What Accounts for Increase in National Spending on Antidiabetic Drugs?

MedicalResearch.com Interview with:
Xiaohui Zhuo, PhD
Division of Diabetes Translation
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention,
Atlanta, GA 

MedicalResearch.com: What is the background for this study?

Response: Prescription drug spending (spending from families and individuals, their medical providers (doctors, hospitals, pharmacies, etc.) and employees across the United States) has increased at a much higher rater than other components of the total medical expenditure associated with diabetes.  The share of spending on prescription drugs in per capita annual excess expenditure due to diabetes increased from 27% to 41% between 1987 and 2011, according to a previous study using national data from the Agency for Healthcare Research and Quality Medical Expenditures Panel Surveys.

In this most recent study, CDC researchers estimated the increase in the national spending on antidiabetic drugs from 2005 to 2016 in total and by drug class and broke down the increase in total national spending by examining what factors have contributed to the increase estimating the magnitude of each factor’s contribution.

Continue reading

Social Risk Factors May Influence Dialysis Quality Measures and Financial Penalties

MedicalResearch.com Interview with:
"Plugged into dialysis" by Dan is licensed under CC BY 2.0Andrew C. Qi,  Medical student

Karen E. Joynt Maddox MD MPH
Assistant professor of medicine
Washington University School of Medicine
Saint Louis, Missouri. 

MedicalResearch.com: What is the background for this study?  

Response: The End-Stage Renal Disease Quality Incentive Program (ESRD QIP) is a Medicare program that evaluates dialysis facilities in the U.S. based on a set of quality measures, and penalizes low-performing facilities. We’ve seen a growing understanding of how social risk factors like poverty and race/ethnicity impact patient outcomes in other settings, making it difficult for providers caring for disadvantaged populations to perform as well in these kinds of pay-for-performance programs. We were interested in seeing if this was the case for dialysis facilities as well, especially since patients receiving dialysis are already a vulnerable population.

Continue reading

US Cancer Deaths Cost Society Billions in Lost Earnings

MedicalResearch.com Interview with:

Farhad Islami, MD PhD Scientific Director, Surveillance Research American Cancer Society, Inc. Atlanta, GA 30303

Dr. Islami

Farhad Islami, MD PhD
Scientific Director, Surveillance Research
American Cancer Society, Inc

MedicalResearch.com: What is the background for this study?  

Response: In the United States, cancer is the second leading cause of death, and premature cancer deaths impose significant economic burden. Contemporary information on the economic burden of cancer mortality can inform policies and help prioritize resources for cancer prevention and control, but this information is lacking.

In our study, we provide contemporary estimates for the loss of future earnings (lost earnings) due to cancer death at national and state levels for all cancers combined and for major cancers.

Continue reading

Children Living with Non-Citizen Parents May Lose Health Care Under New Rules

MedicalResearch.com Interview with:

MedicalResearch.com Interview with: Leah Zallman, MD, MPH Assistant Professor of Medicine Harvard Medical School Physician at Cambridge Health Alliance. Director of Research Institute for Community Health

Dr. Zallman

Leah Zallman, MD, MPH
Assistant Professor of Medicine
Harvard Medical School
Physician at Cambridge Health Alliance.
Director of Research
Institute for Community Health

MedicalResearch.com: What is the background for this study?

Response: In October 2018, the U.S Department of Homeland Security published a proposed change to a longstanding immigration rule. The proposed change would increase the chance of an immigrant being deemed a “public charge”, and increase the chance of being denied legal permanent residency or entry to the United States. Up to now, enrollment in public food, housing and health insurance programs were not counted against immigrants applying for “green cards”; the proposed rule change drastically changes the intent of the rule and newly includes food, housing and health insurance programs as benefits that can be considered counted against immigrants. These proposed changes are expected to cause many immigrant parents to disenroll their families from safety-net programs, largely because of fear and confusion about the rule – even among families to whom the rule does not technically apply.

Continue reading

Americans Support Gene Therapies Even If They Cost More

Dr. Winegarden
Dr. Winegarden

MedicalResearch.com Interview with:

Wayne Winegarden, Ph.D.
Director, Center for Medical Economics and Innovation
Pacific Research Institute

MedicalResearch.com:  What is the background for this poll? Would you tell us a little about the Center for Medical Economics and Innovation? 

Response: Recent press reports have focused on how extensive innovative gene therapies can be.  PRI was interested in learning where Americans stand on these cures of the future, and commission a new national opinion survey to find out.

The Center for Medical Economics and Innovation is a new center launched by PRI this spring to research and advance policies showing how a thriving biomedical and pharmaceutical sector benefits both patients and economic growth. Medical innovation is an important driver of economic growth, responsible for over $1.3 trillion in economic activity each year. As the Milken Institute has found, every job in the biomedical sphere supports another 3.3 jobs elsewhere in the economy.

Among the activities of the Center – which can be accessed at www.medecon.org – are providing free-market analysis to evaluate current policy proposals, producing easy-to-understand data and analysis on current trends in medical science, breaking down complex issues like pharmaceutical and biomedical pricing structures, and demonstrating the benefits that market-based reforms can offer patients and the U.S. health care system.  Continue reading

Lowered Price of Repatha® (evolocumab) Translates to Cost Effectiveness for Range of Heart Conditions in Some High Risk Patients

MedicalResearch.com Interview with:

Gregg C. Fonarow, MD, FACC, FAHA Eliot Corday Professor of Cardiovascular Medicine and Science Director, Ahmanson-UCLA Cardiomyopathy Center Co-Chief of Clinical Cardiology, UCLA Division of Cardiology Co-Director, UCLA Preventative Cardiology Program David Geffen School of Medicine at UCLA Los Angeles, CA, 90095-1679

Dr. Gregg Fonarow

Gregg C. Fonarow, MD, FACC, FAHA
Eliot Corday Professor of Cardiovascular Medicine and Science
Director, Ahmanson-UCLA Cardiomyopathy Center
Co-Chief of Clinical Cardiology, UCLA Division of Cardiology
Co-Director, UCLA Preventative Cardiology Program
David Geffen School of Medicine at UCLA
Los Angeles, CA 

MedicalResearch.com: What is the background for this study?

Response: Last year, Amgen made the PCSK-9 inhibitor evolocumab available at a reduced list price of $5,850 per year This 60% reduction was aimed at improving patient access by lowering patient copays, especially for Medicare beneficiaries.

Additionally, the treatment landscape for PCSK9 inhibitors was further defined in 2018 when the American College of Cardiology/American Heart Association Multisociety Clinical Guideline on the Management of Blood Cholesterol recommended PCSK9 inhibitors for, among other patient populations, patients with very high-risk (VHR) ASCVD whose low-density lipoprotein cholesterol levels remain at 70 mg/dL or more  despite a heart-healthy lifestyle and treatment with standard background therapy.

Continue reading

Non-Invasive Echocardiograms Can Be Overused Leading To Increased Costs

MedicalResearch.com Interview with:

Quinn R Pack, MD Assistant Professor of Medicine at University of Massachusetts Medical School - Baystate Adjunct Assistant Professor of Medicine Tufts University School of Medicine

Dr. Pack

Quinn R Pack, MD
Assistant Professor of Medicine
University of Massachusetts Medical School –
Baystate Adjunct Assistant Professor of Medicine
Tufts University School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Because echocardiograms are non-invasive, very low risk, and nearly universally available, it is easy to over-use this technique.  In myocardial infarction, echo is also recommended in guidelines.

However, in our lab, we frequently find echocardiograms that are ordered purely out of routine, without any thought as to the likelihood of finding an abnormality.   Prior studies also suggested that as many as 70% of echocardiograms provide no additional diagnostic value. When spread across the approximate 600,000 patients in the United States each year, this low diagnostic yield represents an opportunity to reduce costs by reducing echocardiograms. 

Continue reading

Insulin Costs Rise But Mostly Not Paid For Out-of-Pocket by Patients

MedicalResearch.com Interview with:
Dr. Hui ShaoDr. Hui Shao, MBBS, MHA, PhD
CDC

MedicalResearch.com: What is the background for this study? 

Response: 23.1 million people in the U.S. have diagnosed diabetes and 7.4 million regularly use one or more types of insulin. Spending on insulin accounts for a large portion of the costs associated with diabetes. Affordability of insulin has become a public health concern in recent years as high spending on insulin imposes a large financial burden on the national health care system and is associated with poor adherence and health outcomes.

MedicalResearch.com: What are the main findings?

Response: In this study, we analyzed the recent trends in usage and total payments, and patients’ out-of-pocket (OOP) payments for insulin by type in privately insured Americans (MarketScan Claims database) 2003-2017.  We estimated total payment and out-of-pocket payment for a 30-day/yearly supply of different types of insulin and found that, on average, inflation-adjusted annual total payments for insulin increased yearly by around 6% ($153) between 2003 and 2012 and by around 13% ($592) between 2011 and 2017. Similar increase patterns were observed across insulin types.

The major driver for increases in average total payments for a 30-day supply of insulin were explained by increases in payments for existing products and not by changes in the market share of insulin types. In contrast, out-of-pocket payments increased only marginally, suggesting that the increase in insulin spending was not paid directly by the patient.

MedicalResearch.com: What should readers take away from your report?

Response: The average annual total payment increased substantially during the study period, from $1,982 per year in 2003 to $6,360 per year in 2017 (in inflation-adjusted in 2017$). Total payments for insulin have been increasing since 2003 but were at much higher rates after 2011. In contrast, annual out-of-pocket costs increased only marginally from $390 to $451 during the same period, suggesting that the sharp payment increases were not paid out of pocket by the patient. The payment increase occurred across all insulin types, suggesting a lack of inexpensive alternatives in the insulin market. Even for human insulin, the cheapest form of insulin, the average payment for a 30-day supply caught up with insulin analogs in 2017.                                               

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Our study population is those with private insurance with the fee for service. Additional research is needed to help determine if similar spending patterns are observed in persons with other types of health insurance, especially those with high-deductible plans and those without health insurance.

Further research in this area could also help us determine the cause of rising insulin costs, and inform decision-making at all levels, which could reduce insulin cost, or slow the consistent increase in cost. 

MedicalResearch.com: Is there anything else you would like to add?

Response: There are no additional comments or disclosures. For more information about how the CDC works to prevent and control diabetes visit https://www.cdc.gov/diabetes/index.html.

 Citation: ADA 2019 abstract

Trend in Total Payment and Out-of-Pocket Payment on a Yearly Supply of Oral Antidiabetic Drug Types among U.S. Adults with Private Health Insurance from 2003 to 2016

HUI SHAOMICHAEL LAXYSTEPHEN R. BENOITYILING J. CHENGEDWARD GREGG and PING ZHANG

 

[last-modified]

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Fewer Psychiatrists Willing To Accept Medicaid Patients

MedicalResearch.com Interview with:

Hefei Wen, PhDAssistant Professor, Department of Health Management & PolicyUniversity of Kentucky College of Public Health

Dr. Wen

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.

Continue reading

Traumatic Injuries Cost Medicare More Than Heart Failure, Pneumonia, Stroke or Heart Attacks

MedicalResearch.com Interview with:

Dr. Mark R. Hemmila MD Associate Professor of Surgery Division of Acute Care Surgery University of Michigan

Dr. Hemmila

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.  Continue reading

Canadian ERs Use Less Pediatric Diagnostic Imaging Than US

MedicalResearch.com Interview with:

Eyal Cohen, MD, M.Sc, FRCP(C)Professor, PediatricsUniversity of TorontoCo-Founder, Complex Care ProgramThe Hospital for Sick Children

Dr. Cohen

Eyal Cohen, MD, M.Sc, FRCP(C)
Professor, Pediatrics
University of Toronto
Co-Founder, Complex Care Program
The Hospital for Sick Children
 

MedicalResearch.com: What is the background for this study?

Response: Minimizing care that provides little benefit to patients has become an important focus to decrease health care costs and improve the quality of care delivery.  Diagnostic imaging in children is a common focus for campaigns designed to reduce overuse both in Canada and the US. There are some suggestions that there may be more overuse of care in the United States than Canada, but there has been little study in children.

We compared the use of low-value diagnostic imaging rates from four pediatric emergency departments in Ontario to 26 in the United States from 2006 to 2016.  We defined low-value imaging as situations where children are discharged from an emergency department with a diagnosis for which routine use of diagnostic imaging may not be necessary, like asthma or constipation.  Continue reading

Dialysis Unit Profit Primarily From Small Percentage of Privately Insured Patients

MedicalResearch.com Interview with:

Chris Childers, MD, PhDDivision of General SurgeryDavid Geffen School of Medicine at UCLA10833 Le Conte Ave., CHS 72-247Los Angeles, CA 90095

Dr. Childers

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.

Continue reading

Medicaid Payments For Breast Cancer Radiation Vary Widely

MedicalResearch.com Interview with:

Ankit Agarwal, MD, MBAPGY-3, Radiation Oncology ResidentUNC Health Care

Dr. Agarwal

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)  Continue reading

Billions in Tax Revenue Lost Due to Misuse of Opioids

MedicalResearch.com Interview with:

Joel Segel, Ph.D.Assistant ProfessorDepartment of Health Policy and AdministrationThe Pennsylvania State UniversityUniversity Park, PA 16802

Dr. Segel

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.  Continue reading

Cataract Surgery: QI Initiative Markedly Reduced Low-Value Preoperative Care

MedicalResearch.com Interview with:

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

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.

Continue reading

Some Patients Purchasing Over-the-Counter Insulins Due to High Prescription Costs

MedicalResearch.com Interview with:

Jennifer N. Goldstein, MD, MSc Assistant  program Director of Internal Medicine Christiana Care Health System Newark, Delaware

Dr. Goldstein

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.

Continue reading

Price of Existing Biologics Increased When New Drugs Entered Market

MedicalResearch.com Interview with:

Alvaro San-Juan-Rodriguez

Alvaro San-Juan-Rodriguez

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.  Continue reading

How Does the Medicaid Rebate Cap Affect Brand-Name Drug Prices?

MedicalResearch.com Interview with:

Sean Dickson, JD MPH Officer, Drug Spending Research Initiative The Pew Charitable Trusts Washington, DC 20004

Sean Dickson, JD MPH

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.  Continue reading

Younger Cancer Survivors Face Greater Financial Burdens

MedicalResearch.com Interview with:

Zhiyuan "Jason" Zheng PhD Director, Economics and Healthcare Delivery Research American Cancer Society, Inc. Atlanta, GA 30303

Dr. Zheng

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. 

Continue reading

WHO: Profits Outweigh R&D Costs of New Cancer Drugs

MedicalResearch.com Interview with:

Kiu Tay-Teo, PhD World Health Organization Geneva, Switzerland

Dr. Kiu Tay-Teo

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.

Continue reading

Specialty Drugs and Increase Price of Brand Names Raise Health Care Costs

MedicalResearch.com Interview with:

MedicalResearch.com Interview with: Inmaculada Hernandez, PharmD, PhD Assistant Professor of Pharmacy and Therapeutics University of Pittsburgh School of Pharmacy

Dr. Hernandez

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.

Continue reading

Heart Attacks and Stroke Cause Blows to Financial Health

MedicalResearch.com Interview with:

Allan Garland, MD,  MA  Professor of Medicine & Community Health Sciences Co-Head, Section of Critical Care Medicine University of Manitoba

Dr. Garland

Allan GarlandMD,  MA 
Professor of Medicine & Community
Health Sciences
Co-Head, Section of Critical Care Medicine
University of Manitoba

MedicalResearch.com: What is the background for this study?

Response: Heart attacks, strokes and cardiac arrest are common acute health events.  Most studies of serious acute health events look at outcomes such as death and how long is spent in the hospital.  But for working age people, the ability to work and earn income are very important outcomes that have rarely been studied.

We set out to carefully measure, across Canada, how much heart attacks, strokes and cardiac arrests affect the ability of working age people to work and earn.

Continue reading

Emergency-Only Dialysis For Undocumented Immigrants Costs More Money and Lives

MedicalResearch.com Interview with:

Oanh Kieu Nguyen, MD, MA Assistant Professor Division of Hospital Medicine Zuckerberg San Francisco General Hospital UCSF

Dr. Nguyen

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.  Continue reading

Use of Biosimilar Growth Factor Increases in Supportive Cancer Care

MedicalResearch.com Interview with:

Abiy Agiro, PHD HealthCore Inc Wilmington, Delaware

Dr. Agiro

Abiy Agiro, PHD
HealthCore Inc
Wilmington, Delaware 

MedicalResearch.com: What is the background for this study?

Response: Biosimilar approval pathway, authorized in 2010 by the Biologics Price Competition and Innovation Act as part of the Affordable Care Act, aims to increase adoption of biosimilar products and generate significant cost savings to payers and patients alike. Biosimilar filgrastim, used to prevent febrile neutropenia, is one of the first biosimilars to be approved in the United States. A large scale, post-approval real-world analysis was needed that compares biosimilar filgrastim to the original drug for safety and efficacy.

Continue reading

Poor Health Insurance Literacy Linked to Avoidance of Health Care Services

MedicalResearch.com Interview with:
Renuka Tipirneni, MD, MSc Assistant Professor Holder of the Grace H. Elta MD Department of Internal Medicine Early Career Endowment Award 2019-2024 University of Michigan Department of Internal Medicine, Divisions of General Medicine and Hospital Medicine, and Institute for Healthcare Policy & Innovation Ann Arbor, MI 48109Renuka Tipirneni, MD, MSc
Assistant Professor
Holder of the Grace H. Elta MD Department of Internal Medicine Early Career Endowment Award 2019-2024
University of Michigan Department of Internal Medicine
Divisions of General Medicine and Hospital Medicine, and
Institute for Healthcare Policy & Innovation
Ann Arbor, MI 48109

MedicalResearch.com: What is the background for this study? What are the main findings?

Response:  Navigating health insurance and health care choices is challenging and requires significant health insurance literacy (knowledge and application of health insurance concepts). We looked at the association between U.S. adults’ health insurance literacy and avoidance of health care services due to perceived cost.

We found that 30% of people we surveyed reported delayed or foregone care because of perceived cost, and that those with lower health insurance literacy reported significantly greater avoidance of both preventive and nonpreventive health care services.

Continue reading

Cost-effectiveness of Humanitarian Pediatric Cardiac Surgery

MedicalResearch.com Interview with:

Marcelo G. Cardarelli, MD A member of Inova Medical Group

Dr. Cardarelli

Marcelo G. Cardarelli, MD
Inova Children’s Hospita
Fairfax, Falls Church, Virginia

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Global Humanitarian Medical efforts consume a large amount of resources (nearly $38B in 2016) and donors (Countries, International organizations, WHO, Individuals) make the decisions as to where their funds should be allocated based on cost-effectiveness studies. Most resources go to prevent/treat infectious diseases, sanitation efforts and maternal/child care issues. An insignificant amount of resources is directed to satisfy the surgical needs of the populations in low and middle income countries (LMICs).

The idea behind our project was to find out if it was cost-effective to perform a tertiary surgical specialty (pediatric cardiac surgery) in this context and the answer (at $171 per DALY averted) was an overwhelming yes!

But most importantly, we believe, as many others do, that judging the cost/effectiveness of an intervention in order to decide resources allocation is valid for diseases that can be prevented, but not relevant when it comes to surgical problems that are not preventable.

Instead, we propose the use of another measure of effectiveness, what we call “The Humanitarian Footprint”.

The Humanitarian Footprint represents the long term benefits, as measured by changes in the life expectancy, extra years of schooling and potential lifetime earnings of patients treated surgically during humanitarian interventions.

To our surprise and based on the results, the effects on society of at least this particular surgical intervention were greater than we expected. We suspect this measure can be used in many other surgical humanitarian interventions as well.  Continue reading

Untreated Hearing Loss: Higher Health Care Costs, More ER Visits and Readmissions

MedicalResearch.com Interview with:

Nicholas S. Reed, AuD Assistant Professor | Department of Otolaryngology-Head/Neck Surgery Core Faculty  | Cochlear Center for Hearing and Public Health Johns Hopkins University School of Medicine Johns Hopkins University Bloomberg School of Public Health

Nicholas Reed AuD

Nicholas S. Reed, AuD
Assistant Professor | Department of Otolaryngology-Head/Neck Surgery
Core Faculty | Cochlear Center for Hearing and Public Health
Johns Hopkins University School of Medicine
Johns Hopkins University Bloomberg School of Public Health

MedicalResearch.com: What is the background for this study?

Response: This study was a true team effort. It was funded by AARP and AARP Services, INC and the research was a collaboration of representatives from Johns Hopkins University, OptumLabs, University of California – San Francisco, and AARP Services, INC. Given all of the resent research on downstream effects of hearing loss on important health outcomes such as cognitive decline, falls, and dementia, the aim was to explore how persons with hearing loss interacted with the healthcare system in terms of cost and utilization.

MedicalResearch.com: What are the main findings?

Response: Over a 10 year period, untreated hearing loss (hearing aid users were excluded from this study as they are difficult to capture in the claims database) was associated with higher healthcare spending and utilization. Specifically, over 10 years, persons with untreated hearing loss spent 46.5% more, on average, on healthcare (to the tune of approximately $22000 more) than those without evidence of hearing loss. Furthermore, persons with untreated hearing loss had 44% and 17% higher risk for 30-day readmission and emergency department visit, respectively.

Similar relationships were seen across other measures where persons with untreated hearing loss were more likely to be hospitalized and spent longer in the hospital compared to those without evidence of hearing loss. Continue reading

4-Meds in One Glaucoma Eyedrop May Decrease Preservatives, Lower Cost, Improve Compliance

MedicalResearch.com Interview with:

Nathan Radcliffe, MD Senior Faculty, Ophthalmology Glaucoma and Cataract surgeon Mount Sinai Health System

Dr. Radcliffe

Nathan Radcliffe, MD
Senior Faculty, Ophthalmology Glaucoma and Cataract surgeon
Mount Sinai Health System

MedicalResearch.com: What is the background for this study?

Response: Glaucoma is a leading cause of blindness and the mainstay of therapy is to lower the intraocular pressure (IOP) with topical eye drops.

Up to 40% of patients may require more than one eye drop to control the disease, and yet taking more than one eye drop bottle can result in higher costs, more eye irritation, worse therapeutic compliance, and possibly worse outcomes, be sure to consult your eye surgeon before increasing any eye treatment to ensure it won’t do any further damage to the eye. Compounded therapies (not FDA approved, but made at the physician’s request by a compounding pharmacy) can be created to contain multiple glaucoma therapies in one bottle.

We sought to determine if a compounded solution containing three or four drops in one bottle could control glaucoma as well as three or four separate bottles (standard of care) in patients requiring three or four eye drop bottles to control glaucoma.

We performed a multi-center, randomized, observer-masked, parallel-group study comparing a compounded therapy containing latanoprost 0.05%, dorzolamide hydrochloride 2%, timolol maleate 0.5%, brimonidine tartrate 0.2% with 0.01% BAK to standard three or four bottle regaimins. We measured IOP and corneal staining (a sign of preservative toxicity), as well as other safety measures at week one, month one, two and three.

Continue reading

Even in Intensive Care, Health Care Costs Are Factor For Both Patients and Clinicians

MedicalResearch.com Interview with:

Deborah D. Gordon, MBA Mossavar-Rahmani Center for Business and Government Harvard Kennedy School Cambridge, Massachusetts

Deborah  Gordon

Deborah D. Gordon, MBA
Mossavar-Rahmani Center for Business and Government
Harvard Kennedy School
Cambridge, Massachusetts

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Against the backdrop of rising health care costs, and the increasing share of those costs that consumers bear, studies show people are interested in finding health care cost information and engaging with their providers on issues of cost.

We were interested in learning to what extent, if any, discussion or consideration of cost would be documented in electronic health records.

Using machine learning techniques to extract data from unstructured notes, we examined 46,146 narrative clinical notes from ICU admissions. We found that approximately 4% of admissions had at least one note with financially relevant content. That financial content included documentation of cost as a barrier to adhering to treatment prior to admission, and as a consideration in treatment and discharge planning.    Continue reading

Most Health Care Costs Associated With Osteoporotic Fractures Occur in First Year

MedicalResearch.com Interview with:

Kandice A. Kapinos, Ph.D. Economist Professor RAND Corporation Pardee RAND Graduate School 

Dr. Kapinos

Kandice A. Kapinos, Ph.D.
Economist
Professor
RAND Corporation
Pardee RAND Graduate School 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: The economic burden of osteoporotic fractures is substantial with studies estimating the annual healthcare cost burden between $10 to 17 billion. Although estimates from individual studies vary, most studies assessing costs after a fracture only explore up to twelve months following a fracture. There is little investigation of how fracture patients’ costs evolve over a longer post-fracture period.

As osteoporotic fractures are one of the most common causes of disability among older adults and can translate into greater medical costs, we focused on studying Medicare beneficiaries. In fact, previous research has suggested that most of the increase in Medicare spending over time can be explained from costs associated with treating higher risk Medicare beneficiaries.

Our objective in this study was to compare health care costs over a 3-year period of those who experienced a fracture to those who did not among a sample of Medicare beneficiaries who were at an increased risk of having a fracture.

Consistent with previous studies, we found a significant increase in expenditures in the year immediately following a fracture relative to controls: almost $14,000 higher for fractures relative to controls. However, at 2 and 3-years post-fracture, there were no significant differences in the change in expenditures between fracture cases and controls. We note that these findings may be different for beneficiaries living in skilled nursing facilities or other non-community-based settings.

Continue reading