Cost of Health Care
03 Oct Coordination Program Reduced ER Visits and Readmissions in Medicaid Population
Posted at 20:59h
in Author Interviews, Cost of Health Care, Emergency Care, Health Care Systems, Hospital Readmissions, Primary Care
MedicalResearch.com Interview with:
[caption id="attachment_37314" align="alignleft" width="134"]
Dr. Capp[/caption]
Roberta Capp MD
Assistant Professor
Director for Care Transitions in the Department of Emergency Medicine
University of Colorado School of Medicine
Medical Director of Colorado Access Medicaid
Aurora Colorado
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Medicaid clients are at highest risk for utilizing the hospital system due to barriers in accessing outpatient services and social determinants.
We have found that providing care management services improves primary care utilization, which leads to better chronic disease management and reductions in emergency department use and hospital admissions.
03 Oct Does Brand Name 17P Work Better Than Generic In Reducing Preterm Births?
Posted at 11:55h
in Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA, OBGYNE
MedicalResearch.com Interview with:
[caption id="attachment_37260" align="alignleft" width="125"]
Dr. Beam[/caption]
Andrew L. Beam, PhD
Instructor in Biomedical Informatics
Department of Biomedical Informatics
Harvard Medical School
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: This study is one piece of a larger story regarding the use of 17-alpha-hydroxyprogesterone caproate (17P) to treat recurrent preterm birth. This drug was originally only available in a compounded form, but since receiving an orphan drug designation in 2011, a branded and manufactured form was marketed under the name "Makena". This branded form was then sold for a much higher price than the compounded version, but a study that provided concrete data on pricing and outcomes had not been done.
02 Oct Financial Incentives to Physicians Did Not Increase Hospital Discharge Follow-Up Visits
Posted at 19:13h
in Author Interviews, CMAJ, Cost of Health Care, Health Care Systems, Hospital Readmissions
MedicalResearch.com Interview with:
[caption id="attachment_37278" align="alignleft" width="125"]
Dr. Lapointe-Shaw[/caption]
Dr. Lauren Lapointe-Shaw, MD
Physician at University Health Network
Department of Medicine
University of Toronto
MedicalResearch.com: What is the background for this study?
Response: Readmissions after hospital discharge are common and costly. We would like to reduce these as much as possible. Early physician follow-up post hospital discharge is one possible strategy to reduce readmissions. To this end, incentives to outpatient physicians for early follow-up have been introduced in the U.S. and Canada. We studied the effect of such an incentive, introduced to Ontario, Canada, in 2006.
27 Sep Participation in SNAP Food Assistance Linked To Lower Health Care Costs
Posted at 22:07h
in Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA, Nutrition
MedicalResearch.com Interview with:
[caption id="attachment_37208" align="alignleft" width="125"]
Dr. Berkowitz[/caption]
Seth A. Berkowitz, MD, MPH
Division of General Internal Medicine
Diabetes Population Health Unit
Harvard Medical School
Massachusetts General Hospital, Boston
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There is ever growing pressure to contain healthcare costs in the US. Increasingly, attention is turning to programs that address social determinants of health--that is, those factors which affect health but lie outside the realm of clinical medicine.
Prior research has highlighted food insecurity as having a clear association with poor health and higher healthcare costs. SNAP is the nation's largest program to combat food insecurity. However, we did not know whether SNAP participation would be associated with any difference in healthcare costs, compared with eligible non-participants.
This study found that participating in SNAP was associated with approximately $1400 lower healthcare expenditures per year in low-income adults.
12 Sep Global Budget in Maryland Saved Medicare Money By Limiting Hospital Costs
MedicalResearch.com Interview with:
Susan G. Haber, Sc.D.
Director, Health Coverage for Low-Income and Uninsured Populations
RTI International
Waltham, MA 02452-8413
MedicalResearch.com: What is the background for this study?
Response: In 2014, the state of Maryland and the federal Centers for Medicare and Medicaid Services (CMS) began testing an alternative payment structure for inpatient and outpatient hospital services. Known as the All-Payer Model, the new system limits hospitals’ revenues from Medicare, Medicaid, and private insurers to a global budget for the year. This builds on Maryland’s hospital rate-setting system that had operated since the 1970s, where all payers pay the same rates. CMS wanted to test whether global budgets could help Maryland limit cost growth and reduce avoidable hospital use. The goal of the model is to limit per capita total hospital cost growth for both Medicare and all payers and to generate $330 million in Medicare savings over 5 years.
06 Sep Morbidity and Financial Costs of Atrial Fibrillation High and Likely to Grow
MedicalResearch.com Interview with: [caption id="attachment_36808" align="alignleft" width="200"]
Dr. Sandra Jackson[/caption]
Sandra L. Jackson, PhD
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
Chamblee GA
MedicalResearch.com: What is the background for this study?
Response: People who have atrial fibrillation are at increased risk for having a heart attack or stroke. While we know that the percentage of the population with atrial fibrillation is increasing in the US, there is no national surveillance system to track the burden of emergency department visits, hospitalizations and deaths related to atrial fibrillation across all ages and health insurance provider types. This study combined data from the Healthcare Cost and Utilization Project and the National Vital Statistics System to provide national estimates for atrial fibrillation-related healthcare service use and deaths from 2006-2014.
25 Aug Oropharyngeal Cancer Rising In Incidence and Costs to Over $140,000
MedicalResearch.com Interview with: [caption id="attachment_36569" align="alignleft" width="153"]
Dr. Lairson[/caption]
David R. Lairson, PhD
Professor of health economics
Department of Management, Policy, and Community Health
The University of Texas Health Science Center at Houston (UTHealth) School of Public Health
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The study of oropharyngeal cancer treatment cost was initiated by the Head and Neck Cancer Surgery Department at the University of Texas MD Anderson Cancer Center as part of a larger study of the economic and health consequences of human papillomavirus (HPV) related conditions in Texas. State specific information is required for policy-makers to consider future investments in cancer prevention based on HPV immunization and cancer screening. The cost estimates at $140,000 per case for the first two years of treatment are substantially higher than previous estimates. They indicate the potential savings associated with cancer prevention and partially justify increased investment in immunization efforts.
16 Aug Medicaid Patients May Not Have Access to IVIG for Autoimmune Blistering Diseases
MedicalResearch.com Interview with: Kyle T. Amber, MD Department of Dermatology UC Irvine Health Irvine, CA 92697-2400 MedicalResearch.com: What is the background for this study? What are the main findings? Response: The use of IVIg has been shown in randomized controlled trials to be safe and highly effective in the treatment of both pemphigus and bullous pemphigoid. Despite its efficacy, its cost remains a deterrent to its use. Cost studies in the United States point towards IVIg being an overall cost-saving therapy in the treatment of Autoimmune Blistering Diseases when compared to traditional immunosuppressive treatment due to the decrease in associated infections, complications, and hospitalizations.11 Aug Financial Distress Common Among Cancer Patients, Especially Underinsured
MedicalResearch.com Interview with: [caption id="attachment_36369" align="alignleft" width="150"]
Dr. Chino[/caption]
Dr. Fumiko Chino, MD
Duke Radiation Oncology
Duke School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The financial burden of cancer treatment is a growing concern. Out-of-pocket expenses are higher for patients with cancer than for those who have other chronic illnesses. Fifty percent of elderly cancer patients spend at least 10% of their income on treatment-related out-of-pocket expenses. Additionally, high financial burden is associated with both increased risk of poor psychological well-being and worse health-related quality of life. A cancer diagnosis has been shown to be an independent risk factor for declaring personal bankruptcy, and cancer patients who declare personal bankruptcy are at greater risk for mortality. These potentially harmful outcomes resulting from financial burden have been recognized as the financial toxicity of cancer therapy, analogous to the more commonly considered physical toxicity.
We conducted an IRB approved study of financial distress and cost expectations among patients with cancer presenting for anti-cancer therapy. In this cross-sectional, survey based study of 300 patients, over one third of patients reported higher than expected financial burden. Cancer patients with highest financial distress are underinsured, paying nearly 1/3 of income in cancer-related costs. In adjusted analysis, experiencing higher than expected financial burden was associated with high/overwhelming financial distress (OR 4.78; 95% CI 2.02-11.32; p<0.01) and with decreased willingness to pay for cancer care (OR 0.48, 95% CI 0.25-0.95, p=0.03). Sambla, a Scandinavian lender, has been working with many patients to prevent any financial distress resulting from unexpected medical bills. As a result of customer feedback, it has modified the terms of all loans it issues to allow for jumbo loan sizes and reduced interest rates, combined with longer repayment times to help its borrowers.
07 Aug Patients With Social Risks Are More Expensive and Require Greater Medicaid Resources
MedicalResearch.com Interview with: [caption id="attachment_36342" align="alignleft" width="143"]
Dr. Ash[/caption]
Arlene S. Ash, PhD
Department of Quantitative Health Sciences
University of Massachusetts Medical School
Worcester
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: State Medicaid programs (and other health care purchasers) often contract with several managed care organizations, each of which agrees to address all health care needs for some of their beneficiaries. Suppose a Medicaid program has $5000 to spend, on average, for each of its 1 million beneficiaries. How much should they pay health plan “A” for the particular 100,000 beneficiaries it enrolls? If some group, such as those who are homeless, is much more expensive to care for than the payment, plans that try to provide good care for many such people will go broke. We describe the model now used by MassHealth to ensure that plans get more money for enrolling patients with greater medical and social needs. In this medical-social model, about 10% of total dollars is allocated by factors other than the medical-morbidity risk score.
07 Aug Even After Rebates, Use of PCSK9 Inhibitor Would Still Cost Over $5 Million To Prevent One Stroke
MedicalResearch.com Interview with: [caption id="attachment_36336" align="alignleft" width="132"]
Dr. Hernandez[/caption]
Inmaculada Hernandez, PharmD, PhD
Assistant Professor of Pharmacy and Therapeutics
University of Pittsburgh School of Pharmacy
Pittsburgh, PA 1526
MedicalResearch.com: What is the background for this study?
Response: A few months ago, the results of the FOURIER trial were published. This trial was the first one to evaluate the efficacy of PCSK9 inhibitors in the prevention of cardiovascular events, since the approval of these agents was based on trials that evaluated their efficacy in reducing levels of LDL-C. The results of the FOURIER trial did not meet the expectations generated by prior studies that had simulated how much the risk of cardiovascular events should decrease based on the observed reduction in LDL-C levels. A few hours after the publication of the results of the FOURIER trial, Amgen (evolocumab´s manufacturer) announced that it would be willing to engage in contracts where the cost of evolocumab would be refunded for those patients who suffer a heart attack or a stroke while using the drug.
31 Jul Disruptions In Medicaid Coverage For Depression Linked To Increased ER Visits
MedicalResearch.com Interview with: Xu Ji PhD Candidate Emory University Department of Health Policy and Management Rollins School of Public Health Emory University Atlanta, GA What is the background for this study? What are the main findings? Response: Gaps in Medicaid coverage (sometimes called “churning”) can disrupt ongoing outpatient care needed to manage chronic conditions, such as depression, and trigger use of emergency care. This study examined how disruptions in Medicaid coverage impacted acute care use—specifically emergency department visits and hospital stays—in nearly 140,000 adults treated for major depression. We found that those with disruptions in Medicaid coverage were more likely to have emergency department visits and longer hospital stays when they went back on Medicaid compared to those with continuous coverage. We also found that disruptions in Medicaid coverage occurred less frequently for Medicaid enrollees with depression in states requiring only yearly recertification (i.e., more streamlined re-enrollment procedures) than those in states that required recertification every six months or more frequently (i.e., more stringent procedures). Eligibility recertification usually requires enrollees to visit the social welfare office to provide income or other documentation to prove eligibility. Failure to complete the recertification process would drop enrollees out of Medicaid.22 Jul Changes in Hospital Inpatient Stays Over Ten Years: Less Cardiac Care, More Mental Health and Sepsis Admissions
MedicalResearch.com Interview with: Ruirui Sun, Service Fellow, Economist Center for Delivery, Organization and Markets Agency for Healthcare Research and Quality MedicalResearch.com: What is the background for this study? Response: Hospital inpatient care has experienced changes due to factors such as population growth, rising of prevalence of chronic disease and efforts to reduce unnecessary hospitalizations. We generated information from the National Hospital Utilization and Costs path on Fast Stats (https://www.hcup-us.ahrq.gov/faststats/landing.jsp ), to present the trends on national hospitalization and costs from 2005 to 2014, as well as the most common diagnoses among inpatient stays over the 10-year period. MedicalResearch.com: What are the main findings?- Between 2005 and 2014, the inflation-adjusted mean cost per inpatient stay increased by 12.7 percent, from $9,500 to $10,900.
- Inflation-adjusted cost per stay for patients covered by private insurance or Medicaid increased 16-18 percent. Cost per stay for Medicare-covered patients and the uninsured changed minimally.
- The rate of inpatient stays decreased the most among patients in the highest income quartiles (15-20 percent decrease).
- The proportion of Medicaid-covered inpatient stays increased by 15.7 percent, whereas the proportion paid by private insurance and that were uninsured decreased by 12.5 and 13.0 percent, respectively.
- Mental health/substance use accounted for nearly 6 percent of all inpatient stays in 2014, up 20.1 percent from 2005.
- Between 2005 and 2014, septicemia and osteoarthritis became two of the five most common reasons for inpatient stays. Septicemia hospital stays almost tripled.
- Nonspecific chest pain and coronary atherosclerosis decreased by more than 60 percent from 2005 to 2014, falling off the list of top 10 reasons for hospitalization.
20 Jul Higher Cost Sharing For Mental Health Services Could Increase Downstream Costs
Posted at 19:24h
in Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA, Mental Health Research
MedicalResearch.com Interview with:
[caption id="attachment_36015" align="alignleft" width="146"]
Dr. Ravesteijn[/caption]
Bastian Ravesteijn PhD
Department of Health Care Policy
Harvard Medical School
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We find that higher out-of-pocket costs for mental health care could have the unintended consequence of increasing the use of acute and involuntary mental health care among those suffering from the most debilitating disorders.
11 Jul EKGs of Low Risk Patients Remain Common and Associated With More Cardiac Testing
MedicalResearch.com Interview with: Sacha Bhatia, MD, MBA, FRCPC Scientist, Women's College Research Institute Director, Women’s College Hospital Institute for Health System Solutions and Virtual Care Cardiologist, Women's College Hospital and University Health Network Canada MedicalResearch.com: What is the background for this study? What are the main findings? Response: The USPSTF recommends against screening with resting electrocardiography (ECG) for the prediction of coronary heart disease (CHD) events in asymptomatic adults at low risk for CHD events. We conducted a retrospective cohort study of the frequency of resting ECGs in low risk patients within 30 days of an annual health exam. We found that 21.5% of low risk patients in Ontario, Canada had a ECG, with significant variation among primary care physicians (1.8% to 76.1%). Moreover, low risk patients who had a ECG were five times more likely to receive another cardiac test or cardiology consultation than those that did not receive an ECG. At one year the rate of mortality, cardiac hospitalizations and revascularization was <0.5% in each group.10 Jul Supply and Demand for Diabetes Prevention Programs
MedicalResearch.com Interview with: [caption id="attachment_35816" align="alignleft" width="200"]
Dr. Alva[/caption]
Maria L. Alva, DPhil
Economist
RTI International - Research Triangle Institute
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We have strong evidence from trials of structured lifestyle intervention programs (e.g. the Diabetes Prevention Program (DPP)) showing that half of new diabetes cases could be avoided if persons with prediabetes changed their lifestyle habits to lose a modest amount of body weight. Moreover, the DPP has been successfully translated into cost-effective community-based prevention interventions, but nationally, these evidence-based interventions (EBIs) are not being used sufficiently. To scale up the implementation of diabetes prevention EBIs, we need to address the challenges of getting organizations to adopt EBIs, and community members to enroll.
Because cost is a primary barrier we wanted to understand what was the perceived value and demand for diabetes prevention programs in NC. And in particular, the role that community health workers and technology could play in program delivery, from the perspectives of both potential recipients (adults at high risk or diagnosed with prediabetes) and decision-makers in healthcare/public health delivery.
24 Jun Moral Hazard Encourages Consumers To Choose More Expensive Treatment Options
MedicalResearch.com Interview with: [caption id="attachment_35581" align="alignleft" width="200"]
Dr. Mehta[/caption]
Nitin Mehta PhD
Associate Professor in Marketing
Rotman School
MedicalResearch.com: What is the background for this study?
Response: The focus of this paper is an investigation of the increase in health care costs associated with chronic disease in the context of consumers enrolled in employer sponsored insurance plans. Chronic illnesses – including conditions such as heart disease, cancer, hypertension, rheumatoid arthritis, respiratory diseases, diabetes, and kidney disease – account for nearly 75 percent of health care expenditures in the U.S. Treatments vary widely in terms of cost and impact: expensive “frontier” treatments provide the best outcome for only the seriously ill, while cheaper, established treatments prove effective for most other patients. As an example, the annual cost to an insurer for “biologics” – novel genetically modified protein drugs – is upwards of $20,000, while the more established drug – methotrexate – costs only $1,000 a year.
We investigate whether a part of the increase in healthcare costs stems from consumers opting for the more expensive treatments even when the lesser expensive treatments may have worked well. To do so, we examined data from a health insurer in the United States on the insurance plan and treatment options for 3,000 chronically ill patients over a three year period.
19 Jun Optimization of Medication Use Critical to Success of ACOs
MedicalResearch.com Interview with: Kimberly Westrich, MA Vice President, Health Services Research, National Pharmaceutical Council, and Kristina Lunner Principal, Leavitt Partners MedicalResearch.com: What is the background for this study? Response: With the advent of accountable care organizations (ACOs) following passage of the Affordable Care Act in 2010, it became important to understand how success in an ACO world is different from success in a capitated environment, where the focus is only on managing costs. In an ACO, providers are responsible for the quality of care they provide for a defined population in addition to having at least some financial responsibility. We wanted to explore how an ACO can succeed in this environment of dual responsibility for costs and quality, and more specifically, how pharmaceuticals fit into this success. To address these questions, the National Pharmaceutical Council worked with the American Medical Group Association (AMGA), Premier, Inc., and a group of seven leading ACOs to develop a conceptual framework for considering the role of pharmaceuticals in ACOs. This framework shows how optimizing medication use in a value-based healthcare environment, such as an ACO, can help the organization achieve its cost and quality benchmarks. We evaluated ACO readiness to optimize medication use in 2014 and again with our most recent study, published in June 2017 online ahead of print in the Journal of Managed Care & Specialty Pharmacy. For our 2017 study, we worked with Leavitt Partners to survey and interview ACOs to understand how they optimize medication use, determine if there is an association between efforts to optimize medication use and achievement on financial and quality metrics, ascertain organizational factors that correlate with optimized medication use, and identify barriers to optimized medication use.12 Jun Head-to-Head Study Compares All Costs Associated With New Anticoagulants in Non-Valvular AFib
MedicalResearch.com Interview with: [caption id="attachment_35237" align="alignleft" width="200"]
Sabine Luik[/caption]
Sabine Luik, M.D.
Senior vice president, Medicine & Regulatory Affairs
Boehringer Ingelheim Pharmaceuticals, Inc.
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: This study is the first real-world, matched head-to-head study comparing all cause healthcare costs and healthcare resource utilization (HCRU) among novel oral anticoagulants (NOACs).
The study analyzed claims data from 70,898 newly-diagnosed NVAF patients who were newly treated with Pradaxa, rivaroxaban or apixaban.
The analysis found that Pradaxa was associated with lower all-cause costs and HCRU compared to rivaroxaban. Compared to apixaban, Pradaxa was associated with similar all-cause costs and hospitalizations, but higher all-cause outpatient and pharmacy HCRU.
10 Jun Heroin Epidemic Costs US Over $50 Billion Per Year
MedicalResearch.com Interview with: [caption id="attachment_35195" align="alignleft" width="200"]
Dr. Pickard[/caption]
A. Simon Pickard, PhD
Professor, Dept of Pharmacy Systems, Outcomes and Policy
University of Ilinois at Chicago
College of Pharmacy
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The heroin epidemic, which has left virtually no part of American society unscathed, can be viewed as an illness. Unlike some illnesses, however, it was largely manufactured by stakeholders in the healthcare system, wittingly or unwittingly.
The main finding, that heroin addiction costs us just over $50 billion per year, is likely a conservative estimate.
06 Jun Physician Assistants and Nurse Practitioners Are Increasingly Providing Specialty Care
MedicalResearch.com Interview with: [caption id="attachment_35059" align="alignleft" width="130"]
Dr. Ray[/caption]
Kristin Ray, MD, MS
Assistant Professor
Health Policy Institute
University of Pittsburgh School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We were interested in understanding how nurse practitioners and physician assistants are working with specialist physicians to provide specialty care. Much has been described and studied about nurse practitioners and physician assistants providing primary care, but the literature about their role in specialty care is more sparse. There have been many concerns over time about the supply of specialist physicians, heightening our interest in the role of nurse practitioners and physician assistants in working with specialist physicians.
We focused on examining whether care to physician specialist's patients by nurse practitioners and physician assistants has increased over time as well as examining characteristics of patients seen by nurse practitioners and physician assistants.
We found that visits with NPs and PAs for specialty care have increased over time, but remains a small fraction of specialty care overall.
06 Jun Health Care Personnel Have Poor Understanding of Costs of ER Care
MedicalResearch.com Interview with: [caption id="attachment_35207" align="alignleft" width="150"]
Dr. Hoffman[/caption]
Kevin Hoffman, DO
Emergency medicine resident
Lakeland Health in Saint Joseph, Michigan
MedicalResearch.com: What is the background for this study?
Response: In this study, we researched emergency department providers’ understanding of the costs of care for three routine patient presentations. Our study differed from the majority of previous studies with the use of clinical vignettes and cost determination for the entire visit. This is in contrast to previous research which focused on cost assessment of individual tests or medications. We wanted to use a study design that was more realistic and applicable to the way we work in the emergency department (ED). The hope is that with this research based on clinical scenarios that the data will be more easily translated back into potential changes and ways to improve efficiency in the ED.
05 Jun Costs of Bike Accidents Skyrocket
MedicalResearch.com Interview with: [caption id="attachment_34976" align="alignleft" width="200"]
Dr. Gaither[/caption]
Tom Gaither, MD, MAS
Department of Urology
San Francisco, CA 94143
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Admission to the hospital because of bicycle crashes has increased over the past 15 years. We aimed to estimate the costs due to these bicycle crashes.
From 1999 to 2013, the total costs due to these injuries (direct medical costs, work loss costs, and pain and suffering) were $209 billion dollars. Costs due to non-fatal injuries have increased by 137% over the study period. In 2013, the total direct and indirect costs were $24 billion dollars, which is approximately doubling the costs due to occupational injuries in the US.
02 Jun Heart Disease, Trauma and Diabetes Incur Highest Cost Per Person Medical Expenses
MedicalResearch.com Interview with: [caption id="attachment_34995" align="alignleft" width="135"]
Dr. Anita Soni[/caption]
Anita Soni, PhD, MBA
Survey Analyst/Statistician
Agency for Healthcare Research and Quality
MedicalResearch.com: What is the background for this study?
Response: This statistical brief uses the data from the Medical Expenditure Panel Survey (MEPS), which collects a broad range of data related to the health care of the U.S. civilian noninstitutionalized population including health insurance coverage, the number and types of health care events and the sources of payment and payment amounts for those events. The survey also gathers information on which medical conditions are associated with the reported health care events. Condition-specific health care expenditure information derived from MEPS data is useful for policy makers in determining where to focus health policies to improve the quality and efficiency of the health care system from the perspective of disease treatment and management.
This Statistical Brief presents data regarding medical expenditures for nine conditions for which an estimated 10 percent or more of the U.S. civilian noninstitutionalized population (individuals age 18 and older) received health care in 2013.
31 May Fixed-Dose Blood Pressure Medications Save Money In The Long Run
Posted at 19:36h
in Author Interviews, Blood Pressure - Hypertension, Compliance, Cost of Health Care, University Texas
MedicalResearch.com Interview with:
[caption id="attachment_34954" align="alignleft" width="199"]
Dr. Sonawane[/caption]
Kalyani B. Sonawane, PhD
Assistant Professor/ PhD Program Director
Department of Health Services Research, Management and Policy
College of Public Health and Health Professions
University of Florida
Gainesville, FL 32610
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Almost one-third of Americans have high blood pressure. Of those patients who are prescribed medication to control their blood pressure, about 30 percent have problems with side effects and nearly 50 percent will not have their blood pressure controlled within the first year of taking medication. In such scenarios, physicians have the option to either add a medication, such as fixed-dose combination, to the patient’s regimen or gradually increase a patient’s dose of their current drug to achieve blood pressure control; and gradually decrease the dose of their current drug or switch to a different drug to resolve side effects. Using healthcare claims data, we compared the economic impact of these alternative treatment modification strategies.
31 May Opioid Agonist Therapy Found Cost Effective In Preventing HIV in People Who Inject Drugs
MedicalResearch.com Interview with: [caption id="attachment_34943" align="alignleft" width="150"]
Cora Bernard[/caption]
Cora Bernard, MS, PhD candidate
Pre-doctoral Student in Management Science and Enginnering
Affiliate, Center for Health Policy and the Center for Primary Care and Outcomes Research
Stanford Health Policy
MedicalResearch.com: What is the background for this study?
Response: The US opioid epidemic is leading to an increase in the US drug-injecting population, which also increases the risks of HIV transmission. It is critical to public health that the US invests in a coherent and cost-effective suite of HIV prevention programs. In our model-based analysis, we considered programs that have the potential both to prevent HIV and to improve long-term health outcomes for people who inject drugs. Specifically, we evaluated opioid agonist therapy, which reduces the frequency of injection; needle and syringe exchange programs, which reduce the frequency of injecting equipment sharing; enhanced HIV screening and antiretroviral therapy programs, which virally suppress individuals and decrease downstream transmission; and oral HIV pre-exposure prophylaxis (PrEP), which is taken by an uninfected individual and lowers the risk of infection.
21 May MRI Guided Prostate Biopsies Can Improve Care and Reduce Costs
MedicalResearch.com Interview with: [caption id="attachment_34738" align="alignleft" width="133"]
Dr. Gulani[/caption]
Vikas Gulani, MD, PhD
Director, MRI, UH Cleveland Medical Center
Associate Professor, Radiology, CWRU School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We wanted to learn if performing MR before prostate biopsy, followed by MR guided strategies for biopsy, are cost effective for the diagnosis of prostate cancer in men who have not previously undergone a biopsy and who have a suspicion of prostate cancer.
The most significant findings are as follows:
We found that all three MR guided strategies for lesion targeting (cognitive targeting, MR-ultrasound fusion targeting, and in-gantry targeting) are cost effective, as the increase in net health benefits as measured by addition of quality adjusted life years (QALY), outweigh the additional costs according to commonly accepted willingness to pay thresholds in the United States.
Cognitive targeting was the most cost effective. In-gantry biopsy added the most health benefit, and this additional benefit was cost-effective as well.
17 May Study Finds Disconnect Between Price and Quality in Health Care
MedicalResearch.com Interview with: Eric Roberts, PhD Post-doctoral fellow Department of Health Care Policy Harvard Medical School MedicalResearch.com: What is the background for this study? What are the main findings? Response: Increasing consolidation of health care providers has raised regulatory concerns that less competition will lead to higher health care prices and possibly lower quality care for patients. On the other hand, some industry observers have contended that larger and higher-priced practices are better able invest in systems to support care management, and ultimately, better patient care. In this study, we examined whether larger and higher-priced physician practices provided better and more efficient care to their patients. Higher-priced physician groups were paid an average of 36% more by commercial insurers, and were substantially larger than lower-priced practices located within the same geographic areas. Despite large differences in practices’ prices and size, we found few differences in their patients’ quality and efficiency of care. For example, when we compared patients who received care in high-priced versus low-priced practices, we found no differences in patients’ overall care ratings, physician ratings, access to care, physician communication, and use of preventive services. We also found no differences in patients’ hospital admissions or total spending, suggesting that higher-priced practices were not managing their patients’ care more efficiently than their lower-priced counterparts. We did find that patients in higher-priced practices were more likely to receive recommended vaccinations, review of their medications, and results of medical tests, and that they spent less time in the waiting room for a scheduled doctor’s appointment. However, once practice prices exceeded the average for their geographic area, we observed no further gains in quality on most of these measures.13 May Worsening Kidney Function Associated With Significantly Higher Medical Costs
MedicalResearch.com Interview with: [caption id="attachment_34553" align="alignleft" width="200"]
Shaum Kabadi[/caption]
Shaum Kabadi
HEOR Director at AstraZeneca
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: More than 20 million adults – roughly 1 in 10 adults – in the US are estimated to have chronic kidney disease (CKD), and this population is expected to grow as the US population ages. Patients with CKD are at high risk for progression to end-stage renal disease (ESRD), a condition requiring dialysis or kidney transplantation to maintain patients’ long-term survival. The cost of treating ESRD patients was over $40 billion in public and private funds in 2009. Prior research shows per-person annual Medicare expenses attributable to CKD were $1,700 for Stage 2, $3,500 for Stage 3, and $12,700 for Stage 4. Additional research is required to understand the economic burden of CKD by stage in a contemporary cohort of commercially insured patients with non-dialysis-dependent (NDD)-CKD.
This retrospective cohort study utilized data from the HealthCore Integrated Research Environment, which contained medical and pharmacy administrative claims integrated with laboratory result values from 14 regionally dispersed Anthem health plans in the US.
Of 16,030 patients identified with CKD, the mean (SD) estimated glomerular filtration rate (eGFR) (all in mL/min/1.73 m2) in 2014 was 44.3 (±18.7), and the breakdown by eGFR levels was: Stage 1 (≥90) 3%, Stage 2 (60–89) 13%, Stage 3a (45–59) 27%, Stage 3b (30–44) 35%, Stage 4 (15–29) 19%, and Stage 5 (<15) 3%. Mean age across all stages was 67.4 years, and 47% were women. Hospitalization rate (%) and number of outpatient encounters (visits per patient per year) by stage were: Stage 1 (11.6%, 19.8), Stage 2 (14.9%, 22.5), Stage 3a (16.2%, 23.6), Stage 3b (23.7%, 29.5), Stage 4 (30.7%, 36.3), and Stage 5 (30.8%, 61.7) (p-trend).