[Repost] Medical Cost Offsets from Prescription Drug Utilization Among Medicare Beneficiaries

Medical Cost Offsets from Prescription Drug Utilization Among Medicare Beneficiaries

Excerpt from the commentary by M. Christopher Roebuck, PhD, MBA

SUMMARY

This brief commentary extends earlier work on the value of adherence to derive medical cost offset estimates from prescription drug utilization. Among seniors with chronic vascular disease, 1% increases in condition-specific medication use were associated with significant (P<0.001) reductions in gross nonpharmacy medical costs in the amounts of 0.63% fordyslipidemia, 0.77% for congestive heart failure, 0.83% for diabetes, and1.17% for hypertension.

J Manag Care Pharm.

2014;20(10):994-95

Excerpts:

With about half of patients not taking their medications as directed, avoidable adverse health events and use of medical services are estimated to add up to $290 billion in U.S.health care expenditures annually. Improvements in clinical and economic outcomes from medication adherence have been demonstrated across a variety of conditions and patientcohorts. As an example, in 2011 my colleagues and I (Roebuck et al.) determined that adherence to medication for chronic vascular disease was associated with fewer inpatient hospital days and emergency department visits and lower overal health care costs. Specifically, annual net savings in healtcare expenditures for an adherent (compared to nonadherent) elderly beneficiary were estimated to be $7,893 for congestive

heart failure, $5,824 for hypertension, $5,170 for diabetes, and $1,847 for dyslipidemia—or approximately 9% to 28% of total

health care costs. This research employed a rigorous observational study design that addressed a key concern and limitation

ofprior analyses—the potentialendogeneity (confounding) of adherence. More plainly, results reported in earlier publications mayhave been biased if patients who took medications as directed also engaged in other unmeasured healthy behaviors

(i.e., the “healthy adherer effect”)

..

Figure 1 presents the new findings and includes the CBO estimate for reference. Specifically, 1% increases in condition-specific prescription drug utilization were significantly (P<0.001) associated with reductions in seniors’ gross nonpharmacy medical costs in the amounts of 0.63% for dyslipidemia, 0.77% for congestive heart failure, 0.83% for diabetes, and 1.17% for hypertension. These results demonstrate that medical cost offsets from prescription drug utilization likely vary bychronic condition and that impacts for therapeutic classes used to treat these 4 conditions—which represent 40% of Medicare Part D utilization—may be between 3 and 6 times greater than the CBO’s assumption. In dollar terms, these relative impacts are not trivial. For example, 53% of Medicare (fee-for-service) beneficiaries have the comorbidity combination of hyperten sion plus high cholesterol—with average annual medical costs of $13,825. The current findings suggest that a 5% increase in the use of antihypertensive medication by patients with those conditions may prompt reductions in medical (Parts A and B) costs of more than $800 annually per beneficiary.

….

The present analysis examined retirees with employer-sponsored insurance in addition to Medicare. To the extent that these individuals differed from the broader Medicare population, the generalizability of study findings may be limited.

[News item] Vitamin supplements may lower exercise endurance (but the jury seem to be out)

Vitamin supplements may lower exercise endurance |BBC Health

Excerpts:

Taking some types of vitamin supplement may make it harder to train for big endurance events like marathons, researchers in Norway suggest.

They said vitamins C and E should be used with caution as they may “blunt” the way muscles respond to exercise.

However, actual athletic performance was not affected in the 11-week trial leading other experts to questions the research.

The findings were published in The Journal of Physiology.

The team at the Norwegian School of Sport Sciences in Oslo argued vitamin supplements were readily taken and available, but were unsure if they affected athletic ability.

…

Endurance runs

There was no difference in their performance during a Beep test – running faster and faster between two points 20m apart.

However, blood samples and tissue biopsies suggested there were differences developing inside the muscle.

Each muscle cell contains lots of tiny mitochondria which give the muscle cell its energy.

Those taking the supplements seemed to be producing fewer extra mitochondria to cope with the increasing demands placed on the muscle.

…

Hmmm

However, Mike Gleeson, a professor of exercise biochemistry at Loughborough University, is not convinced.

He said the biggest factor in performance was how fast the heart and lungs could get oxygen to the muscle, not mitochondria.

 

[News item] Millions in unused medical supplies in U.S. operating rooms each year — ScienceDaily

Millions in unused medical supplies in U.S. operating rooms each year — ScienceDaily.

Date:

October 27, 2014

Source:

Johns Hopkins Medicine

Summary:

Surgeons urge the salvage of syringes, sutures, gauze, towels to improve care in developing countries. A new report highlights not only an opportunity for U.S. hospitals to help relieve the global burden of surgically treatable diseases, but also a means of reducing the cost and environmental impact of medical waste disposal at home, authors say.

Excerpt:

Johns Hopkins research team reports that major hospitals across the U.S. collectively throw away at least $15 million a year in unused operating room surgical supplies that could be salvaged and used to ease critical shortages, improve surgical care and boost public health in developing countries.

A report on the research, published online Oct. 16 in the World Journal of Surgery, highlights not only an opportunity for U.S. hospitals to help relieve the global burden of surgically treatable diseases, but also a means of reducing the cost and environmental impact of medical waste disposal at home.

The fact of surgical supply waste is nothing new, the researchers note, but say their investigation may be one of the first systematic attempts to measure the national extent of the problem, the potential cost savings and the impact on patients’ lives. While several organizations run donation programs for leftover operating room materials, such efforts would be far more successful if they were made standard protocol across all major surgical centers, the authors say.

“Perfectly good, entirely sterile and, above all, much-needed surgical supplies are routinely discarded in American operating rooms,”

…

The researchers tracked outcomes among 33 Ecuadorian patients whose surgeries were made possible as a result of the donations. Their analysis showed that donated surgical supplies prevented, on average, eight years of disability per patient.

In the study, materials topping the 19-item surgical supplies list included gauze, disposable syringes, sutures and surgical towels. However, the investigators say, it is important to tailor shipping to the specific needs of each hospital. Matching of donor leftovers to recipient need, they say, will prevent unnecessary shipping costs and avoid creating medical waste locally. In addition, the receiving hospital must have a demonstrated capability and the equipment to clean and sterilize the shipped materials before use in the operating room.

Persistent pain estimated in 19 percent of U.S. Adults — ScienceDaily

Persistent pain estimated in 19 percent of U.S. Adults — ScienceDaily.

Date:

October 27, 2014

Source:

American Pain Society

Summary:

39 million people in the United States, or 19 percent have persistent pain, and the incidence varies according to age and gender, a new study reports. The authors noted that persistent pain correlated with other indices of health-related quality of life, such as anxiety, depression and fatigue. Individuals with those conditions were far more likely to report persistent pain.

Excerpt from the news story:

n 2011, the Institute of Medicine reported that 100 million Americans have chronic pain. The authors explained that the disparity between the estimated pain incidence in their study and what the IOM reported is attributable almost entirely to differences in operational definitions of persistent pain.

In the 2010 NHIS, an estimated 60 percent of adults reported lower back pain in the past three months, and all of them would have been described in the IOM report as having chronic pain. However, only 42 percent of the NHIS study respondents with back pain described their pain as frequent or daily and lasting more than three months.

From a public health perspective the difference is significant. Those with persistent pain have high rates of work disability, fatigue, anxiety and depression. They also are at higher risk for long-term exposure to and dependency on pain medications.

The authors concluded that measuring pain persistence has policy implications because persistent pain is an indicator of an unmet medical need for pain management in the general population, as well as a risk factor for anxiety and depression.

[Repost] Neglect of culture in medicine is ‘single biggest barrier’ to achieving better health | Daily Science News

Neglect of culture in medicine is ‘single biggest barrier’ to achieving better health | Daily Science News.

From the 28 October post

The systematic neglect of culture is the single biggest barrier to advancing the highest attainable standard of health worldwide, say the authors of a major new report on culture and health, led by Professor David Napier, a leading medical anthropologist from University College London (UCL), UK, and published in The Lancet.

Bringing together experts from many different fields, including anthropologists, social scientists, and medics, the Commission is the first ever detailed appraisal of the role of culture in health. The authors argue that cultures of all kinds – not only people’s religious or ethnic identity, but also professional and political cultures – have been sidelined and misunderstood by both medical professionals and society as a whole.

Until now, culture has largely been conceived of as an impediment to health, rather than a central determining feature of it. However, the Commission makes a powerful case to the contrary, showing that culture not only determines health – for example, through its influence on behaviours such as smoking and unhealthy eating – but also defines it through different cultural groups’ understandings of what it means to be well.

Culture is often blamed for clinical malpractice,…

Letting patients change their own meds using apps and connected devices

Letting patients change their own meds using apps and connected devices.

Aneroid sphygmomanometer with stethoscope, used for auscultatory blood pressure measurement. (Photo credit: Wikipedia)

From the 18 September 2014 post at iMedicalapps

A recent trial published in the Journal of the American Medical Association has demonstrated the efficacy of self-titration of blood pressure medications by patients with hypertension.

Personally, I’m a proponent of giving patients self-titration schedules, particularly in my patients with systolic heart failure in whom I’m trying to maximize medical therapy. It’s a strategy I use somewhat sparingly though in part because of the difficulty to follow the home monitoring these patients are doing between clinic visits.

…

In this study, the self-titration plan was agreed upon in a clinic visit and then transcribed onto a paper given to the patient. The patient then used an unconnected blood pressure cuff at home with pre-set parameters for the patient to notify their primary care physician if their readings were too high or too low. Notifications of self-titration were accomplished by having the patient send in paper notifications to their primary care physician.

There are clearly a number of opportunities here to streamline the process to help make it less cumbersome for the patient and improve the monitoring of patients undertaking this kind of self-titration strategy. There are a number of wireless blood pressure cuffs on the market as well as wired devices that can transmit data through USB connections to a computer.

With the coming standardization of health data being captured by personal health devices thanks to Google Fit and Apple HealthKit, this data can then be readily transferred into the electronic health record. Practice Fusion already does that with some personal health devices; Apple and Epic are working on developing that integration as well. Trials and pilots underway at institutions like Stanford and Duke are exploring the creation of automated alert systems to help filter the data being collected with pre-specified rules as it flows into their EHR.

There are a number of limitations in this study.

…

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