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Health Affairs

Timothy Stoltzfus Jost
As federal efforts to stabilize the individual market foundered on abortion coverage, states adopted a variety of approaches. The 2019 payment notice broadened states' options in implementing the ACA.
May 14, 2018: Health Affairs
Kenneth E Thorpe, Peter Joski, Kenton J Johnston
Antibiotic-resistant infections are a global health care concern. The Centers for Disease Control and Prevention estimates that 23,000 Americans with these infections die each year. Rising infection rates add to the costs of health care and compromise the quality of medical and surgical procedures provided. Little is known about the national health care costs attributable to treating the infections. Using data from the Medical Expenditure Panel Survey, we estimated the incremental health care costs of treating a resistant infection as well as the total national costs of treating such infections...
March 21, 2018: Health Affairs
Cinnamon S Bloss, Justin Stoler, Cynthia E Schairer, Sara B Rosenthal, Cynthia Cheung, Holly M Rus, Jessica L Block, Jiue-An Jay Yang, Doug Morton, Helen Bixenman, David Wellis
A goal of the Precision Medicine Initiative All of Us Research Program (AoURP) is recruitment of participants who reflect the diversity of the US. Recruitment from among blood bank donors, which may better reflect the demographic makeup of local communities, is one proposed strategy. We evaluated this strategy by analyzing the results of a survey of San Diego Blood Bank donors conducted in November 2015. Whites were more likely than nonwhites to respond to the survey (7.1 percent versus 3.9 percent). However, race was not a significant predictor of interest in participating in precision medicine research...
May 2018: Health Affairs
Latrice G Landry, Nadya Ali, David R Williams, Heidi L Rehm, Vence L Bonham
Precision medicine is predicted to revolutionize the clinical practice of medicine, in part by using molecular biomarkers to assess patients' risk, prognosis, and therapeutic response more precisely. However, reliance on biomarkers could present challenges for diverse populations that are not equitably represented in precision medicine research. We examined the populations included in genomic studies whose data were available in the following two public databases: the Genome-Wide Association Study Catalog and the database of Genotypes and Phenotypes...
May 2018: Health Affairs
L Daniel Muldoon, Pamela M Pelizzari, Kelsey A Lang, Joe Vandigo, Bruce S Pyenson
New oncology therapies can contribute to survival or quality of life, but payers and policy makers have raised concerns about the cost of these therapies. Similar concerns extend beyond cancer. In seeking a solution, payers are increasingly turning toward value-based payment models in which providers take financial risk for costs and outcomes. These models, including episode payment and bundled payment, create financial gains for providers who reduce cost, but they also create concerns about potential stinting on necessary treatments...
May 2018: Health Affairs
Megan C Roberts, W David Dotson, Christopher S DeVore, Erica M Bednar, Deborah J Bowen, Theodore G Ganiats, Ridgely Fisk Green, Georgia M Hurst, Alisdair R Philp, Charité N Ricker, Amy C Sturm, Angela M Trepanier, Janet L Williams, Heather A Zierhut, Katherine A Wilemon, Heather Hampel
Cascade screening is the process of contacting relatives of people who have been diagnosed with certain hereditary conditions. Its purpose is to identify, inform, and manage those who are also at risk. We conducted a scoping review to obtain a broad overview of cascade screening interventions, facilitators and barriers to their use, relevant policy considerations, and future research needs. We searched for relevant peer-reviewed literature in the period 1990-2017 and reviewed 122 studies. Finally, we described 45 statutes and regulations related to the use and release of genetic information across the fifty states...
May 2018: Health Affairs
Ameet Sarpatwari, Reed F Beall, Abdurrahman Abdurrob, Mengdong He, Aaron S Kesselheim
For thirty-five years the Orphan Drug Act of 1983 has provided incentives for pharmaceutical manufacturers to develop drugs to treat rare diseases-conditions that affect fewer than 200,000 people in the US. One key statutory incentive is an exclusive seven-year marketing right for the rare disease indication, which has been heralded as driving a dramatic increase in the number of rare disease treatments. However, most new drugs are also protected by patents. In this study we assessed all new small-molecule drugs approved in the period 1985-2014 that had at least one indication for an orphan-designated disease as of January 1, 2017...
May 2018: Health Affairs
Lincoln D Nadauld, James M Ford, Daryl Pritchard, Thomas Brown
Despite rapid advances in molecular diagnostics and targeted therapeutics, the adoption of precision medicine into clinical oncology workflows has been slow. Questions about clinical utility, inconsistent reimbursement for molecular diagnostics, and limited access to targeted therapies are some of the major hurdles that have hampered clinical adoption. Despite these challenges, providers have invested in precision medicine programs in an ongoing search for innovative care models to deliver improved patient outcomes and achieve economic gains...
May 2018: Health Affairs
Lisa B Feng, Scott D Grosse, Ridgely Fisk Green, Aliza K Fink, Gregory S Sawicki
Cystic fibrosis is a life-threatening genetic disease that causes severe damage to the lungs. Ivacaftor, the first drug that targeted the underlying defect of the disease caused by specific mutations, is a sterling example of the potential of precision medicine. Clinical trial and registry studies showed that ivacaftor improved outcomes and reduced hospitalizations. Our study used US administrative claims data to assess the real-world effectiveness of ivacaftor. Comparing twelve-month rates before and after starting the use of ivacaftor among people who initiated therapy during 2012-2015, we found that overall and cystic fibrosis-related inpatient admissions fell by 55 percent and 81 percent, respectively...
May 2018: Health Affairs
Benjamin S Wilfond, Tia L Kauffman, Gail P Jarvik, Jacob A Reiss, C Sue Richards, Carmit McMullen, Marian Gilmore, Patricia Himes, Stephanie A Kraft, Kathryn M Porter, Jennifer L Schneider, Sumit Punj, Michael C Leo, John F Dickerson, Frances L Lynch, Elizabeth Clarke, Alan F Rope, Kevin Lutz, Katrina A B Goddard
Genomics-based carrier screening is one of many opportunities to use genomic information to inform medical decision making, but clinicians, health care delivery systems, and payers need to determine whether to offer screening and how to do so in an efficient, ethical way. To shed light on this issue, we conducted a study in the period 2014-17 to inform the design of clinical screening programs and guide further health services research. Many of our results have been published elsewhere; this article summarizes the lessons we learned from that study and offers policy insights...
May 2018: Health Affairs
Vineeta Agarwala, Sean Khozin, Gaurav Singal, Claire O'Connell, Deborah Kuk, Gerald Li, Anala Gossai, Vincent Miller, Amy P Abernethy
The majority of US adult cancer patients today are diagnosed and treated outside the context of any clinical trial (that is, in the real world). Although these patients are not part of a research study, their clinical data are still recorded. Indeed, data captured in electronic health records form an ever-growing, rich digital repository of longitudinal patient experiences, treatments, and outcomes. Likewise, genomic data from tumor molecular profiling are increasingly guiding oncology care. Linking real-world clinical and genomic data, as well as information from other co-occurring data sets, could create study populations that provide generalizable evidence for precision medicine interventions...
May 2018: Health Affairs
Marc S Williams, Adam H Buchanan, F Daniel Davis, W Andrew Faucett, Miranda L G Hallquist, Joseph B Leader, Christa L Martin, Cara Z McCormick, Michelle N Meyer, Michael F Murray, Alanna K Rahm, Marci L B Schwartz, Amy C Sturm, Jennifer K Wagner, Janet L Williams, Huntington F Willard, David H Ledbetter
Health care delivery is increasingly influenced by the emerging concepts of precision health and the learning health care system. Although not synonymous with precision health, genomics is a key enabler of individualized care. Delivering patient-centered, genomics-informed care based on individual-level data in the current national landscape of health care delivery is a daunting challenge. Problems to overcome include data generation, analysis, storage, and transfer; knowledge management and representation for patients and providers at the point of care; process management; and outcomes definition, collection, and analysis...
May 2018: Health Affairs
(no author information available yet)
Every human being has twenty-three chromosomes and thousands of genes. Precision medicine aims to assess risk and customize treatment for specific genetic variants and disease characteristics associated with these human building blocks. Large databases of genetic information are needed to locate the best targets for specific therapies. This month's DataGraphic focuses on precision medicine's rapid growth in the past two decades in genetic tests and therapies and its successes in prolonging life and cutting some costs...
May 2018: Health Affairs
Alessandro Blasimme, Marta Fadda, Manuel Schneider, Effy Vayena
Data sharing is a precondition of precision medicine. Numerous organizations have produced abundant guidance on data sharing. Despite such efforts, data are not being shared to a degree that can trigger the expected data-driven revolution in precision medicine. We set out to explore why. Here we report the results of a comprehensive analysis of data-sharing guidelines issued over the past two decades by multiple organizations. We found that the guidelines overlap on a restricted set of policy themes. However, we observed substantial fragmentation in the policy landscape across specific organizations and data types...
May 2018: Health Affairs
(no author information available yet)
No abstract text is available yet for this article.
May 2018: Health Affairs
Lisette Pregelj, Thomas J Hwang, Damian C Hine, Evan B Siegel, Ross T Barnard, Jonathan J Darrow, Aaron S Kesselheim
Precision medicines can benefit patients by increasing the probability of a successful treatment response in selected patient populations. The potential for more immediate signals of efficacy during clinical trials suggests such medicines will reach the market more rapidly than traditional drugs will. Using data from the Food and Drug Administration (FDA), we examined the regulatory review and pivotal trial characteristics of precision medicines. We found that in the period January 2013-June 2017, precision medicines were developed and reviewed almost two years faster than nonprecision medicines...
May 2018: Health Affairs
James M Schuster, Charles F Reynolds, Tracy Carney
No abstract text is available yet for this article.
May 2018: Health Affairs
Siddhartha Mukherjee
Advanced medical technologies make it easier to identify people at risk for cancer, but there are risks involved in oversurveillance, too.
May 2018: Health Affairs
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