Author Interviews, Cancer Research, Cost of Health Care, Health Care Systems, JAMA / 11.07.2016

MedicalResearch.com Interview with: Laura B. Vater, MPH MD Candidate 2017 Indiana University School of Medicine MedicalResearch.com: What is the background for this study? Response: In the United States, cancer center advertisements are common. Previous research has shown that these ads use emotion-based techniques to influence viewers and omit information about benefits, risks, and costs of cancer treatment. There is a concern that cancer center advertising may increase demand for unnecessary tests and treatments, increase healthcare costs, and provide unrealistic expectations about the benefits of cancer treatment. In this study, we examined cancer center advertising spending from 2005 to 2014, with particular attention to trends within media (television networks, magazines, newspapers, radio stations, billboards, and the Internet) and by target audience (national versus local). (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA / 10.07.2016

MedicalResearch.com Interview with: Lisa Soleymani Lehmann, MD, PhD Associate Professor of Medicine and Medical Ethics Director, Center for Bioethics Brigham and Women's Hospital Harvard Medical School Boston, Massachusetts MedicalResearch.com: What is the background for this study? Response: The background for this study is the Choosing Wisely Campaign from the American Board of Internal Medicine (ABIM). This campaign has asked specialty boards to come up with lists of interventions (e.g., imaging, medications, tests) that patients and doctors should question. When it initially came out, we thought it was a great idea, but wondered if patients and doctors would agree that some of the interventions are low value. It’s hard to cut back on things that patients feel are valuable to their care, especially as patient ratings of their doctor’s care become part of hospital ratings and physician reimbursement. (more…)
AHRQ, Author Interviews, Cost of Health Care / 07.07.2016

MedicalResearch.com Interview with: Jessica Vistnes, Ph.D. Senior Economist, Center for Financing, Access and Cost Trends Agency for Healthcare Research and Quality MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Medical Expenditure Panel Survey – Household Component (MEPS-HC), sponsored by the Agency for Healthcare Research and Quality (AHRQ), is one of the few sources of nationally representative data that can assess changes in the percentage of Americans gaining and losing health insurance coverage between 2013 and 2014, the first year that many provisions of the Affordable Care Act (ACA) were implemented. The MEPS-HC is also one of the few data sources that can be used to assess changes in the rates at which Americans are uninsured for a full calendar year. Three new AHRQ studies use data from the MEPS-HC and show large declines from 2013 to 2014 in the percentage of non-elderly adults who were uninsured throughout the calendar year. They also show large increases in the likelihood of gaining health care coverage from 2013-2014 compared to 2012-2013 across demographic groups defined by age, race/ethnicity and education. (more…)
Author Interviews, Colon Cancer, Cost of Health Care, Gastrointestinal Disease, Vanderbilt / 06.07.2016

MedicalResearch.com Interview with: Erica R. H. Sutton, MD Assistant Professor Department of Surgery, General Vanderbilt MedicalResearch.com: What is the background for this study? What are the main findings? Response: Colorectal cancer is one of the most preventable diseases that we face; however, despite the great strides that we have made in the realm of early detection, many people still do not undergo screenings. We sought to increase the availability of screenings to those in our community who are at high risk for colorectal cancer and uninsured by providing free colonoscopies to them and to examine the cost-effectiveness of this intervention. Over a 12-month period, 682 uninsured people underwent screening colonoscopies, and 9 cancers were detected. Compared to the Surveillance, Epidemiology, and End Results (SEER) registry, our patient population included more early-stage cancers, and our program was found to be cost-neutral. (more…)
Alzheimer's - Dementia, Author Interviews, Cost of Health Care, Geriatrics / 22.06.2016

MedicalResearch.com Interview with: Pei-Jung Lin, Ph.D. Assistant Professor Center for the Evaluation of Value and Risk in Health Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston, MA 02111 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Alzheimer’s disease (AD) is a slow, progressive disease. Many people with AD may live for years with the disease left unrecognized or untreated, in part because the early symptoms are mild and often mistaken as part of normal aging. In this study, we found that Alzheimer’s patients may use more health care services and incur higher costs than those without dementia even before they receive a formal diagnosis. For example, total Medicare expenditures were 42% higher among Alzheimer’s patients than matched controls during the year prior to diagnosis ($15,091 vs. $10,622), and 192% higher in the first year immediately following diagnosis ($27,126 vs. $9,274). We also found similar trends among Medicare patients with mild cognitive impairment (MCI)— a prodromal stage of AD and associated with higher dementia risk. Our study suggests that an Alzheimer’s disease or MCI diagnosis appears to be prompted by other health problems such as cardiovascular and cerebrovascular diseases, pneumonia, renal failure, urinary tract infections, and blood and respiratory infections. This finding likely reflects a failure of ambulatory care related to the impact of cognitive impairment on other chronic conditions. (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, Heart Disease, JAMA, Pharmacology / 22.06.2016

MedicalResearch.com Interview with: Thomas Andrew Gaziano, MD, MSc Department of Cardiology Assistant Professor Harvard Medical School MedicalResearch.com: What is the background for this study? Response: Heart failure (HF) is the leading cause of admissions to hospitals in the United States and the associated costs run between $24-47 billion annually. Targeting neurohormonal pathways that aggravate the disease has the potential to reduce admissions. Enalapril, an angiotensin converting enzyme-inhibitor (ACEI), is more commonly prescribed to treat HF than Sacubitril/Valsartan, an angiotensin-receptor/neprilysin inhibitor (ARNI). The latter was shown to reduce cardiovascular death and hospitalizations due to heart failure in a multi-country, randomized clinical (PARADIGM-HF), compared to Enalapril. In order to assess the cost-effectiveness of Sacubitril/Valsartan, compared to Enalapril, in the United States, we created a model population with population characteristics equivalent to the population in the PARADIGM-HF trial. Using a 2-state Markov model we simulated HF death and hospitalizations for patients with a left ventricular ejection fraction (LVEF) of 40% or less. (more…)
Annals Internal Medicine, Author Interviews, Cost of Health Care, Hepatitis - Liver Disease / 20.06.2016

MedicalResearch.com Interview with: J. Morgan Freiman, MD Infectious disease research fellow Boston Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Freiman:  There are 130-150 million persons infected with chronic HCV with 75% of all cases occurring in low- and middle- income countries (LMICs). Diagnosis is a 2-step process that starts with screening for exposure with an assay that detects antibodies to HCV (anti-HCV), followed by nucleic acid testing (NAT) for persons with reactive anti-HCV to measure HCV ribonucleic acid (RNA) and confirm active viremia. In LMICs diagnostic capacity is low, and fewer than 1% of patients are aware of their infection. Additionally, a significant proportion of patients who test positive for anti-HCV are lost to follow-up before nucleic acid testing. The 2-step diagnostic process is thus a major bottleneck to the HCV cascade of care. Testing for hepatitis C virus core antigen (HCVcAg) is a potential replacement for NAT. Our systematic review evaluated the accuracy of diagnosis of active HCV infection among adults and children for 5 commercially available HCVcAg tests compared with NAT. We found that HCVcAg assays with signal amplification have high sensitivity, high specificity, and have the potential to replace NAT in settings with high HCV prevalence. (more…)
AHRQ, Author Interviews, Cost of Health Care / 16.06.2016

MedicalResearch.com Interview with: Celeste M. Torio, Ph.D., M.P.H Scientific Review Officer AHRQ MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Torio: Hospital care expenditures constitute the largest single component of health care spending. These expenses are of significant concern to policymakers because of their impact on governments, consumers and insurers. MedicalResearch.com: What are the main findings? • Aggregate hospital costs for 35.6 million hospital stays totaled $381.4 billion in 2013. • Septicemia, osteoarthritis, newborn infants, complication of device, and acute myocardial infarction are the five most expensive conditions, and account for 1/5 of the total aggregate costs for hospitalizations. • Sixty-three percent of aggregate hospital costs were covered by Medicare and Medicaid, while 28 percent were covered by private insurance and 5 percent were covered by the uninsured. (more…)
Author Interviews, Cost of Health Care, JAMA, Macular Degeneration, Ophthalmology / 09.06.2016

MedicalResearch.com Interview with: Adam Glassman, M.S. Director, DRCRnet Coordinating Center Jaeb Center for Health Research Tampa, FL 33647 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Diabetic macular edema (DME) is the most common cause of vision loss in patients with diabetes, impairing the vision of approximately 750,000 people in the United States. The most common treatment involves the injection into the eye of one of 3 drugs that inhibit vascular endothelial growth factor (VEGF). The Diabetic Retinopathy Clinical Research Network, funded by the National Institutes of Health, conducted a randomized clinical trial on the comparative effectiveness of the 3 anti-VEGF drugs EYLEA®, Avastin®, or Lucentis® for eyes with decreased vision from diabetic macular edema. There are substantial cost differences between the three drugs. In the United States, EYLEA® costs approximately $1850, repackaged (compounded) Avastin® $60, and Lucentis® $1170 per injection. In eyes with relatively good starting vision, there were no differences in vision outcomes; all three groups, on average, had improved vision. In eyes with starting vision of 20/50 or worse, EYLEA® had better vision outcomes at 1 year than either Avastin® or Lucentis®, and better vision outcomes at 2 years than Avastin®. However, given that, on average, eyes will receive 9 to 10 injections within the first year of treatment and 5 injections in the second year, neither EYLEA® nor Lucentis® would be considered cost effective by standard benchmarks compared with Avastin® unless their prices decrease substantially. (more…)
ASCO, Author Interviews, Biomarkers, Cancer Research, Cost of Health Care, Immunotherapy / 07.06.2016

MedicalResearch.com Interview with: Neil T. Mason, MBA Personalized Medicine Strategist Personalized Cancer Medicine Division of Population Science Moffitt Cancer Center MedicalResearch: What is the background for this study? What are the main findings? Response: Immune checkpoint inhibitors targeting PD-1 (nivolumab and pembrolizumab) and CTLA-4 (ipilimumab) have revolutionized the treatment of metastatic disease in melanoma and non-small cell lung cancer with additional indications showing positive results. These drugs have elicited profound and durable responses in a significant number of patients, but have been criticized for their high cost. Though the price of the drugs themselves can reach over $100,000 per year, they can also cause severe, life threatening toxicities that are difficult and expensive manage. This model utilizes patient data from a large, NCI-designated cancer center to estimate the average cost of treatment with immune checkpoint inhibitors based on average duration of treatment and reported incidence of major toxicities. Based on the model, PD-1 inhibitor therapies are less costly than ipilimumab due to the significantly higher cost per dose of ipilimumab and average treatment duration of less than a year for PD-1 inhibitors. Managing drug-related toxicities were estimated to contribute between $8,200 and $9,600 to the cost of therapy with nivolumab adding the most cost. (more…)
ASCO, Author Interviews, Cost of Health Care, Prostate Cancer, Surgical Research / 06.06.2016

MedicalResearch.com Interview with: Sarmad Sadeghi MD, MS, PhD Assistant Professor of Medicine Norris Comprehensive Cancer Center University of Southern California MedicalResearch.com: What is the background for this study? Dr. Sadeghi: Several years ago analyses of outcomes for radical prostatectomy highlighted the significant impact of surgical experience on the oncological outcome for the patients. In this case experience was measured by the number of radical prostatectomies performed by the surgeon, and oncological outcome was measured by treatment failure rates (rising PSA). Despite this data, the move for redirecting patients to “high volume centers” where more experienced surgeons perform the operation has been sluggish. There was insufficient data on what is involved in referring patients to high volume centers and whether or not such action is cost effective. In a previous study we demonstrated that for every referral to a high volume center, there would be an average of $1,800 over a follow-up period of 20 years in societal cost savings. The main source of these savings is fewer treatment failures. The next question was who is a good candidate for referral and whether these savings can offset the referral costs. (more…)
Author Interviews, Cancer Research, Cost of Health Care, Global Health, Lancet / 26.05.2016

MedicalResearch.com Interview with: Dr Mahiben Maruthappu MD Senior Fellow to the CEO,NHS England Imperial College London, UK MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Maruthappu: There are over 8 million deaths due to cancer every year. At the same time, there are around 40 million unemployed people across the OECD, 7 million more than before the recent economic crisis. As a result, understanding how economic changes affect cancer survival, given the economic climate, is crucial. (more…)
Author Interviews, Cost of Health Care / 19.05.2016

MedicalResearch.com Interview with: Mike Rosenbaum Founder and CEO Pegged Software Mr. Mike Rosenbaum Founder and CEO Pegged Software MedicalResearch.com editor’s note: As part of an ongoing series on changes in the health care landscape, we interviewed Mr. Mike Rosenbaum, founder of Pegged Software.  Pegged Software uses an advanced "analytics engine to selecting job candidates based on the actual determinants of high performance", specifically in the health care field. The Pegged team “serves a broad set of healthcare organizations, applying modern technology and data tools to workforce construction and talent identification”.  MedicalResearch.com: Can you tell us a little about yourself?  How did you get interested in this field? Mr. Rosenbaum: I was on a path to become an academic, and as a fellow at Harvard I was interested in, and doing research about, and writing on topics related to the application of data to the most subjective areas of human endeavor.  My interest in the application of predictive analytics to talent grew out of that work. I initially started a business that applied these concepts to the software engineering space, and in 2009 I met an executive at a hospital who explained to me the issue they were facing and asked if I could help.  We ended up making a copy of the same technology we used in the software engineering space and putting it in a new company, which we called Pegged Software, and built that technology specifically for the healthcare and hospital space.  We ran the technology in that hospital and several others for about two and a half years, and in that time our best deployment reduced turnover by 77% and our worst reduced turnover by 45%.  So in late 2012 we started building out the team, and today we are deployed into over 400 healthcare facilities and have a median impact of a turnover reduction of 38%. (more…)
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Columbia, Cost of Health Care / 19.05.2016

MedicalResearch.com Interview with: Nathalie Moise, MD, MS Assistant Professor Center for Behavioral Cardiovascular Health Department of Medicine Columbia University Medical Center New York, NY 10032 MedicalResearch.com: What is the background for this study? Dr. Moise:  Our research aimed to compare the number of lives saved and changes in medical costs expected if intensive blood pressure goals of less than 120 mmHg were implemented in high cardiovascular disease risk patients. In 2014, the 8th Joint National Committee (JNC8) on Detection, Evaluation, and Treatment of High Blood Pressure issued new guidelines recommending that physicians aim for a systolic blood pressure (SBP) of 140 mmHg in adults with diabetes and/or chronic kidney disease and 150 mmHg in healthy adults over age 60. The new guidelines represented a major departure from previous JNC7 guidelines recommending SBPs of 130 mmHg and 140, mmHg for these groups, respectively. Under the 2014 guidelines, over 5 million fewer individuals annually would receive drug treatment to lower their blood pressure, compared with the prior 2003 guidelines. Recently, the Systolic Blood Pressure Intervention Trial (SPRINT) found that having a more intensive systolic blood pressure (SBP) goal of 120 mmHg in patients at high risk for cardiovascular disease reduced both cardiovascular events and mortality by about one quarter, compared with the current goal of 140 mmHg. These recent studies and guidelines have created uncertainty about the safest, most effective and high-value blood pressure goals for U.S. adults with hypertension, but no prior study has compared the cost-effectiveness of adding more intensive blood pressure goals in high cardiovascular disease risk groups to standard national primary prevention hypertension guidelines like JNC8 and JNC7. Our team at Columbia University Medical Center conducted a computer simulation study to determine the value of adding the lower, life-saving  systolic blood pressure goal identified in SPRINT to the JNC7 and JNC8 guidelines for high-risk patients between the ages of 35 and 74 years. (High risk was defined as existing cardiovascular disease, chronic kidney disease, or a 10-year cardiovascular disease risk greater than 15 percent in patients older than 50 years and with a pre-treatment SBP greater than 130 mmHg) (more…)
Author Interviews, Cost of Health Care, JAMA / 17.05.2016

MedicalResearch.com Interview with: Andrew M. Ibrahim, MD Robert Wood Johnson Clinical Scholar (VA Scholar), Institute for Healthcare Policy & Innovation, University of Michigan Ann Arbor, MI MedicalResearch.com: What is the background for this study? Dr. Ibrahim: Critical access hospital designation was created to help ensure access to the more than 59 million people living in rural populations. Hospitals were eligible for critical access designation if they had less than 25 beds and were located more than 35 miles away from another hospital. With this designation they were paid above total cost for the care they provided. Previous reports suggest these centers provide lower quality of care for common medical admissions, however little was known about surgical conditions.  MedicalResearch.com: What are the main findings? Dr. Ibrahim: This study included a review of 1,631,904 Medicare beneficiary admissions to critical access hospitals (n = 828) and non-critical access hospitals (n = 3,676) for 1 of 4 common types of surgical procedures: appendectomy, gall bladder removal, removal of all or part of the colon, and hernia repair. Patient who underwent surgery at critical access hospitals were, on average, less medically complex. Compared to larger urban hospitals, these small rural hospitals (i.e. critical access hospitals) had the same 30-day mortality rates and lower complications rates. In addition, critical access hospitals costs on average $1400 less per patient to Medicare, despite being paid in an alternative payment system. These findings remained significant after accounting for the patient’s pre-operation health condition.   (more…)
Author Interviews, Cost of Health Care, Gastrointestinal Disease, Hepatitis - Liver Disease / 16.05.2016

MedicalResearch.com Interview with: Darius Lakdawalla PhD Quintiles Chair in Pharmaceutical Development and Regulatory Innovation School of Pharmacy Professor in the Sol Price School of Public Policy University of Southern California  MedicalResearch.com: What is the background for this study? Dr. Lakdawalla: New treatments for hepatitis-C are highly effective but also involve high upfront costs.  Because they effectively cure the disease, all the costs of treatments are paid over a short period of time – about three months – but the benefits accrue for the rest of a patient’s life.  This creates problems for the private health insurance system, where patients switch insurers.  The insurer that pays the bill for the treatment might not be around to enjoy the benefits of averting liver damage, liver transplants, and other costly complications associated with hepatitis-C. (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA, Race/Ethnic Diversity / 16.05.2016

MedicalResearch.com Interview with: Benjamin D. Sommers, MD, PhD Assistant Professor of Health Policy & Economics Harvard T. H. Chan School of Public Health / Brigham & Women's Hospital Boston, MA 02115  Molly E. Frean Data Analyst Department of Health Policy and Management Harvard T.H. Chan School of Public Health Boston, MA 02115 MedicalResearch.com: What is the background for this study? Dr. Sommers: We conducted this study in an effort to see how Native Americans have fared under the Affordable Care Act. In addition to the law's expansion of coverage via Medicaid and tax credits for the health insurance marketplaces, the law also provided support for Native Americans’ health care specifically through continued funding of the Indian Health Service (IHS). We sought to see how both health insurance coverage patterns and IHS use changed in the first year of the law's implementation. (more…)
Author Interviews, Breast Cancer, Cost of Health Care, Radiation Therapy / 11.05.2016

MedicalResearch.com Interview with: Jayant S Vaidya MBBS MS DNB FRCS PhD Professor of Surgery and Oncology, Scientific Director, Clinical Trials Group, Division of Surgery and Interventional Science, University College London Whittington Health - Clinical Lead for Breast Cancer Royal Free Hospital University College London HospitalJayant S Vaidya MBBS MS DNB FRCS PhD  Professor of Surgery and Oncology, Scientific Director, Clinical Trials Group, Division of Surgery and Interventional Science, University College London Whittington Health - Clinical Lead for Breast Cancer Royal Free Hospital University College London Hospital  MedicalResearch.com: What is the background for this study? What are the main findings? Prof. Vaidya: TARGIT-A randomised clinical trial (ISRCTN34086741) compared giving TARGIT IORT during lumpectomy vs. traditional EBRT given over several weeks after lumpectomy for breast cancer; local-recurrence-free-survival was similar in the two arms of the trial, particularly when TARGIT was given simultaneously with lumpectomy. Also, there were significantly fewer deaths from other causes with TARGIT IORT. This study calculated journeys made by patients with breast cancer to receive their radiotherapy, using the geographic and treatment data from a large randomised trial. The study then assessed the same outcomes (travel distances, travel time and CO2emissions) in two semi-rural breast cancers—the results of this assessment confirm and reinforce the original results: the benefit of the use of TARGIT for patients from two semi=rural breast centres was even larger (753 miles (1212 km), 30 h, 215 kg CO2 per patient). (more…)
Author Interviews, Cost of Health Care, Education, JAMA / 11.05.2016

MedicalResearch.com Interview with: Dr. James Song-Jeng Yeh, MD Brigham and Women's Hospital Boston MA MedicalResearch.com: What is the purpose for this study? Dr. Yeh: A number of factors influence physicians’ prescribing behavior, including physician’s knowledge and understanding of the drugs.  Pharmaceutical detailing and financial incentives may affect such behavior.  My interest in evidence-based medicine and how medical knowledge is translated into practice lead me to think about how physicians’ financial relationships with the pharmaceutical industry may affect prescribing patterns. In our study, we linked the Massachusetts physicians open payment database with the Medicare drug prescription claims database to determine if financial relationships with the industry are associated with increased brand-name statin drug prescribing.  The open payment database reports payments that physicians receive from pharmaceutical and medical device industries.  The open payment database when linked to the drug prescription claims database allowed us to answer this question. We looked at year 2011, when two of the most commonly prescribed brand-name statin drugs (Lipitor and Crestor) were not yet available in generic formulation. The outcome measured was what percentage of all statin prescription claims (both generic and brand-name) were brand-names. (more…)
Author Interviews, Cost of Health Care, Fertility, OBGYNE / 09.05.2016

MedicalResearch.com Interview with: Dr. Scott Sills MD, PhD Medical Director at the Center for Advanced Genetics an IVF program based in Carlsbad, California  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Sills: Often regarded as a miracle procedure by many infertile couples, in vitro fertilization (IVF) can be financially difficult for those without insurance coverage for the treatment. This prohibitive cost leads many would-be parents who pursue IVF to transfer multiple embryos at once, to increase their chances of getting a baby and minimize the need for additional attempts. This new study now reports that the economic impact of IVF deserves a closer look. As corresponding author E. Scott Sills, MD PhD noted, rates of cesarean-section deliveries, premature births, and low birth weight of babies are all greater with two or more embryos transferred to the mother at once, compared to a lower risk, single-embryo pregnancy. The data derived from a comprehensive analysis of all IVF cases in Vermont (UVM) and was recently published in the journal Applied Health Economics & Health Policy. It is believed to be the first effort to calculate the difference in infant hospital costs based on the number of embryos transferred. Sills and his team had access to UVM Medical Center records of patients who conceived through IVF and delivered at least 20 weeks into their pregnancies between 2007 and 2011. (more…)
Author Interviews, Cancer Research, Cost of Health Care / 28.04.2016

MedicalResearch.com Interview with: Stacie B. Dusetzina, PhD Assistant Professor Division of Pharmaceutical Outcomes and Policy Eshelman School of Pharmacy University of North Carolina at Chapel Hill Chapel Hill, NC  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Dusetzina: Drug prices are of significant policy interest, particularly the prices for so-called “specialty” medications which are used to treat rare and/or complex conditions like cancer. In this study I estimated monthly price for orally-administered cancer treatments that were approved between 2000 and 2014. First I looked at the price of the drug during the year of initial FDA approval and then I looked at annual changes in the price after the year of approval. The main findings are that, even after inflation adjustment, the monthly price paid for orally-administered cancer treatments is increasing rapidly both at the time of approval and in subsequent years. As an example, if you compare average monthly prices during the first year post-approval for treatments approved between 2000-2010 to those approved after 2010 there was a major increase in launch prices from $5,529 per month to $9,013 per month. Year-to-year changes in price after launch varied a lot by drug ranging from decreases in price of -2.7% per year to increases of 11.4% per year. However, nearly all of the products studied increased in price over time. (more…)
Author Interviews, Cost of Health Care / 28.04.2016

MedicalResearch.com Interview with: Andrew L. Pecora, M.D., F.A.C.P., C.P.E.
COTA Founder and Executive Chairman
Chief Innovations Officer and Vice President of Cancer Services at Hackensack University Medical Center
  Background: Key leadership of health care informatics company, COTA, Inc., will travel to Vatican City after being invited to speak at The Vatican’s Third International Conference on the Progress of Regenerative Medicine and Its Cultural Impact. COTA’s founder, Dr. Andrew Pecora, will discuss health care inequality and how new therapies only exacerbate the problem due to high costs. He will talk about the approaches COTA takes to address the problem, increasing access and affordability.  MedicalResearch.com: What is the background and mission of COTA? Dr. Pecora: Right now, up to 30 percent of health care delivered in the United States is not ideal, meaning doctors are providing treatments that do not necessarily need to be provided or do not precisely align with what is best for the client – a factor called ‘adverse variance.’ The fundamental problem we’re facing today is that we haven’t been able to successfully recognize and predict adverse variance. This is an issue that the entire world is dealing with, and COTA’s mission is to remove that variance and make the best care completely clear to patients, doctors, hospitals, payers and the government. COTA’s aim is to ensure patients are getting the best possible care, leading to the best possible outcome at the best possible price. (more…)
Author Interviews, Cancer Research, Cost of Health Care, Radiology / 20.04.2016

MedicalResearch.com Interview with: Dr. Christine Fisher MD, MPH Department of Radiation Oncology University of Denver MedicalResearch.com: What is the background for this study? Dr. Fisher: Screenable cancers are treated by oncologists every day, including many in invasive, advanced, or metastatic settings.  We aimed to determine how health insurance status might play into this, with the hypothesis that better access to health care would lead to presentation of earlier cancers.  While this sounds intuitive, there is much debate over recent expansions in coverage through the Affordable Care Act and how this may impact health in our country. MedicalResearch.com: What are the main findings? Dr. Fisher: The findings confirm that those without health insurance present with more advanced disease in breast, cervix, colorectal, and prostate cancers, including tumor stage, grade and elevated tumor markers.  That is to say, all else being equal for risk of cancer, lack of health insurance was an independent risk factor for advanced presentation.  (more…)
Author Interviews, Cost of Health Care, Heart Disease, NYU / 06.04.2016

MedicalResearch.com Interview with: Joseph A. Ladapo, MD, PhD Assistant Professor of Medicine and Population Health Section on Value and Effectiveness Department of Population Health NYU Langone School of Medicine New York NY 10016 MedicalResearch.com: What are the main findings? Dr. Ladapo: While cardiac implantable electronic devices (CIEDs) are increasingly used to treat patients with arrhythmias, heart failure, and other risk factors for sudden cardiac death, these implantable devices require life-long follow-up to assess their performance and functionality. This need for continuous monitoring has galvanized the development of remote monitoring technologies for patients with CIEDs. Although randomized studies have shown that remote monitoring may reduce healthcare utilization and expenditures when compared to in-office monitoring, little is known about whether these findings generalize to day-to-day clinical practice. We aimed to address this uncertainty by evaluating healthcare utilization and expenditures in a cohort of patients with newly-implanted CIEDs who were followed remotely or with in-office monitoring. MedicalResearch.com: What is the background for this study? Dr. Ladapo: Remote monitoring is associated with a reduction in patients’ utilization of ambulatory and acute care and a reduction in expenditures associated with this utilization—at least over 24 months. This reduction was most pronounced among remotely monitored patients with implantable cardioverter defibrillators (ICDs).  Although many of our comparisons between remote and office monitoring were not statistically significant, they trended toward favoring remote monitoring. (more…)
Author Interviews, Cost of Health Care, Heart Disease, JACC / 05.04.2016

MedicalResearch.com Interview with: Dr. Jordan B. King Post Doctoral Fellow Pharmacotherapy Outcome Resctr, University of Utah MedicalResearch.com: What is the background for this study? What are the main findings? Response: The cornerstone of treatment in heart failure with reduced ejection fraction (HFrEF) revolves around low-cost generic medications such as angiotensin converting enzyme inhibitors (ACEIs) and beta-blockers (BBs). However, recently the dual-acting angiotensin receptor neprilysin inhibitor (ARNI) sacubitril-valsartan, demonstrated improved survival and reduction in heart failure hospitalizations relative to enalapril, an ACEI, and optimal background therapy. This creates a situation in which we have a new medication which improves outcomes, but carries a high price tag ($4,560 per year) compared with ACEIs, the standard of care over the last 20 years, and are available as generic medications for <$50 per year. We set out to determine the incremental cost-effectiveness ratio (ICER) per quality adjusted life year gained (QALY) from the perspective of a health care payer in the U.S. The ICER is a measure of how much we have to pay for sacubitril-valsartan to gain 1 unit of health relative to enalapril. In this case the unit of health is a year of life adjusted for quality. We used a Markov model to estimate the costs and effectiveness of the two treatment options over a lifetime. In the base case, the ICER for sacubitril-valsartan was $50,959 per QALY gained. Health care interventions which cost <$50,000 per QALY are generally considered cost-effective, but some argue that <$100,000 per QALY is a more appropriate threshold in the U.S. In a probabilistic sensitivity analysis, 57% and 80% of all simulations fell below the $50,000 and $100,000 per QALY thresholds, respectively. Sacubitril-valsartan was the less costly treatment arm in 5% of simulations, and enalapril dominated (less costly and more effective) in 17% of simulations. (more…)
Annals Internal Medicine, Author Interviews, Cost of Health Care / 04.04.2016

MedicalResearch.com Interview with: Quinn Grundy, PhD, RN Postdoctoral Research Associate Charles Perkins Centre Faculty of Pharmacy The University of Sydney MedicalResearch.com: What is the background for this study? Dr. Grundy: In 2010, United States (US) lawmakers passed the Physician Payments Sunshine Act as part of the Affordable Care Act. The goal of this legislation was to make publicly transparent the financial relationships between physicians and pharmaceutical and medical device companies. These relationships are associated with increased prescribing of high cost, brand name medications with limited track records for safety. Policymakers hoped that increased transparency would help to deter relationships between physicians and industry that could bias treatment decision-making in this way. What caught our attention was that nurses, though they represent the largest proportion of health professionals, are omitted from the US Sunshine legislation. We questioned whether policymakers believed that nurses did not have the same kinds of relationships with industry as their physician counterparts, or, whether they did not believe that the consequences of nurse-industry interactions would warrant regulation. Rather than assuming that nurses interacted with industry in the same way that physicians do, we conducted an exploratory, in-depth qualitative study of nurses’ interactions with industry representatives in day-to-day clinical practice. At 4 hospitals in the western US, we interviewed 72 nurses, hospital administrators, supply chain professionals and industry representatives. Over a period of 2 years, we also directly observed nurses’ interactions with what we call “medically-related” industry, including pharmaceutical, medical equipment and device, infant formula, and health technology companies. (more…)
Author Interviews, Cost of Health Care, Hospital Readmissions, Outcomes & Safety, UT Southwestern / 04.04.2016

MedicalResearch.com Interview with: Oanh Kieu Nguyen, MD, MAS | Assistant Professor UT Southwestern Medical Center Divisions of General Internal Medicine and Outcomes and Health Services Research Dallas, TXOanh Kieu Nguyen, MD, MAS | Assistant Professor UT Southwestern Medical Center Divisions of General Internal Medicine and Outcomes and Health Services Research Dallas, TX MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Nguyen: The impetus for this study was Steven Brill’s 2013 Time magazine award-winning article, “Bitter Pill: Why Medical Bills Are Killing Us.” This report investigated inflated charges for hospital bills, and and suggested that a major driver of irrationally high charges was the disproportionate negotiating power of hospitals, as evidenced through their high profit margins. As hospital physicians, our reaction was “But what if hospitals that make more money are delivering more value and better outcomes to patients? If that’s the case, wouldn’t most people say that their profits justifiably earned?” Surprisingly, we found that no one had really looked at this issue in a systematic way. We set out to answer this question using hospital financial data from California’s Office of Statewide Health Planning and Development (OSHPD) and outcomes data on 30-day readmissions and mortality for congestive heart failure, acute myocardial infarction (‘heart attacks’), and pneumonia from the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website. California has more hospitals than any other state other than Texas, and also has a wide diversity of hospital types. The OSHPD financial data are also audited, so we thought these would be more reliable than using data from other sources. Because the outcomes reported on Hospital Compare are viewable by the general public, we thought hospitals would be most motivated to target improvements in these outcomes. We found that there was almost no association between how much money a hospital made and its subsequent performance on outcomes. The exception to this was we found that hospitals that had better finances reported higher rates of 30-day mortality for congestive heart failure, which was counterintuitive. We’re not sure why this was the case but speculate that it is possible that hospitals with better finances take care of sicker heart failure patients because they have more advanced (and more expensive) treatments available. Additionally, we looked to see if hospitals with lower readmissions rates subsequently made less money. This is a specific area of policy concern given federal penalties in the U.S. for excessive hospital readmissions. Many critics of these penalties have argued that reducing readmissions makes no financial sense for hospitals, since readmissions still generate hospital revenue despite the penalties. Thus, reducing readmissions would reduce a key source of hospital revenue and lead to poorer hospital finances. However, our analysis showed that lower readmissions rates were not associated with poorer hospital finances, as has been feared.  (more…)
Author Interviews, Cost of Health Care, JAMA, Prostate Cancer / 30.03.2016

MedicalResearch.com Interview with: HICOR portraits, Nov. 4, 2014 Joshua A. Roth, PhD, MHA Assistant Member AHRQ Patient-Centered Outcomes Research K12 Scholar Hutchinson Institute for Cancer Outcomes ResearchJoshua A. Roth, PhD, MHA Assistant Member AHRQ Patient-Centered Outcomes Research K12 Scholar Hutchinson Institute for Cancer Outcomes Research MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Roth: PSA prostate cancer screening is controversial because of uncertainty about the overall benefit-risk balance of screening and conflicting recommendations from a variety of prominent national panels. For example, there is debate about whether the cancer early-detection benefits of screening outweigh potential harms related to overdiagnosis of prostate cancer and associated overtreatment (for example, surgery and/or radiation therapy). However, this benefit-risk balance largely depends on how screening programs are structured (for example, the age range over which screening occurs, how often screened occurs, and the PSA level that triggers biopsies) and how screening detected prostate cancers are managed. With these factors in mind, we developed a simulation model to estimate the morbidity, mortality, and cost outcomes of many PSA screening approaches that have been proposed by national panels or discussed in the peer-reviewed literature. The model calculates these outcomes using inputs from national databases and major PSA screening clinical trials. The primary outcome of our model was the cost per quality-adjusted life year gained—a measure that reflects the value of medical interventions through impacts on cost, survival, and health-related quality of life. We don’t have explicit rules for willingness to pay per quality-adjusted life year in the United States, but interventions that cost $100,000 to $150,000 per quality-adjusted life year are generally considered to be of at least low to moderate value (whereas, for example, an intervention that costs $400,000 per quality-adjusted life year would be generally considered to be of very poor value). Using the model, we found that more conservative PSA screening strategies (that is, those with less frequent screening and higher PSA level thresholds for biopsy referral) tended to be more cost-effective than less conservative strategies. Importantly, we found that no strategy was likely to be of high value under contemporary treatment patterns where many men with low-risk prostate cancer (that is, those with a Gleason score lower than 7 and clinical T2a stage cancer or lower) receive treatment with surgery or radiation therapy, but several strategies were likely to be of at least moderate value (cost per qualityadjusted life-year=$70 831-$136 332) with increased use of conservative management (that is, treating only after clinical progression) for low-risk, screen-detected cancers. (more…)
Author Interviews, Cost of Health Care / 14.03.2016

MedicalResearch.com Interview with: Steffie Woolhandler MD, MPH, FACP and David U. Himmelstein MD, FACP CUNY School of Public Health at Hunter College MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Cadillac Tax aims to eventually eliminate tax subsides to employer-sponsored coverage.  When an employer provides health benefits to an employee, the employee pays no income or FICA tax on the value of those benefits, although the benefits are obviously part of the employee's compensation.  In other words, the taxpayers are currently picking up part of the employee's health insurance costs. Economists and politicians have been justifying the ACA's Cadillac Tax by portraying it as a "Robin Hood" tax that would take from the rich and give to the poor. That view of the Cadillac Tax is untrue.   We found that the main beneficiaries of the current tax subsidies to employer sponsored coverage are middle class families (defined by a family income between $39,000 and $100,000 in 2009 dollars) for whom the subsidies boost their effective income by about 5%.   These middle class people are the ones who would be most harmed when the Cadillac Tax kicks-in and curtails the current tax subsidies. (more…)