 158 organizations who submitted comments.   We also examined each organization’s relationship to opioid manufacturers. Most organizations supported the guidelines, regardless of whether or not they had a financial relationship to a drug company. However, organizations receiving funding from opioid manufacturers were significantly more likely to be opposed to the guidelines than those who did not receive such funding.
Author Interviews, Cost of Health Care, JAMA, Johns Hopkins, Medicare / 17.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31255" align="alignleft" width="150"]Ge Bai, PhD, CPA Assistant Professor The Johns Hopkins Carey Business School Washington, DC 20036 Dr. Ge Bai[/caption] Ge Bai, PhD, CPA Assistant Professor The Johns Hopkins Carey Business School Washington, DC 20036  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The average anesthesiologist, emergency physician, pathologist and radiologist charge more than four times what Medicare pays for similar services, often leaving privately-insured out-of-network patients stuck with surprise medical bills that are much higher than they anticipated. The average physician charged roughly 2.5 times what Medicare pays for the same service. There are also regional differences in excess charges. Doctors in Wisconsin, for example, have almost twice the markups of doctors in Michigan (3.8 vs. two).
Author Interviews, Cost of Health Care, JAMA / 11.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31052" align="alignleft" width="131"]Joel Segel, Ph.D. Assistant Professor Department of Health Policy and Administration The Pennsylvania State University University Park, PA 16802 Dr. Joel Segel[/caption] Joel Segel, Ph.D. Assistant Professor Department of Health Policy and Administration The Pennsylvania State University University Park, PA 16802 MedicalResearch.com: What is the background for this study? Response: Americans’ health insurance plans increasingly include deductibles, which require patients to pay a certain amount out-of-pocket before the health plan will cover most services. In addition, the levels of these deductibles have been increasing with more and more Americans enrolling in high-deductible health plans (HDHP’s), which in 2013 were plans with a deductible of $1,250 or more for an individual or $2,500 or more for a family. Furthermore, nearly 40% of those with private insurance have a HDHP including most of the bronze and silver plans on the federal Marketplace. This trend has many worried that patients are facing greater financial risk and may delay or forego necessary care because of costs. A population that may be most vulnerable to these problems are Americans with common chronic conditions.
Annals Internal Medicine, Author Interviews, Cost of Health Care / 11.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31055" align="alignleft" width="200"]Devan Kansagara MD, MCR Associate Professor of Medicine, Oregon Health and Science University Director, Evidence-based Synthesis Program, Portland VA Medical Center Staff Physician, Portland VA Medical Center Dr. Devan Kansagara[/caption] Devan Kansagara MD, MCR Associate Professor of Medicine Oregon Health and Science University Director, Evidence-based Synthesis Program, Portland VA Medical Center Staff Physician, Portland VA Medical Center MedicalResearch.com: What is the background for this study? Response: Historically, the US health care system has been dominated by a fee-for-service payment structure in which health care providers are paid for discrete procedures and visits regardless of care quality. Pay for performance programs are part of the move towards value-based care. They tie a portion of payments to individual health care providers, institutions, or health care systems to performance on a discrete set of measures of health care quality. In theory, these programs are meant to encourage the right care at the right time and thereby improve the health of the patient population. Over the last decade, many studies in and outside the US have examined whether or not, in fact, these programs do result in improved care, reduced cost, and improved patient health. Our study is a systematic review of this literature.
Author Interviews, Cost of Health Care, Prostate Cancer / 10.01.2017

MedicalResearch.com Interview with: Tudor Borza, MD, MS Urologic Oncology and Health Service Research Fellow Department of Urology, University of Michigan MedicalResearch.com: What is the background for this study? Response: Starting in the late 2000’s studies began to identify overdiagnosis and overtreatment in men with prostate cancer. Because of the indolent nature of some prostate cancers many men who ended up diagnosed and treated would have never had any consequences from their prostate cancer. This led national organizations (like the American Urological Association and the National Comprehensive Cancer Network) to call for decreased prostate cancer screening (using the serum PSA test) and eventually led to the US Preventive Services Task Force to recommend against routine PSA screening, citing that the harms from diagnosis and treatment outweighed the harms from the disease. Over the same specialists treating the disease began to report on the safety of surveillance strategies in select men with prostate cancer. Watchful waiting (delaying any treatment until men become symptomatic from their cancer and then offering palliative treatment) was found to be comparable to initial treatment in men with a limited life expectance, either from advanced age or multiple comorbidities. Similarly, active surveillance (a technique employing intense monitoring with PSA testing, digital rectal exams, repeat biopsies and possible use of MRI or other biomarkers) was introduced with the goal of delaying treatment in some men with low risk cancer until the cancer becomes more aggressive and was shown to have similar outcomes to initial treatment in carefully selected men. We wanted to study the trends in initial prostate cancer treatment in this context of recommendations for decreased screening and recognition of the feasibility of surveillance in certain patients with prostate cancer.
Author Interviews, Breast Cancer, Cancer Research, Colon Cancer, Cost of Health Care, Mammograms, Medical Imaging, Race/Ethnic Diversity, Radiology / 09.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31020" align="alignleft" width="133"]Dr. Gregory Cooper, MD Program Director, Gastroenterology, UH Cleveland Medical Center Co-Program Leader for Cancer Prevention and Control, UH Cleveland Medical Center Professor, Medicine, CWRU School of Medicine Co-Program Leader for Cancer Prevention and Control UH Seidman Cancer Center Dr. Gregory Cooper[/caption] Dr. Gregory Cooper, MD Program Director, Gastroenterology UH Cleveland Medical Center Co-Program Leader for Cancer Prevention and Control, UH Cleveland Medical Center Professor, Medicine, CWRU School of Medicine Co-Program Leader for Cancer Prevention and Control UH Seidman Cancer Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Affordable Care Act, among other features, removed out of pocket expenses for approved preventive services, and this may have served as a barrier to cancer screening in socioeconomically disadvantaged individuals. If so, then the gap in screening between socioeconomic groups should narrow following the ACA. The main findings of the study were that although in the pre-ACA era, there were disparities in screening, they narrowed only for mammography and not colonoscopy.
Author Interviews, Cost of Health Care, NEJM / 08.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31066" align="alignleft" width="142"]John Z. Ayanian, MD, MPP</strong> Director of the Institute for Healthcare Policy and Innovation and Alice Hamilton Professor of Medicine University of Michigan Dr. John Z. Ayanian[/caption] John Z. Ayanian, MD, MPP Director of the Institute for Healthcare Policy and Innovation and Alice Hamilton Professor of Medicine University of Michigan MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our study assessed the broad economic impact of Medicaid expansion in Michigan – one of several Republican-led states that have chosen to expand Medicaid under the Affordable Care Act. About 600,000 low-income adults in Michigan are covered through the program, known as the Healthy Michigan Plan, which began in April 2014. Using an economic modeling tool that is also used to advise the state government for fiscal planning, we found that federal funding for the Healthy Michigan Plan is associated with over 30,000 additional jobs, about $2.3 billion in increased personal income in Michigan, and about $150 million in additional state tax revenue annually. One third of the new jobs are in health care, and 85 percent are in the private sector. The state is also saving $235 million annually that it would have spent on other safety net programs if Medicaid had not been expanded. Thus, the total economic impact of the Healthy Michigan Plan is generating more than enough funds for the state budget to cover the state’s cost of the program from 2017 through 2021. Beginning in 2017, states are required to cover 5 percent of the costs of care for Medicaid expansion enrollees, and the state share of these costs will rise to 10 percent in 2020. The remaining costs are covered by federal funding.
Author Interviews, Cost of Health Care, JAMA, Medicare, Orthopedics, University of Pennsylvania / 06.01.2017

MedicalResearch.com Interview with: [caption id="attachment_30994" align="alignleft" width="180"]MedicalResearch.com Interview with: Amol Navathe, MD PhD University of Pennsylvania Staff Physician, CHERP, Philadelphia VA Medical Center Assistant Professor of Medicine and Health Policy, Perelman School of Medicine Senior Fellow, Leonard Davis Institute of Health Economics, The Wharton School Co-Editor-in-Chief, HealthCare: the Journal of Delivery Science and Innovatio Dr. Amol Navathe[/caption] Amol Navathe, MD PhD University of Pennsylvania Staff Physician, CHERP, Philadelphia VA Medical Center Assistant Professor of Medicine and Health Policy, Perelman School of Medicine Senior Fellow, Leonard Davis Institute of Health Economics, The Wharton School Co-Editor-in-Chief, HealthCare: the Journal of Delivery Science and Innovation MedicalResearch.com: What is the background for this study? Response: Bundled payments pay a fixed price for an episode of services that starts at hospital admission (in this case for joint replacement surgery) and extends 30-90 days post discharge (30 days in this study). This includes physician fees, other provider services (e.g. physical therapy), and additional acute hospital care (hospital admissions) in that 30 day window.
Author Interviews, Cost of Health Care, Diabetes, JAMA / 05.01.2017

MedicalResearch.com Interview with: [caption id="attachment_30753" align="alignleft" width="125"]Joseph Dieleman, PhD Institute for Health Metrics and Evaluation | University of Washington Seattle, WA 98121 Dr. Joseph Dieleman[/caption] Joseph Dieleman, PhD Institute for Health Metrics and Evaluation University of Washington Seattle, WA 98121 MedicalResearch.com: What is the background for this study? What are the main findings? Response: The objective of this study was to provide a estimate of total health care spending in the United States for an exhaustive list of health conditions, over an extended period of time – from 1996 to 2013. The study primarily focuses on personal health spending, which includes both individual out-of-pocket costs as well as spending by private and government insurance programs on care provided in inpatient and outpatient facilities, emergency departments, nursing care facilities, dentist offices, and also on pharmaceuticals. There were 155 conditions included in the analysis, and spending was also disaggregated by type of care, and age and sex of the patient. In 2013, we accounted for $2.1 trillion in personal health spending in the U.S. It was discovered that just 20 health conditions made up more than half of all dollars spent on health care in the U.S. in 2013, and spending for each condition varied by age, sex and type of care. Diabetes was the most expensive condition, totaling $101 billion in diagnoses and treatments, growing at an alarmingly rate – a 6.5% increase per year on average. Ischemic heart disease, the number one killer in the U.S., ranked the second most expensive at $88.1 billion, followed by low back and neck pain at $87.6, treatment of hypertension at $83.9 billion, and injury from falls at $76.3. Women aged 85 and older spent the most per person in 2013, at more than $31,000 per person. More than half of this spending (58%) occurred in nursing facilities, while 20% was expended on cardiovascular diseases, 10% on Alzheimer’s disease, and 7% on falls. Men ages 85 and older spent $24,000 per person in 2013, with only 37% on nursing facilities, largely because women live longer and men more often have a partner at home to provide care.
Author Interviews, Cost of Health Care, Dermatology, Melanoma / 28.12.2016

MedicalResearch.com Interview with: Isabelle Hoorens, MD, PhD Department of Dermatology Ghent University Hospital Ghent, Belgium MedicalResearch.com: What is the background for this study? What are the main findings? Response: In this study we questioned whether a population-based screening for skin cancer is cost-effective. In addition we compared the cost-effectiveness of two specific screening techniques. The first technique, a lesion-directed screening being a free-of-charge skin cancer check of a specific lesion meeting 1 or more of the following criteria: ABCD rule (asymmetry, border irregularity, color variation, and diameter >6 mm), “ugly duckling” sign, new lesion lasting longer than 4 weeks, or red nonhealing lesions. The second screening technique consisted of a systematic total body examination in asymptomatic patients. A clinical screening study was performed in Belgium in 2014.
Author Interviews, Cost of Health Care, JACC, UCLA / 28.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30823" align="alignleft" width="200"]Joseph A. Ladapo, MD, PhD David Geffen School of Medicine at UCLA Department of Medicine, Division of General Internal Medicine and Health Services Research Los Angeles, California Dr. Joseph A. Ladapo[/caption] Joseph A. Ladapo, MD, PhD David Geffen School of Medicine at UCLA Department of Medicine, Division of General Internal Medicine and Health Services Research Los Angeles, California MedicalResearch.com: What is the background for this study? What are the main findings? Response: Four million stable patients in the US undergo testing for suspected ischemic heart disease (IHD) annually. There is substantial variation in how these patients are managed by physicians, and both clinical and economic factors have been used to explain this variation. However, it is unknown whether patients’ beliefs and preferences influence management decisions, and we aimed to answer this question. Based on interviews of 351 stable patients at Geisinger Health System newly referred for cardiac stress testing/coronary computed tomographic angiography (CTA) for suspected IHD, we found that patients with an accurate understanding of their initial test result were less likely to undergo follow-up tests/procedures if the initial test was negative and more likely to undergo follow-up tests/procedures if the initial test was positive.
Author Interviews, Cost of Health Care, Critical Care - Intensive Care - ICUs, JAMA / 27.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30798" align="alignleft" width="133"]Dr. Dong W. Chang, MD MS</strong> Division of Respiratory and Critical Care Physiology and Medicine Los Angeles Biomed Research Institute at Harbor-University of California Los Angeles, Medical Center Torrance California Dr. Dong Chang[/caption] Dr. Dong W. Chang, MD MS Division of Respiratory and Critical Care Physiology and Medicine Los Angeles Biomed Research Institute at Harbor-University of California Los Angeles, Medical Center Torrance California MedicalResearch.com: What is the background for this study? Response: The study was based on our overall impression that ICU care is often delivered to patients who are unlikely to derive long-term benefit (based on their co-morbidities/severity of illness, etc.). However, what surprised us was the magnitude of this problem. Our study found more than half the patients in ICU at a major metropolitan acute-care hospital could have been cared for in less expensive and invasive settings.
Author Interviews, Cost of Health Care, Immunotherapy, Melanoma, Pharmacology / 22.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30744" align="alignleft" width="141"]Herbert H F Loong MBBS(HK), PDipMDPath(HK), MRCP(UK), FHKCP, FHKAM(Medicine) Specialist in Medical Oncology Clinical Assistant Professor, Department of Clinical Oncology Deputy Medical Director, Phase 1 Clinical Trials Centre The Chinese University of Hong Kong Prince of Wales Hospital Hong Kong SAR Dr. Herbert Loong[/caption] Herbert H F Loong MBBS(HK), PDipMDPath(HK), MRCP(UK), FHKCP, FHKAM(Medicine) Specialist in Medical Oncology Clinical Assistant Professor, Department of Clinical Oncology Deputy Medical Director, Phase 1 Clinical Trials Centre The Chinese University of Hong Kong Prince of Wales Hospital Hong Kong SAR MedicalResearch.com: What is the background for this study?  Response: Advanced melanoma have previously been known to be a disease with a dismal prognosis. Over the last few years, clinical trials data and real-world clinical experience of checkpoint inhibitors have significantly changed the treatment landscape for advanced melanoma patients. This was first demonstrated with the Anti-CTLA4 Ab Ipilimumab, and more recently with the Anti-PD1 Ab pembrolizumab. Whilst we have seen dramatic improvements in disease control with the use of these agents, the high costs of these drugs may be prohibitive to the average patient who has to pay out-of-pocket and potentially may place significant burdens on healthcare systems. There is a need to rationally assess the cost-effectiveness of these new agents, specifically addressing the potential benefits to the individual patient and to society, whilst balancing the costs that such a treatment may entail. The assessment of cost-effectiveness of a particular treatment is extremely important in Hong Kong, as this has direct implications on drug reimbursement and accessibility of the particular drug in question at public hospitals in Hong Kong. The aim of the study is to assess the cost-effectiveness of pembrolizumab in patients with advanced melanoma used in the first-line setting in Hong Kong, and comparing it to (1) ipilimumab and (2) cytotoxic chemotherapy. Cytotoxic chemotherapy chosen for comparison were drugs commonly used in the first line setting in Hong Kong, which included dacarbazine, temozolomide and carboplatin+paclitaxel combination. It is important to note that whilst ipilimumab is registered for this indication in Hong Kong, there is no reimbursement of this drug by the Hospital Authority in Hong Kong and patients have to pay out-of-pocket. The cost of ipilimumab and the associated side effects has been prohibitive to most advanced melanoma patients in the public setting.
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