ASCO, Author Interviews, Cancer Research, Cost of Health Care, Race/Ethnic Diversity / 06.06.2019

MedicalResearch.com Interview with: [caption id="attachment_49644" align="alignleft" width="161"]Blythe J.S. Adamson, PhD, MPH Senior Quantitative Scientist Flatiron Health Dr. Adamson[/caption] Blythe J.S. Adamson, PhD, MPH Senior Quantitative Scientist Flatiron Health MedicalResearch.com: What is the background for this study? Response: Racial disparities in access and outcomes have been documented across the full trajectory of cancer-related care. This includes access to prevention and screening, to early diagnosis, treatment, survival and other health outcomes. While these disparities have been well documented, finding mechanisms to reduce disparities is more challenging. One potential mechanism to reduce treatment disparities is to improve access to insurance coverage. The Affordable Care Act (ACA), passed in March 2010, included as its overall goals the improvement in healthcare quality and access, and enhancing equity in treatment and outcomes. The ACA allowed states to expand Medicaid to poor and near-poor adults, and this was implemented by many states starting in 2014. In addition, the ACA established private insurance marketplaces with income-based premium subsidies and limits on out-of-pocket spending for qualifying low-income enrollees. Prior research has demonstrated that ACA Medicaid expansions are associated with increased coverage and improved overall access for cancer survivors; and for newly diagnosed patients, the ACA was associated with increased coverage and shifts to earlier stage diagnosis for some cancers. To our knowledge, no research has yet demonstrated that the ACA coverage expansions affected the process of cancer care, specific cancer treatments received or specific treatment outcomes, let alone whether disparities were reduced.  In this study we looked at the time from advanced/metastatic diagnosis to start of systemic treatment for black vs. white patients and based on whether they were diagnosed at a time and in a state that had vs. had not implemented Medicaid expansion. Our study hypothesis was that Medicaid expansion reduced disparity in timely treatment of black patients compared to white patients with advanced cancer. We defined timely treatment as start of systemic therapy within 30 days of advanced/metastatic diagnosis. This is a retrospective observational study, not a randomized controlled trial. In other words, we selected a cohort of patients diagnosed with advanced or metastatic cancers over time and observed whether they received timely treatment. The Flatiron Health EHR-derived database was the principal data source for this research. Flatiron contributing practices include 280 cancer community based clinics and academic hospital outpatient settings (~800 sites of care) representing more than 2.2 million patients with cancer in the United States. Practices are located in 40 states. To produce the database, Flatiron extracted data from structured fields, including demographics, and recorded medication orders and administrations. Flatiron also abstracted unstructured data, using technology assisted review by highly trained clinicians. Abstracted data include diagnosis date, stage, and prescribed oral anticancer medications. The database used for research purposes was de-identified. We also used data from the Kaiser Family Foundation which has tracked Medicaid implementation policies for over twenty years, and the US Bureau of Labor Statistics from which we pulled state-year unemployment rates.
Author Interviews, Cost of Health Care, JAMA, Mental Health Research / 06.06.2019

MedicalResearch.com Interview with: [caption id="attachment_48428" align="alignleft" width="200"]Hefei Wen, PhDAssistant Professor, Department of Health Management & PolicyUniversity of Kentucky College of Public Health Dr. 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? Response: Medicaid is the principal payer of behavioral health services in the U.S. and expected to play an increasing role in financing behavioral health services following Medicaid expansions under the ACA.
Accidents & Violence, Author Interviews, Cost of Health Care, JAMA, Surgical Research, University of Michigan / 05.06.2019

MedicalResearch.com Interview with: [caption id="attachment_49606" align="alignleft" width="156"]Dr. Mark R. Hemmila MD Associate Professor of Surgery Division of Acute Care Surgery University of Michigan Dr. Hemmila[/caption] Dr. Mark R. Hemmila MD Associate Professor of Surgery Division of Acute Care Surgery University of Michigan  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Traumatic injury has a tendency to be thought of as a disease that preferentially impacts younger people.  We wanted to explore the prevalence and impact of traumatic injury within the population of patients for whom Medicare is the third party payer. 
Author Interviews, Cost of Health Care, JAMA / 22.05.2019

MedicalResearch.com Interview with: [caption id="attachment_49269" align="alignleft" width="150"]Dan LyPh.D. Program in Health PolicyHarvard Dan Ly[/caption] Dan Ly, MD, MPP Ph.D. Program in Health Policy Harvard MedicalResearch.com: What is the background for this study? Response: There is some mixed evidence regarding whether state level tort reform reduces defensive medicine, or the practicing of medicine in such a way to reduce medical liability. This includes “positive” defensive medicine, or performing certain tests and procedures to reduce such liability. Other research finds that the perception of malpractice risk drives such defensive medicine, including the use of diagnostic imaging, such as CT scans and MRIs. I was interested in exploring what influenced the perception of this risk, hypothesizing that, for a physician, a report of an injury against one’s colleague might increase the perception of this risk and lead to an increase the use of diagnostic imaging.
Author Interviews, Cancer Research, Cost of Health Care, JAMA / 19.05.2019

MedicalResearch.com Interview with: [caption id="attachment_49162" align="alignleft" width="191"]Nina Niu Sanford, M.D. Assistant ProfessorUT Southwestern Department of Radiation OncologyDallas TX 75390 Dr. Sanford[/caption] Nina Niu Sanford, M.D.  Assistant Professor UT Southwestern Department of Radiation Oncology Dallas TX 75390  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The background for this study is that we know cancer survivors are at risk for uninsurance or underinsurance and the most commonly cited reason for this is cost of insurance.  However, there have been no prior studies assessing from the patient perspective the reasons for not having insurance. In addition, there has been further recent controversy over the Affordable Care Act, including threats from the current administration to dismantle it.  Thus assessing the impact of the ACA among at risk populations including cancer survivors is timely.
Author Interviews, Cost of Health Care, Kidney Disease, UCLA / 14.05.2019

MedicalResearch.com Interview with: [caption id="attachment_49111" align="alignleft" width="200"]Chris Childers, MD, PhDDivision of General SurgeryDavid Geffen School of Medicine at UCLA10833 Le Conte Ave., CHS 72-247Los Angeles, CA 90095 Dr. Childers[/caption] Chris Childers, MD, PhD Division of General Surgery David Geffen School of Medicine at UCLA Los Angeles, CA 90095 MedicalResearch.com: What is the background for this study? Response: Patients with end-stage renal disease – poorly functioning kidneys – often have to receive dialysis. This typically requires a patient to visit an outpatient clinic several times a week to have their blood filtered by a machine. Over the past few years, two for-profit companies have increased their control over the outpatient dialysis market – DaVita and Fresenius. Combined they control approximately ¾ of the market.  A number of concerns have been raised against these for-profit companies suggesting that the quality of care they deliver may be worse than the care delivered at not-for-profit companies. But, because they control so much of the market and because patients have to receive dialysis so frequently, patients may not have much choice in the clinic they visit. Medicare covers patients who are 65 years or older and also patients on dialysis regardless of age.  Medicare pays a fixed rate for dialysis which they believe is adequate to cover the clinics' costs. However, if a patient also has private insurance, the insurer is required to pay for dialysis instead of Medicare. Whereas Medicare rates are fixed by the federal government, private insurers have to negotiate the price they pay, and may pay much more as a result.
Author Interviews, Cost of Health Care, Radiation Therapy / 23.04.2019

MedicalResearch.com Interview with: [caption id="attachment_48748" align="alignleft" width="133"]Ankit Agarwal, MD, MBAPGY-3, Radiation Oncology ResidentUNC Health Care Dr. Agarwal[/caption] Ankit Agarwal, MD, MBA PGY-3, Radiation Oncology Resident UNC Health Care MedicalResearch.com: What is the background for this study? What are the main findings? Response: Medicaid provides vital health insurance for millions of mostly low income Americans throughout the United States. However, it is well known that patients with Medicaid have worse clinical outcomes than patients with private insurance or Medicare insurance. Part of the reason for this may be due to difficulties with access to care, in part due to the traditionally very low payments in the Medicaid system. We found that Medicaid payment rates for a standard course of breast cancer radiation treatment can vary over fivefold (ranging from $2,945 to $15,218) 
Author Interviews, Cost of Health Care, Hospital Readmissions, JAMA, Outcomes & Safety / 16.04.2019

MedicalResearch.com Interview with: [caption id="attachment_48537" align="alignleft" width="145"]Karen Joynt Maddox, MD, MPHAssistant Professor of MedicineWashington University Brown School of Social Work Dr. Joynt Maddox[/caption] Karen Joynt Maddox, MD, MPH Assistant Professor of Medicine Washington University Brown School of Social Work  MedicalResearch.com: What is the background for this study? Response: Medicare’s Hospital Readmissions Reduction Program has been controversial, in part because until 2019 it did not take social risk into account when judging hospitals’ performance. In the 21st Century Cures Act, Congress required that CMS change the program to judge hospitals only against other hospitals in their “peer group” based on the proportion of their patients who are poor. As a result, starting with fiscal year 2019, the HRRP divides hospitals into five peer groups and then assesses performance and assigns penalties. 
Author Interviews, Cost of Health Care, Opiods / 16.04.2019

MedicalResearch.com Interview with: [caption id="attachment_48576" align="alignleft" width="92"]Joel Segel, Ph.D.Assistant ProfessorDepartment of Health Policy and AdministrationThe Pennsylvania State UniversityUniversity Park, PA 16802 Dr. Segel[/caption] Joel E. 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? What are the main findings?  Response: Earlier research has shown that the societal costs of opioid misuse are high, including the impact on employment. However, previous work to understand the costs of opioid misuse borne by state and federal governments has largely focused on medical costs such as care related to overdoses and the cost of treating opioid use disorder. Our main findings are that when individuals who misuse opioids are unable to work, state and federal governments may bear significant costs in the form of lost income and sales tax revenue. We estimate that between 2000 and 2016, state governments lost $11.8 billion in tax revenue and the federal government lost $26.0 billion. 
Author Interviews, Cost of Health Care, General Medicine, Hospital Readmissions, JAMA, Race/Ethnic Diversity / 02.04.2019

MedicalResearch.com Interview with: [caption id="attachment_48340" align="alignleft" width="142"]Teryl K. Nuckols, MDVice Chair, Clinical ResearchDirector, Division of General Internal MedicineCedars-Sinai Medical Center  Dr. Nuckols[/caption] Teryl K. Nuckols, MD Vice Chair, Clinical Research Director, Division of General Internal Medicine Cedars-Sinai Medical Center  MedicalResearch.com: What is the background for this study?   Response: Healthcare policymakers have long worried that value-based payment programs unfairly penalize hospitals treating many African-American patients, which could worsen health outcomes for this group. For example, policy experts have suspected that the Medicare Hospital Readmission Reduction Program unevenly punishes institutions caring for more vulnerable populations, including racial minorities. They've also feared that hospitals might be incentivized to not give patients the care they need to avoid readmissions. The study Investigators wanted to determine whether death rates following discharges increased among African-American and white patients 65 years and older after the Medicare Hospital Readmission Reduction Program started.
Author Interviews, Cost of Health Care, UCLA / 27.03.2019

MedicalResearch.com Interview with: [caption id="attachment_37423" align="alignleft" width="200"]John N. Mafi MPH Assistant Professor of Medicine David Geffen School of Medicine University of California, Los Angeles Natural scientist in Health Policy RAND Corporation Santa Monica, California Dr. Mafi[/caption] John N. Mafi, MD, MPH Division of General Internal Medicine and Health Services Research Department of Medicine David Geffen School of Medicine at UCLA RAND Health, RAND Corporation MedicalResearch.com: What is the background for this study? What types of services are low-value in this setting?  Response: For decades we have known that offering routine preoperative testing for patients undergoing cataract surgery provides limited value, yet low-value preoperative testing persists at very high rates, even at Los Angeles County Department of Health Services, one of the largest safety net health systems in the United States.
Author Interviews, Cost of Health Care, Gastrointestinal Disease, Opiods / 12.03.2019

MedicalResearch.com Interview with: [caption id="attachment_47904" align="alignleft" width="133"]Howard Franklin, MD, MBAVice President of Medical Affairs and StrategySalix Pharmaceuticals Dr. Franklin[/caption] Howard Franklin, MD, MBA Vice President of Medical Affairs and Strategy Salix Pharmaceuticals MedicalResearch.com: What is opioid-induced constipation? Response: Opioid-induced constipation (OIC) is a side effect in as many as 80 percent of chronic pain patients on opioids. OIC is unlikely to improve over time without treatment and can lead to suffering and discomfort. More importantly, the insufficient treatment of OIC can have negative implications for patients, both those on opioid therapy for chronic non-cancer pain as well as advanced illness, and for hospitals. 
Author Interviews, Cost of Health Care, Kidney Disease, Medicare, Transplantation / 07.03.2019

MedicalResearch.com Interview with: [caption id="attachment_47825" align="alignleft" width="100"]Allyson Hart MD MSDepartment of Medicine, Hennepin Healthcare,University of MinnesotaMinneapolis, Minnesota Dr. Hart[/caption] Allyson Hart MD MS Department of Medicine, Hennepin Healthcare, University of Minnesota Minneapolis, Minnesota MedicalResearch.com: What is the background for this study? What are the main findings? Response: Kidney transplantation confers profound survival, quality of life, and cost benefits over dialysis for the treatment of end-stage kidney disease. Kidney transplant recipients under 65 years of age qualify for Medicare coverage following transplantation, but coverage ends after three years for patients who are not disabled. We studied 78,861 Medicare-covered kidney transplant recipients under the age of 65, and found that failure of the transplanted kidney was 990 percent to 1630 percent higher for recipients who lost Medicare coverage before this three-year time point compared with recipients who lost Medicare on time. Those who lost coverage after 3 years had a lesser, but still very marked, increased risk of kidney failure. Recipients who lost coverage before or after the three-year time point also filled immunosuppressive medications at a significantly lower rate than those who lost coverage on time.
Author Interviews, Cost of Health Care, JAMA, Outcomes & Safety / 01.03.2019

MedicalResearch.com Interview with: [caption id="attachment_47659" align="alignleft" width="150"]Mr. Tim Badgery-Parker ELS, BSc(Hons), MBiostatResearch Fellow,Value in Health Care Division,Menzies Centre for Health Policy Mr. Badgery-Parker[/caption] Mr. Tim Badgery-Parker ELS, BSc(Hons), MBiostat Research Fellow,Value in Health Care Division Menzies Centre for Health Policy MedicalResearch.com: What is the background for this study? Response: This is part of a large program of work at the Menzies Centre for Health Policy on low-value care in the Australian health system. We have previously published rates of low-value care in public hospitals in Australia’s most populous state, New South Wales, and a report on rates in the Australian private health insurance population is due for publication shortly. We have also done similar analyses for other Australian state health systems. This particular paper extends the basic measurement work to focus on what we call the ‘cascade’ effects. That is, looking beyond how much low-value care occurs to examine the consequence for patients and the health system of providing these low-value procedures.
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA, Surgical Research, Weight Research / 24.02.2019

MedicalResearch.com Interview with: [caption id="attachment_47635" align="alignleft" width="125"]Jagpreet Chhatwal PhDAssistant Professor, Harvard Medical SchoolSenior Scientist, Institute for Technology AssessmentMassachusetts General Hospital Dr. Jagpreet Chhatwal[/caption] Jagpreet Chhatwal PhD Assistant Professor, Harvard Medical School Senior Scientist, Institute for Technology Assessment Massachusetts General Hospital [caption id="attachment_47636" align="alignleft" width="125"]Chin Hur, MDAssociate Professor of MedicineHarvard Medical School Dr. Chin Hur[/caption] Chin Hur, MD Associate Professor of Medicine Harvard Medical School       MedicalResearch.com: What is the background for this study? Response: Nonalcoholic steatohepatitis (NASH), a severe form of nonalcoholic fatty liver disease, is one of the leading causes of liver transplantation. Because of increasing prevalence of obesity in the United States, NASH-related cirrhosis cases are expected to increase in the near future. Unfortunately, there are few pharmacological treatments for NASH, and none with proven long-term benefit. Weight loss can be effective in managing NASH but not many patients can lose the sufficient weight necessary to impact NASH and/or maintain long-term weight loss. In contrast, bariatric surgery can provide long-term weight loss and thus potentially reverse liver damage in cirrhosis. However, bariatric surgery is associated with mortality and morbidity associated with the procedure.
Author Interviews, Cost of Health Care, JAMA, Pharmacology / 21.02.2019

MedicalResearch.com Interview with: [caption id="attachment_47591" align="alignleft" width="150"]Jennifer N. Goldstein, MD, MSc Assistant  program Director of Internal Medicine Christiana Care Health System Newark, Delaware Dr. Goldstein[/caption] Jennifer N. Goldstein, MD, MSc Assistant  program Director of Internal Medicine Christiana Care Health System Newark, Delaware MedicalResearch.com: What is the background for this study? Response: Human synthetic insulins have been available over-the-counter for nearly a century, and at relatively low cost for around a decade under a Walmart brand name. However, little is known about  the frequency of sale of over-the-counter insulin or the reasons why patients use it. While prescription insulins (insulin analogues) are considered by many to be easier to use and more predictable than the over-the-counter versions, the cost of these insulins has skyrocketed. Our study examined the frequency of sale of over-the-counter insulins and whether patients potentially use over-the-counter insulin as a substitute for expensive prescription insulins.
Author Interviews, Cost of Health Care, JAMA, Pharmacology, University of Pittsburgh / 19.02.2019

MedicalResearch.com Interview with: [caption id="attachment_47508" align="alignleft" width="150"]Alvaro San-Juan-Rodriguez Alvaro San-Juan-Rodriguez[/caption] Alvaro San-Juan-Rodriguez, PharmD Pharmacoeconomics, Outcomes and Pharmacoanalytics Research Fellow Pharmacy and Therapeutics School of Pharmacy University of Pittsburgh MedicalResearch.com: What is the background for this study? Response: Before 2009, etanercept (Enbrel®), infliximab (Remicade®), and adalimumab (Humira®) were the only tumor necrosis factor (TNF) inhibitors approved by the FDA for rheumatoid arthritis. Subsequently, 3 therapies gained FDA approval: subcutaneous golimumab (Simponi®) in April 2009, certolizumab pegol (Cimzia®) in May 2009, and intravenous golimumab (Simponi Aria®) in July 2013. All 6 agents are brand-name drugs. Our study aimed to evaluate how the prices of existing TNF inhibitors (Enbrel®, Remicade® and Humira®) changed in response to the market entry of new TNF inhibitors. 
Author Interviews, Cost of Health Care, Critical Care - Intensive Care - ICUs, Health Care Systems, Hospital Acquired, JAMA, Urinary Tract Infections / 06.02.2019

MedicalResearch.com Interview with: [caption id="attachment_47312" align="alignleft" width="184"]Heather Hsu, MD MPH Assistant Professor of Pediatrics Boston University School of Medicine Boston Medical Center Boston, MA 02118 Dr. Hsu[/caption] Heather Hsu, MD MPH Assistant Professor of Pediatrics Boston University School of Medicine Boston Medical Center Boston, MA 02118 MedicalResearch.com: What is the background for this study? What are the main findings?  Response: In October 2013, the Centers for Medicare and Medicaid Services (CMS) implemented value-based incentive programs to financially reward or penalize hospitals based on quality metrics. Two of these programs – Hospital Value Based Purchasing and the Hospital Acquired Condition Reduction Program – began targeting hospitals’ rates of certain healthcare-associated infections deemed to be preventable in October 2015. Previous studies demonstrated minimal impact of these value-based payment programs on other measures of hospital processes, patient experience, and mortality. However, their impact on healthcare-associated infections was unknown. Our goal was to study the association of value-based incentive program implementation with healthcare-associated infection rates, using catheter-associated urinary tract infection in intensive care units (one of the targeted outcomes) as an example. We found no evidence that federal value-based incentive programs had any measurable association with changes in catheter-associated urinary tract infection rates in the critical care units of US hospitals.
Author Interviews, Cost of Health Care / 28.01.2019

MedicalResearch.com Interview with: [caption id="attachment_47034" align="alignleft" width="200"]Sean Dickson, JD MPH Officer, Drug Spending Research Initiative The Pew Charitable Trusts Washington, DC 20004 Sean Dickson, JD MPH[/caption] Sean Dickson, JD MPH Officer, Drug Spending Research Initiative The Pew Charitable Trusts Washington, DC 20004 MedicalResearch.com: What is the background for this study? Response: Price increases on existing drugs are an ongoing challenge for patients and insurers, including government programs like Medicaid and Medicare. The Medicaid program requires drug manufacturers to provide a rebate that offsets price increases greater than inflation, but that rebate is capped once price increases exceed 433 percent above inflation. When these rebates are capped, manufacturers may find it more profitable to take very large price increases, raising costs for all payers. The Medicaid program has proposed removing the cap, and this study considers the effects of that proposal. 
Author Interviews, Cancer Research, Cost of Health Care / 21.01.2019

MedicalResearch.com Interview with: [caption id="attachment_47059" align="alignleft" width="200"]Zhiyuan "Jason" Zheng PhD Director, Economics and Healthcare Delivery Research American Cancer Society, Inc. Atlanta, GA 30303 Dr. Zheng[/caption] Zhiyuan "Jason" Zheng PhD Director, Economics and Healthcare Delivery Research American Cancer Society, Inc. Atlanta, GA 30303 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Historically, the cost of healthcare can be a substantial burden for cancer survivors and their families in the US. Even with health insurance, a cancer diagnosis can impose significant out-of-pocket costs for medical care.  These are partially due to the rising costs of cancer treatments in recent years, moreover, the increasing levels of coinsurance, copayments, and deductibles also shift a significant portion of the burden to cancer patients. We found that younger cancer survivors, those aged 18-49 years, bear a higher burden than their older counterparts. We also found that two-thirds of cancer survivors enrolled in high-deductible health plans did not have health savings accounts, and they are more vulnerable to financial hardship than those in high-deductible health plans with health savings accounts and those covered by low-deductible plans. These findings are important to patients because although cancer patents have benefited from newer and more advanced treatments, financial hardship may lead to emotional distress, cause changes in health behaviors, and jeopardize treatment adherence and health outcomes. 
Author Interviews, Cost of Health Care, Heart Disease, Inflammation, JAMA, Stanford / 17.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46992" align="alignleft" width="150"]Thomas S. G. Sehested MD Department of Cardiology Copenhagen University Hospital Gentofte Dr. Sehested[/caption] Thomas S. G. Sehested MD Department of Cardiology Copenhagen University Hospital Gentofte [caption id="attachment_46991" align="alignleft" width="150"]Jenny Bjerre, MD Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Copenhagen, Denmark Department of Health Research and Policy Stanford University School of Medicine Stanford, California Dr. Bjerre[/caption]   Jenny Bjerre, MD Department of Cardiology Copenhagen University Department of Health Research and Policy Stanford University School of Medicine Stanford, California   MedicalResearch.com: What is the background for this study? Response: n 2017, the results from the much-awaited Canakinumab Anti-inflammatory Thrombosis Outcome Study (CANTOS) trial were published, confirming the inflammatory hypothesis, i.e. that targeting inflammation can reduce cardiovascular disease. The trial tested the monoclonal antibody canakinumab in a population of post-myocardial infarction patients with elevated inflammation markers (hs-CRP). Canakinumab is currently used for rare diseases and carries an orphan drug price: the 150mg dose used in CANTOS costs approximately $73,000 per year. Due to the high prevalence of cardiovascular disease, millions of patients could potentially be eligible for treatment with this high-priced anti-inflammatory drug. Therefore, we wanted to investigate the cost-effectiveness for canakinumab for secondary prevention of cardiovascular disease, using the reported results from CANTOS.
Author Interviews, Cost of Health Care, Dartmouth, JAMA, Pharmaceutical Companies / 09.01.2019

MedicalResearch.com Interview with: Steven Woloshin, MD, MS Professor Co-director of the Center for Medicine and Media The Dartmouth InstituteSteven Woloshin, MD, MS Professor Co-director of the Center for Medicine and Media The Dartmouth Institute MedicalResearch.com: What is the background for this study? What are the main findings? What influence does medical marketing have on medical care and drug prices? Response: There are published studies looking at promotional spending mostly for drugs (DTC and professional).  This paper is unique because it is such a broad look including not just drugs but also marketing of disease (in "awareness campaigns"), health services and laboratory tests. What is new here is the size and scope of marketing.  For context, $29.9 billion spent on promoting prescription drugs, disease awareness campaigns, health services, and laboratory tests corresponds approximately to $1000 per American.    For context, FDA's total budget is around $5 billion – and NIH's total budget is about $30 billion. This figure is up from $17.7 billion in 1997, with the most rapid increase in DTC promotion of prescription drugs and health services.   Pharmaceutical marketing to professionals (detailing visits and samples) accounted for most spending and remained high despite policies to limit industry influence. $30 billion is of an underestimate (egg, we did not include monies spent on professional marketing (detailing) of laboratory tests, health services or devices, the value of drug coupons/discounts/rebates, company marketing budgets, lobbying or campaign contributions). Further it is just the tip of the iceberg – marketing works so promotional spending is an important driver of why medical care is so expensive:  it leads to more – and more expensive - tests and treatments.
Author Interviews, Cancer Research, Cost of Health Care, JAMA / 08.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46845" align="alignleft" width="200"]Kiu Tay-Teo, PhD World Health Organization Geneva, Switzerland Dr. Kiu Tay-Teo[/caption] Kiu Tay-Teo, PhD World Health Organization Geneva, Switzerland MedicalResearch.com: What are the main findings? Response: High costs and high risks of R&D for drugs have been presented to justify high drug prices, especially for cancer drugs. However, it is unclear whether prices are in fact justifiable compared to the overall return on R&D investment. In this paper, we systematically compared incomes from the sales of cancer drugs with the R&D costs. We quantified the incomes generated from the sales of 99 cancer drugs approved by FDA from 1989–2017. This was based on sales figures reported in the originator companies’ annual financial reports, and where necessary, estimates deduced from the reported figures. The sales incomes were net of rebates and discounts, but without accounting for expenses and taxes. For the R&D costs of bringing one new cancer drug to the market, the literature reported a typical costs of between $219 million and $2.9 billion, after accounting for the costs of failed products that were investigated but not marketed and the opportunity costs. For the main analysis, we used a median cost of $794 million, as reported in the literature. To be clear, this analysis did not estimate profit return because we do not have information about the costs and year-to-year variations in costs (i.e. expenses and taxes) specific to cancer drugs.
Author Interviews, Cost of Health Care, University of Pittsburgh / 08.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46836" align="alignleft" width="132"]MedicalResearch.com Interview with: Inmaculada Hernandez, PharmD, PhD Assistant Professor of Pharmacy and Therapeutics University of Pittsburgh School of Pharmacy Dr. Hernandez[/caption] Inmaculada Hernandez, PharmD, PhD Assistant Professor of Pharmacy and Therapeutics University of Pittsburgh School of Pharmacy MedicalResearch.com: What is the background for this study? What are the main findings? Response: The objective of our study was to answer a research question of high policy relevance: to what extent are rising drug costs due to inflation in the prices of existing products versus the market entry of new, more expensive drugs. We found that rising prices of brand-name drugs are largely driven by manufacturers increasing prices of medications that are already in the market rather than to the entry of new products. In contrast, increases in costs of specialty and generic drugs were driven by the entry of new drugs.
Annals Internal Medicine, Author Interviews, Beth Israel Deaconess, Cost of Health Care, Heart Disease, Lipids / 02.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46753" align="alignleft" width="150"]Dhruv S. Kazi, MD, MSc, MS Associate Directo Richard A. and Susan F. Smith Center for Outcomes Research Boston MA 02215 Associate Director Cardiac Critical Care Unit Beth Israel Deaconess Medical Center Dr. Kazi[/caption] Dhruv S. Kazi, MD, MSc, MS Associate Director Richard A. and Susan F. Smith Center for Outcomes Research Boston MA 02215 Associate Director Cardiac Critical Care Unit Beth Israel Deaconess Medical Center  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The ODYSSEY Outcomes trial found that addition of alirocumab to statin therapy reduces the incidence of a composite of cardiovascular death, myocardial infarction, and stroke among patients with a recent history of a myocardial infarction and elevated low-density lipoprotein cholesterol. We modeled the cost-effectiveness of alirocumab and found that, at the March 2018 price of the drug, it would not be cost-effective (either relative to statin alone or statin + ezetimibe) for this indication. We found that a large price-reduction would be required to meet the cost-effectiveness threshold of $100,000 per quality-adjusted life year. Shortly after the preliminary findings of this study were released, both manufacturers of PCSK9 inhibitors announced large price reductions in order to improve access to these drugs.
Alzheimer's - Dementia, Author Interviews, Cost of Health Care, JAMA / 27.12.2018

MedicalResearch.com Interview with: [caption id="attachment_46720" align="alignleft" width="200"]Lee A. Jennings, MD, MSHS Assistant Professor of Medicine Director, Oklahoma Healthy Aging Initiative Reynolds Department of Geriatric Medicine University of Oklahoma Health Sciences Center Oklahoma City, OK 73117 Dr. Jennings[/caption] Lee A. Jennings, MD, MSHS Assistant Professor of Medicine Director, Oklahoma Healthy Aging Initiative Reynolds Department of Geriatric Medicine University of Oklahoma Health Sciences Center Oklahoma City, OK 73117 MedicalResearch.com: What is the background for this study? Response: The research study focused on a novel model of care for persons living with Alzheimer’s disease and other types of dementia, the UCLA Alzheimer’s and Dementia Care Program. In the program, people with dementia and their caregivers meet with a nurse practitioner specializing in dementia care for a 90-minute in-person assessment and then receive a personalized dementia care plan that addresses the medical, mental health and social needs of both people. The nurse practitioners work collaboratively with the patient’s primary care provider and specialist physicians to implement the care plan, including adjustments as needs change over time. The research was designed to evaluate the costs of administering the program, as well as the health care services used by program participants, including hospitalizations, emergency room visits, hospital readmissions and long-term nursing home placement. A total of 1,083 Medicare beneficiaries with dementia were enrolled in the program and were followed for three years. The study compared them to a similar group of patients living in the same ZIP codes who did not participate in the program.
Author Interviews, Cost of Health Care, JAMA, Kidney Disease, UCSF / 27.12.2018

MedicalResearch.com Interview with: [caption id="attachment_46717" align="alignleft" width="155"]Oanh Kieu Nguyen, MD, MA Assistant Professor Division of Hospital Medicine Zuckerberg San Francisco General Hospital UCSF Dr. Nguyen[/caption] Oanh Kieu Nguyen, MD, MA Assistant Professor Division of Hospital Medicine Zuckerberg San Francisco General Hospital UCSF MedicalResearch.com: What is the background for this study? Response: In U.S. citizens and permanent residents with kidney failure or end-stage renal disease (ESRD), having health insurance, Medicare, or Medicaid guarantees access to regularly scheduled hemodialysis 2-3 times per week, the evidence-based standard of care for ESRD. This treatment helps people live relatively normal lives. In 40 of 50 U.S. states, undocumented immigrants with ESRD have limited access to hemodialysis because they are not eligible for any form of federal assistance including Medicare or Medicaid, and must wait until they are life-threateningly ill to receive dialysis through a hospital emergency department, a situation called “emergency-only hemodialysis.” There are an estimated 6,500 undocumented individuals in the U.S. suffering from ESRD. A unique opportunity made it feasible for uninsured undocumented immigrants with ESRD receiving emergency-only dialysis in Dallas, Texas, to enroll in private, commercial health insurance plans in 2015 and made it possible for researchers to compare scheduled vs. emergency-only dialysis among undocumented immigrants with ESRD. This natural experiment included 181 undocumented immigrants, 105 of whom received insurance coverage and enrolled in scheduled dialysis and 76 of whom remained uninsured.