Cost of Health Care
09 Aug CareSkore Allows Hospitals To Do Risk Analysis and Care Planning in Real Time
MedicalResearch.com Interview with:
CareSkore co-founders:
Dr. Puneet Dhillon Grewal MD
CareSkore co-founder and Chief Medical Officer
Dr. Grewal is an Internal Medicine physician and Cardiologist. She had completed her residency from Rosalind Franklin University of Medical Science, and is currently a Cardiology Fellow at the same institution and
Jaspinder Grewal, MBA CareSkore co-founder and Chief Executive Officer,
a graduate from the University of Chicago Booth School of Business and a computer engineer. He has 13 years of experience working with large health systems , managing technology and operations.
MedicalResearch.com: What is the background for the CareSkore company? What is its mission and objectives?
Response: The Affordable Care Act, through penalties and bundled payments, requires hospitals and providers to be accountable for the quality of care they provide. For example, if a patient is readmitted to the hospital within 30-days after discharge, hospital reimbursement is reduced, and in many cases not paid at all.
In order to improve the quality of care, hospitals need to understand the clinical risk of patients, so that they can focus efforts on the patient most likely to face adverse events. The three biggest areas of improvement are readmissions, over utilization of services, and hospital acquired conditions (such as pneumonia and surgical site infections).
08 Aug Health Benefits of Insurance Coverage Under ACA Become More Apparent With Time
MedicalResearch.com Interview with: [caption id="attachment_24380" align="alignleft" width="123"]
Dr. Benjamin D. Sommers[/caption]
Benjamin D. Sommers, M.D., Ph.D
Assistant Professor of Health Policy & Economics Department of Health Policy & Management
Harvard T.H. Chan School of Public Health
Assistant Professor of Medicine Division of General Medicine & Primary Care
Brigham & Women’s Hospital / Harvard Medical School
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: More than half of states have expanded Medicaid under the Affordable Care Act, and several states have taken alternative approaches, such as using federal Medicaid funds to purchase private insurance for low-income adults. Our study looks at the effects of these two different approaches - vs. not expanding at all - in three southern states (Kentucky Arkansas, and Texas). What we find is that expanding coverage, whether by Medicaid (Kentucky) or private insurance (Arkansas), leads to significant improvements in access to care, preventive care, quality of care, and self-reported health for low-income adults compared to not expanding (Texas). The benefits of the coverage expansion also took a while to become evident - the first year of expansion (2014) showed some of these changes, but they become much more apparent in the second year (2015).
08 Aug ICU Care May Lead To More Tests and Costs Without Necessarily Better Outcomes
Posted at 17:47h
in Author Interviews, Cost of Health Care, Critical Care - Intensive Care - ICUs, JAMA
MedicalResearch.com Interview with:
Dong W. Chang, MD, MS
Dong W. Chang, MD, is a lead researcher at LA BioMed, one of the nation’s leading independent nonprofit research institutes. His research interests include improving the delivery of care to patients with a focus on identifying new healthcare models for reducing hospital re-admission. He also is the director of Medical-Respiratory ICU at Harbor-UCLA Medical Center in Torrance
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: With the use of intensive care units (ICUs) on the rise in many hospitals, researchers at LA BioMed and UCLA examined ICU usage. They found patients who were admitted to these units underwent more costly and invasive procedures but didn’t have better mortality rates than hospitalized patients with the same medical conditions who weren’t admitted to the ICU.
The study, published in JAMA Internal Medicine, examined records from 156,842 hospitalizations at 94 acute care hospitals for four medical conditions where ICU care is frequently provided but may not be medically necessary:diabetic ketoacidosis, pulmonary embolism, upper gastrointestinal hemorrhage and congestive heart failure. The study found the hospitals that utilize ICUs more frequently were more likely to perform invasive procedures and incur higher costs. But the study found these hospitals had no improvement in mortality among patients in the ICU when compared with other hospitalized patients with these four conditions.
Smaller hospitals and teaching hospitals used ICUs at higher rates for patients with the four conditions studied that did larger hospitals. The difference in the average costs ranged from $647 more for upper gastrointestinal hemorrhage care in the ICU to $3,412 more to care for a patient with congestive heart failure in the ICU when compared with hospital care for the same conditions outside the ICU.
08 Aug Traditional Non-Medicaid Insurance Associated With Earlier Testicular Cancer Diagnosis
Posted at 17:35h
in Author Interviews, Brigham & Women's - Harvard, Cancer Research, Cost of Health Care
MedicalResearch.com Interview with:
Sarah C. Markt, ScD, MPH
Research Associate
Harvard T.H. Chan School of Public Health | Department of Epidemiology
Boston, MA 02115
MedicalResearch.com: What is the background for this study?
Response: Age is associated with insurance status, with the greatest proportion of uninsured between the ages of 20 to 34 years. For testicular cancer this is important because the median age of diagnosis is 33 years and the majority of the cases are diagnosed between then ages of 20 and 44 years. Previous studies have shown that people with cancer who are uninsured are more likely to present with worse disease, less likely to receive treatment, and are more likely to die of their disease, compared with those who have private insurance. Furthermore, the associations between Medicaid coverage and cancer outcomes have been conflicting.
28 Jul Safety-Net Hospitals Can Reduce Costs By Shifting Complex Surgery Patients to Other Hospitals
Posted at 01:01h
in Author Interviews, Cost of Health Care, Health Care Systems, JAMA, Surgical Research
MedicalResearch.com Interview with:
[caption id="attachment_26484" align="alignleft" width="160"]
Dr. Richard Hoehn[/caption]
Richard Hoehn, MD
Resident in General Surgery
College of Medicine
University of Cincinnati
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: A recent study from our research group (Hoehn et al, JAMA Surgery, 2015) found that safety-net hospitals perform complex surgery with higher costs compared to other hospitals, and that these higher costs are potentially due to intrinsic differences in hospital performance.
In this analysis, we decided to simulate different policy initiatives that attempt to reduce costs at safety-net hospitals. Using a decision analytic model, we analyzed pancreaticoduodenectomy performed at academic hospitals in the US and tried to reduce costs at safety-net hospitals by either
1) reducing their mortality,
2) reducing their patients’ comorbidities and complications, or
3) sending their patients to non-safety-net hospitals for their surgery.
While reducing mortality had a negligible impact on cost and reducing comorbidities/complications had a noticeable impact on cost, far and away the most successful way to reduce costs at safety-net hospitals, based on our model, was to send patients away from safety-net hospitals for their pancreaticoduodenectomy.
25 Jul Patients Switch to Lower-Priced Labs If Required To Pay Out-of-Pocket Difference
MedicalResearch.com Interview with: [caption id="attachment_26408" align="alignleft" width="152"]
Dr. James C. Robinson[/caption]
James C. Robinson PhD
Leonard D. Schaeffer Professor of Health Economics
Director, Berkeley Center for Health Technology
Division Head, Health Policy and Management
University of California
School of Public Health
Berkeley, CA
MedicalResearch.com: What is the background for this study?
Response: To moderate the increase in insurance premiums, employers are increasing consumer cost sharing requirements. Under reference pricing, the employer establishes a limit to what it will contribute towards each service or product, typically set at the 60th percentile or other midpoint in the distribution of prices in the market. If the patient selects a facility charging less than or equal to this contribution, he/she receives full coverage, but if a more expensive facility is chosen, the patient must pay the full difference.
22 Jul Women Still Getting CA-125 and CT Testing After Ovarian Cancer, Despite Lack of Clear Benefit
Posted at 00:39h
in Author Interviews, Beth Israel Deaconess, Biomarkers, Cost of Health Care, Medical Imaging, Ovarian Cancer
MedicalResearch.com Interview with:
[caption id="attachment_26310" align="alignleft" width="120"]
Dr. Katharine M. Esselen[/caption]
Katharine Mckinley Esselen, M.D.
Instructor in Obstetrics, Gynecology and Reproductive Biology
Beth Israel Deaconess Medical Center
Brigham and Womens Hospital
MedicalResearch.com: What is the background for this study?
Response: There is no consensus on how to follow a patient in remission from ovarian cancer in order to detect recurrent disease. However, a 2009 randomized clinical trial demonstrated that using CA-125 blood tests for routine surveillance in ovarian cancer increases the use of chemotherapy and decreases patient’s quality of life without improving survival compared with clinical observation. Published guidelines categorize CA-125 tests as optional and discourage the use of radiographic imaging for routine surveillance. Thus, this study aims to examine the use of CA-125 tests and CT scans at 6 Cancer Centers and to estimate the economic impact of this surveillance testing for ovarian cancer.
21 Jul Interventions Involving Patients and Providers Required To Reduce Low-Value Care
Medicalresearch.com Interview with: [caption id="attachment_26365" align="alignleft" width="200"]
Alex Mainor[/caption]
Alex Mainor, JD, MPH
Research Project Coordinator
The Dartmouth Institute for Health Policy and Clinical Practice
Lebanon, NH 03756
Carrie H. Colla, Alexander J. Mainor, Courtney Hargreaves, Thomas Sequist, Nancy Morden
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Waste in the healthcare system is an important concern to healthcare providers, patients, policymakers, and taxpayers, and is estimated to account for 30% of all healthcare costs. Low-value care can expose patients to unnecessary costs for little or no medical benefit, or to potential harm from unnecessary tests and procedures. In recent years, the concept of low-value care has gained wider acknowledgement and acceptance as a pressing concern for the healthcare system, and many interventions have been studied to reduce the use of this wasteful care. However, the landscape of these interventions has not been studied in a systematic and comprehensive way.
In this review, we found that interventions to reduce the use of wasteful medical care are often studied and published selectively. Findings suggest that interventions using clinical decision support, clinician education, patient education, and interventions combining elements from each have strong potential to reduce low-value care.
20 Jul Statewide Collaboration Reduced Preventable Hospital Readmissions by 20%
Posted at 20:38h
in Author Interviews, Cost of Health Care, Health Care Systems, Hospital Readmissions
MedicalResearch.com Interview with:
[caption id="attachment_26313" align="alignleft" width="150"]
Dr. Thomas Meehan[/caption]
Thomas P. Meehan, MD, MPH
Associate Medical Director
Harvard Pilgrim Health Care
Qualidigm, Wethersfield
Quinnipiac University, North Haven
CT
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There is a national effort to decrease preventable hospital readmissions in order to improve both the quality and cost of healthcare. Part of this national effort includes local quality improvement projects which are organized and conducted by a variety of organizations working by themselves or with others. We describe one statewide quality improvement project which was led by a Medicare-funded Quality Improvement Organization and conducted with a hospital association and many other collaborators. We document our activities and a relative decrease in the statewide 30-day aggregate readmission rate among fee-for service Medicare beneficiaries of 20.3% over four and a half years. While we are extremely proud of our work and this outcome, we recognize that there are many factors that impacted the outcome and that we can’t claim sole credit.
13 Jul Dietary Supplements Are A $36 Billion Business
MedicalResearch.com Interview with: [caption id="attachment_24349" align="alignleft" width="200"]
Ms. Leigh Purvis[/caption]
Leigh Purvis, MPA
Director of Health Services Research
AARP Public Policy Institute
Editors’ note: In conjunction with the AARP’s new investigative piece, 'Supplement Pills That Promise Too Much', Leigh Purvis, Director of the AARP Health Services Research program discussed the issue of the proliferation of supplements, often with labels that make extraordinary health benefit claims.
MedicalResearch.com: How many Americans use nutritional supplements? How big is the business of supplements?
Response: Supplements are very popular in the United States. This is particularly true for older adults. A recent study found that the proportion of older adults using supplements increased from 52 percent in 2005 to 64 percent in 2011, and the share using multiple supplements grew by nearly 50 percent.
According to the National Institutes of Health, American spent an estimated $36.7 billion on dietary supplements in 2014.
11 Jul Spending on Cancer Center Advertising Tripled Over 10 Years
Posted at 19:00h
in Author Interviews, Cancer Research, Cost of Health Care, Health Care Systems, JAMA
MedicalResearch.com Interview with:
[caption id="attachment_25955" align="alignleft" width="160"]
Laura Vater[/caption]
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).
10 Jul Patients Often Don’t Agree With Their Doctor As To What Constitutes A Low-Value Test
MedicalResearch.com Interview with: [caption id="attachment_25980" align="alignleft" width="180"]
Dr. Lisa Lehmann[/caption]
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.
07 Jul AHRQ Studies Find Large Declines in Number of Uninsured Adults
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.06 Jul Vanderbilt Free Colonoscopies For Uninsured Detected Some Early Cancers and Was Cost Neutral
Posted at 14:45h
in Author Interviews, Colon Cancer, Cost of Health Care, Gastrointestinal Disease, Vanderbilt
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.
28 Jun Multiple Generics Required To Drive Down Price of Brand Name Drugs
Posted at 21:22h
in Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA, Lipids
MedicalResearch.com Interview with: [caption id="attachment_25649" align="alignleft" width="200"] Dr. Jing Luo[/caption] Jing Luo, MD, MPH Program on Regulation, Therapeutics, and Law (PORTAL) Division of Pharmacoepidemiology and Pharmacoeconomics Department of Medicine Brigham and Women’s Hospital and Harvard Medical School Boston, Massachusetts MedicalResearch.com: What is the background for this study? Response: Until recently, the cholesterol lowering drug atorvastatin was the highest selling...
22 Jun Patients with Dementia Incur Higher Health Care Costs Even Before Diagnosis
MedicalResearch.com Interview with: [caption id="attachment_25446" align="alignleft" width="142"]
Dr. Pei-Jung Lin[/caption]
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.
22 Jun Entresto (valsartan/sacubitril) Extends Life and Reduces Hospitalizations and Costs in Heart Failure Patients
Posted at 22:37h
in Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, Heart Disease, JAMA, Pharmacology
MedicalResearch.com Interview with:
[caption id="attachment_25442" align="alignleft" width="120"]
Dr. Thomas Gaziano[/caption]
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.
20 Jun Single-Step Testing Can Improve Access To Hepatitis C Testing
Posted at 22:44h
in Annals Internal Medicine, Author Interviews, Cost of Health Care, Hepatitis - Liver Disease
MedicalResearch.com Interview with:
[caption id="attachment_25322" align="alignleft" width="160"]
Dr. Morgan Freiman[/caption]
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.
16 Jun Infections, Newborns and Heart Attacks Among Most Expensive Health Care Costs
MedicalResearch.com Interview with: [caption id="attachment_25243" align="alignleft" width="154"]
Dr. Celeste Torio[/caption]
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.
09 Jun Severe Diabetic Macular Edema: EYLEA® Had Better Outcomes Than Avastin® or Lucentis® At One Year, But at Much Greater Cost
Posted at 20:39h
in Author Interviews, Cost of Health Care, JAMA, Macular Degeneration, Ophthalmology
[caption id="attachment_22245" align="alignleft" width="111"]
Adam Glassman[/caption]
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.
07 Jun Chemotherapy and Toxicities of Immune Checkpoint Inhibitors May Be Prohibitively Expensive
Posted at 13:59h
in ASCO, Author Interviews, Biomarkers, Cancer Research, Cost of Health Care, Immunotherapy
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.
06 Jun Radical Prostatectomies: Referral to High Volume Centers Saves Money
Posted at 13:59h
in ASCO, Author Interviews, Cost of Health Care, Prostate Cancer, Surgical Research
MedicalResearch.com Interview with:
[caption id="attachment_24840" align="alignleft" width="183"]
Dr. Sarmad Sadeghi[/caption]
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.
26 May Global Economic Downturn Linked To Increase in Cancer Deaths
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.19 May People Analytics Firm Aims To Improve Care While Reducing Labor Turnover
MedicalResearch.com Interview with:
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%.
19 May Lower Blood Pressure Goals Would Save Lives and Money
Posted at 13:25h
in AHA Journals, Author Interviews, Blood Pressure - Hypertension, Columbia, Cost of Health Care
MedicalResearch.com Interview with:
[caption id="attachment_24488" align="alignleft" width="150"]
Dr. Nathalie Moise[/caption]
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)
17 May Critical Access Rural Hospitals Provide Safe Care At Lower Costs
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.16 May Insurers Can Pay High Cost of Hepatitis C Drugs, But Not Benefit If Patient Switches Plans
Posted at 19:04h
in Author Interviews, Cost of Health Care, Gastrointestinal Disease, Hepatitis - Liver Disease
MedicalResearch.com Interview with:
[caption id="attachment_24409" align="alignleft" width="200"]
Dr. Darius Lakdawalla[/caption]
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.
16 May ACA Increased Rates of Health Insurance Coverage For Native Americans
Posted at 16:00h
in Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA, Race/Ethnic Diversity
MedicalResearch.com Interview with:
[caption id="attachment_24380" align="alignleft" width="123"] Dr. Benjamin D. Sommers[/caption]
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
[caption id="attachment_24406" align="alignleft" width="125"]
Molly E. Frean[/caption]
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.
11 May Intra-operative Radiation For Breast Cancer Better For Patients and Environment
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 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).