Approximately 60% of U.S. patients who underwent percutaneous coronary intervention (PCI) were referred for cardiac rehabilitation before hospital discharge, researchers reported.
A new type of blood test is starting to transform cancer treatment, sparing some patients the surgical and needle biopsies long needed to guide their care. The tests, called liquid biopsies, capture cancer cells or DNA that tumors shed into the blood, instead of taking tissue from the tumor itself. A lot is still unknown about the value of these tests, but many doctors think they are a big advance that could make personalized medicine possible for far more people. They give the first noninvasive way to repeatedly sample a cancer so doctors can profile its genes, target drugs to mutations, tell quickly whether treatment is working, and adjust it as the cancer evolves.
Hoag Memorial Hospital Presbyterian, one of the largest and most respected facilities in Orange County, needed to move quickly. A big insurer had warned that its maternity costs were too high and it might be cut from the plan's network. The reason? Too many cesarean sections. "We were under intense scrutiny," said Dr. Allyson Brooks, executive medical director of Hoag's women's health institute. The C-section rate at the time, in early 2012, was about 38 percent. That was higher than the state average of 33 percent and above most others in the area, according to the California Maternal Quality Care Collaborative, which seeks to use data to improve birth outcomes.
Providing appropriate preventive drugs to patients free of charge following a heart attack would increase survival and save billions annually, a cost-effectiveness analysis finds. From MedPage Today.
Providing appropriate preventive drugs to patients free of charge following a heart attack would increase survival and save billions annually, a cost-effectiveness analysis found.
Compared with usual coverage, providing beta-blockers, angiotensin-converting enzyme inhibitors (ACE I) or angiotensin receptor blockers (ARB), statins, and aspirin without cost to patients would result in greater quality-adjusted survival (0.14 quality-adjusted life years) and less cost ($4,011 savings) per patient.
The researchers constructed a Markov model to estimate long-term outcomes and costs among privately insured patients enrolled in several trials, including their own previously reported health policy study known as Post-Myocardial Infarction Free Rx Event and Economic Evaluation (MI FREEE).
In that study, eliminating copayments for beta-blockers, ACE inhibitors, ARBs, and statins recommended post-MI was found to improve drug adherence and reduce major vascular events (but not revascularization) without increasing overall cost spending, but follow-up was just over 1 year.
No-Cost Preventive Meds and the ACA
Their newly published cost-effectiveness analysis extended this follow-up to 5 years of intervention.
The finding that this intervention would save both lives and money could have major implications for both private health insurers and public policymakers as they develop cost-sharing strategies based on value-based insurance design (VBID), the researchers noted.
"Under-use of effective drugs is a major contribution to suboptimal disease control and poor outcomes," Choudhry and colleagues wrote, citing a 2007 study which found a 10% increase in patient cost sharing to be associated with increases in the use of costly health services, such as an emergency department visit, and decreases in prescription drug use.
"In the current policy climate where efforts to improve healthcare quality must be coupled with efforts to contain costs, our analysis extended the growing evidence that VBID is a promising approach that could be easily scaled to large populations to improve the quality of care for post-MI patients," they wrote.
In an editorial, Steven Farmer, MD, PhD, and William Borden, MD, of George Washington University School of Medicine, Washington, D.C., wrote that the timing of the new study, "could not be better."
"The rapid growth in high-deductive insurance plans creates an urgency to identify areas where low or no cost-sharing makes sense, even for high-deductible plans," they wrote.
Free Post MI Heart Drugs: 'Everybody Wins'
In a telephone interview, Farmer told MedPage Today that the cost-effectiveness analysis makes a strong case for providing appropriate preventive drugs to patients post MI free of charge.
"Basically everybody wins," he said. "Patients win because survival is improved and they are not paying for needed medications, and payers win because their overall costs are less."
He noted that while the ACA has extended health insurance coverage to an estimated 16.4 million new patients, a large percentage of these newly insured people have opted for the lowest cost plans with the highest deductibles.
"Even in the case of low-cost, generic medications, if a patient is taking four or five or even more drugs a month the costs can add up," Farmer said. "Even a $5 or $10 copay will act as a barrier to stay on medications for some patients. The people that can least afford them are being hit with the highest copays, and that can distort judgment."
In their editorial, Farmer and Borden noted that if all, and not just some private insurers implement proven interventions like those provided in MI FREEE, patients with high-deductible insurance plans will be less inclined to switch providers frequently -- a practice known as churn.
"Although challenges to VBID certainly exist, the MI FREEE and follow-up study show that providing free medications post MI is smart, plain and simple," they wrote. "The medical community should continue to look for situations where removing financial barriers to evidence-based care is effective in improving healthcare value, and then work to remove those barriers."
The measles vaccine provides benefits beyond merely protecting against that highly contagious viral respiratory disease that remains a leading childhood killer in parts of the world, scientists say. By blocking the measles infection, the vaccine prevents measles-induced immune system damage that makes children much more vulnerable to numerous other infectious diseases for two to three years, a study published on Thursday found. The research focused on a phenomenon called "immune amnesia" in which the measles infection destroys cells in the immune system, the body's natural defense against disease-causing microbes, that "remember" how to fend off previously encountered pathogens.
A new federal report shows a high number of Americans are not undergoing recommended screenings for colorectal, breast and cervical cancers. New data released Thursday from the U.S. Centers for Disease Control and Prevention (CDC), shows that in 2013, which is the latest data available, screening for the three cancers either dropped lower than previous rates or showed no improvement. The numbers show that around 20% of women said they were not up to date with cervical-cancer screenings, and a quarter of women were not getting recommended breast cancer screening.