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https://www.readbyqxmd.com/read/28436209/medication-prior-authorization-in-pediatric-hematology-and-oncology
#1
David S Dickens, Brad H Pollock
BACKGROUND: Medication prior authorization (PA) is a commonly occurring requirement, particularly for medications used for rare conditions. Based on standard definitions, cancer and many blood disorders affecting children are rare. The study aims were to describe the relative frequency of PA requests and their association with payers and medications in order to identify opportunities to improve system efficiency. PROCEDURE: Requests for medication PA were logged prospectively for patients seen at a single institution over a 7-month period...
June 2017: Pediatric Blood & Cancer
https://www.readbyqxmd.com/read/28435485/impact-of-health-policy-changes-on-emergency-medicine-in-maryland-stratified-by-socioeconomic-status
#2
Laura Pimentel, David Anderson, Bruce Golden, Edward Wasil, Fermin Barrueto, Jon M Hirshon
INTRODUCTION: On January 1, 2014, the financing and delivery of healthcare in the state of Maryland (MD) profoundly changed. The insurance provisions of the Patient Protection and Affordable Care Act (ACA) began implementation and a major revision of MD's Medicare waiver ushered in a Global Budget Revenue (GBR) structure for hospital reimbursement. Our objective was to analyze the impact of these policy changes on emergency department (ED) utilization, hospitalization practices, insurance profiles, and professional revenue...
April 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28434387/cost-utility-of-biological-treatment-sequences-for-luminal-crohn-s-disease-in-europe
#3
Fanni Rencz, László Gulácsi, Márta Péntek, Krisztina B Gecse, Axel Dignass, Jonas Halfvarson, Fernando Gomollón, Petra Baji, Laurent Peyrin-Biroulet, Péter L Lakatos, Valentin Brodszky
OBJECTIVES: To compare the cost-effectiveness of treatment sequences with available biologics, including adalimumab (ADA), biosimilar infliximab (bsIFX), originator infliximab (IFX) and vedolizumab (VEDO) for luminal Crohn's disease in nine European countries. METHODS: A Markov-model was constructed to simulate five-year medical costs and quality-adjusted life years (QALYs). Data on clinical efficacy were obtained from randomised controlled trials. Country-specific unit costs, discount rates and a third-party payer perspective were applied...
April 24, 2017: Expert Review of Pharmacoeconomics & Outcomes Research
https://www.readbyqxmd.com/read/28433337/increased-resource-utilization-and-overall-morbidity-are-associated-with-general-versus-regional-anesthesia-for-carotid-endarterectomy-in-data-collected-by-the-michigan-surgical-quality-collaborative
#4
Ahmad S Hussain, Andrew Mullard, William F Oppat, Kevin D Nolan
OBJECTIVE: Advocates for performing carotid endarterectomy (CEA) under regional anesthesia (RA) cite reduction in hemodynamic instability and the ability for neurologic monitoring, but many still prefer general anesthesia (GA) as benefits of RA have not been clearly demonstrated, reliable RA may not be available in all centers, and a certain amount of movement by the patient during the procedure may not be uniformly tolerated. We evaluated the association of anesthesia type and perioperative morbidity and mortality as well as resource utilization in patients undergoing CEA using the Michigan Surgical Quality Collaborative (MSQC) database...
April 19, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28433325/the-role-of-private-non-profit-healthcare-organizations-in-nhs-systems-implications-for-the-portuguese-hospital-devolution-program
#5
REVIEW
Álvaro S Almeida
The national health services (NHS) of England, Portugal, Finland and other single-payer universalist systems financed by general taxation, are based on the theoretical principle of an integrated public sector payer-provider. However, in practice one can find different forms of participation of non-public healthcare providers in those NHS, including private for profit providers, but also third sector non-profit organizations (NPO). This paper reviews the role of non-public non-profit healthcare organizations in NHS systems...
April 1, 2017: Health Policy
https://www.readbyqxmd.com/read/28431415/potential-impact-of-affordable-care-act-related-insurance-expansion-on-trauma-care-reimbursement
#6
John W Scott, Pooja U Neiman, Peter A Najjar, Thomas C Tsai, Kirstin W Scott, Mark G Shrime, David M Cutler, Ali Salim, Adil H Haider
BACKGROUND: Nearly one quarter of trauma patients are uninsured and hospitals recoup less than 20% of inpatient costs for their care. This study examines changes to hospital reimbursement for inpatient trauma care if the full coverage expansion provisions of the Affordable Care Act (ACA) were in effect. METHODS: We abstracted nonelderly adults (ages 18-64 years) admitted for trauma from the Nationwide Inpatient Sample during 2010-the last year before most major ACA coverage expansion policies...
May 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28430557/utilization-management-of-high-cost-imaging-in-an-outpatient-setting-in-a-large-stable-patient-and-provider-cohort-over-7-years
#7
Jeffrey B Weilburg, Christopher L Sistrom, Daniel I Rosenthal, Markus B Stout, Keith J Dreyer, Helaine R Rockett, Jason M Baron, Timothy G Ferris, James H Thrall
Purpose To quantify the effect of a comprehensive, long-term, provider-led utilization management (UM) program on high-cost imaging (computed tomography, magnetic resonance imaging, nuclear imaging, and positron emission tomography) performed on an outpatient basis. Materials and Methods This retrospective, 7-year cohort study included all patients regularly seen by primary care physicians (PCPs) at an urban academic medical center. The main outcome was the number of outpatient high-cost imaging examinations per patient per year ordered by the patient's PCP or by any specialist...
April 21, 2017: Radiology
https://www.readbyqxmd.com/read/28429667/sex-based-disparities-in-venous-thromboembolism-outcomes-a-national-inpatient-sample-nis-based-analysis
#8
Ariela L Marshall, Adam C Bartley, Aneel A Ashrani, Rajiv K Pruthi, Urshila Durani, Wilson I Gonsalves, Prashant Kapoor, Shahrukh K Hashmi, Mustaqeem A Siddiqui, Ronald S Go
Venous thromboembolism (VTE) contributes to significant morbidity, mortality, and socioeconomic burden. There is a paucity of literature regarding sex-based sociodemographic differences in VTE presentation and short-term outcomes. We aimed to compare clinical outcomes between men and women hospitalized for VTE management. We performed a retrospective analysis using data from the National Inpatient Sample (NIS) database from 2012 to 2013. Inclusion criteria were age 18 years and older and a primary discharge diagnosis of VTE...
April 2017: Vascular Medicine
https://www.readbyqxmd.com/read/28428169/assessing-the-medication-adherence-app-marketplace-from-the-health-professional-and-consumer-vantage-points
#9
Lindsey E Dayer, Rebecca Shilling, Madalyn Van Valkenburg, Bradley C Martin, Paul O Gubbins, Kristie Hadden, Seth Heldenbrand
BACKGROUND: Nonadherence produces considerable health consequences and economic burden to patients and payers. One approach to improve medication nonadherence that has gained interest in recent years is the use of smartphone adherence apps. The development of smartphone adherence apps has increased rapidly since 2012; however, literature evaluating the clinical app and effectiveness of smartphone adherence apps to improve medication adherence is generally lacking. OBJECTIVE: The aims of this study were to (1) provide an updated evaluation and comparison of medication adherence apps in the marketplace by assessing the features, functionality, and health literacy (HL) of the highest-ranking adherence apps and (2) indirectly measure the validity of our rating methodology by determining the relationship between our app evaluations and Web-based consumer ratings...
April 19, 2017: JMIR MHealth and UHealth
https://www.readbyqxmd.com/read/28427466/determinants-of-orphan-drugs-prices-in-france-a-regression-analysis
#10
Daria Korchagina, Aurelie Millier, Anne-Lise Vataire, Samuel Aballea, Bruno Falissard, Mondher Toumi
BACKGROUND: The introduction of the orphan drug legislation led to the increase in the number of available orphan drugs, but the access to them is often limited due to the high price. Social preferences regarding funding orphan drugs as well as the criteria taken into consideration while setting the price remain unclear. The study aimed at identifying the determinant of orphan drug prices in France using a regression analysis. METHODS: All drugs with a valid orphan designation at the moment of launch for which the price was available in France were included in the analysis...
April 21, 2017: Orphanet Journal of Rare Diseases
https://www.readbyqxmd.com/read/28426345/economic-evaluation-of-ezetimibe-treatment-in-combination-with-statin-therapy-in-the-united-states
#11
Glenn M Davies, Ami Vyas, Carl A Baxter
AIMS: This study assessed the cost-effectiveness of ezetimibe with statin therapy versus statin monotherapy from a United States (US) payer perspective, assuming the impending patent expiration of ezetimibe. METHODS: A Markov-like economic model consisting of 28 distinct health states was used. Model population data were obtained from US linked claims and electronic medical records, with inclusion criteria based on diagnostic guidelines. Inputs came from recent clinical trials, meta-analyses, and cost-effectiveness analyses...
April 20, 2017: Journal of Medical Economics
https://www.readbyqxmd.com/read/28426186/issue-at-the-heart-of-advancing-the-de-adoption-of-low-value-care-proceedings-from-an-expert-roundtable
#12
Janet Weiner, Rebecka Rosenquist
Identifying and paying for value has become a recurrent theme of health care reforms. Its corollary, reducing the prevalence of, and resources directed to, ineffective or marginally effective care, has received far less attention. In July 2016, the University of Pennsylvania’s Leonard Davis Institute of Health Economics (LDI) convened a diverse set of national leaders and stakeholders representing industry, think-tanks, provider and patient groups, and academic experts to tackle how health systems, payers, and providers can spur the ‘de-adoption’ of medical practices and technologies no longer considered valuable...
April 2017: LDI Issue Brief
https://www.readbyqxmd.com/read/28424057/personalized-medicine-in-europe-not-yet-personal-enough
#13
Antonello Di Paolo, François Sarkozy, Bettina Ryll, Uwe Siebert
BACKGROUND: Personalized medicine has the potential to allow patients to receive drugs specific to their individual disease, and to increase the efficiency of the healthcare system. There is currently no comprehensive overview of personalized medicine, and this research aims to provide an overview of the concept and definition of personalized medicine in nine European countries. METHODS: A targeted literature review of selected health databases and grey literature was conducted to collate information regarding the definition, process, use, funding, impact and challenges associated with personalized medicine...
April 19, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28423460/individual-and-neighborhood-characteristics-of-children-seeking-emergency-department-care-for-firearm-injuries-within-the-pecarn-network
#14
Patrick M Carter, Lawrence J Cook, Michelle L Macy, Mark R Zonfrillo, Rachel M Stanley, James M Chamberlain, Joel A Fein, Elizabeth R Alpern, Rebecca Cunningham
OBJECTIVE: To describe the characteristics of children seeking emergency care for firearm injuries within the PECARN network, and assess the influence of both individual and neighborhood factors on firearm-related injury risk. METHODS: This was a retrospective, multicenter cross-sectional analysis of children (<19-years-old) presenting to 16 pediatric EDs (2004-2008). ICD-9-CM E-codes were used to identify and categorize firearm injuries by mechanism/intent. Neighborhood variables were derived from home address data...
April 19, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28423111/-what-is-purchased-how-and-from-whom-by-seguro-popular-in-mexico-experience-with-strategic-purchasing-at-national-level-and-in-a-pioneer-institution
#15
Miguel Ángel González-Block
Objective: To analyze the scope of demand subsidies through strategic purchasing of health services. Materials and methods: Interviews and document analyses at national level and a case study of the state of Hidalgo. Results: SPSS explicitly prioritizes interventions to be financed and regulates prices and expenditure ceilings. Public providers are predominantly funded through the purchasing of inputs and the contracting of human resources, in the absence of competition and with a low degree of managerial autonomy...
January 2017: Salud Pública de México
https://www.readbyqxmd.com/read/28421454/quality-indicators-in-endoscopic-ablation-for-barrett-s-esophagus
#16
REVIEW
Samuel Han, Sachin Wani
Barrett's esophagus (BE) is a well-established premalignant condition for esophageal adenocarcinoma (EAC); a cancer that is associated with a poor 5-year survival rate. Several strategies have been explored in the context of reducing the burden of EAC. Endoscopic eradication therapy (EET) is considered the standard of care for the management of patients with BE with dysplasia and early neoplasia; a practice that has been endorsed by all gastroenterology societal guidelines. The effectiveness of EET has been demonstrated in multiple studies and contemporary management includes a combination of endoscopic mucosal resection (EMR) of all visible lesions followed by eradication of the remaining BE using ablative techniques of which radiofrequency ablation (RFA) has the best evidence supporting effectiveness and safety...
April 18, 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28420990/managed-entry-agreements-for-oncology-drugs-lessons-from-the-european-experience-to-inform-the-future
#17
Kim Pauwels, Isabelle Huys, Sabine Vogler, Minne Casteels, Steven Simoens
Objectives: The aim of this study is to conduct an analysis on the regulation and application of managed entry agreements (MEA) for oncology drugs across different European countries. Methods: Literature search and document analysis were performed between September 2015 and June 2016 to collect information on the regulatory framework and practice of MEA in Belgium, The Netherlands, Scotland, England and Wales, Sweden, Italy, Czech Republic and France. An overview of the content and typology of MEA applied for oncology drugs between 2008 and 2015 was generated based on publically available sources and contributions by national health authorities...
2017: Frontiers in Pharmacology
https://www.readbyqxmd.com/read/28420648/association-of-magnet-status-with-hospitalization-outcomes-for-ischemic-stroke-patients
#18
Kimon Bekelis, Symeon Missios, Todd A MacKenzie
BACKGROUND: It is not clear whether Magnet recognition by the American Nurses Credentialing Center (nursing excellence program) is associated with improved patient outcomes. We investigated whether hospitalization in a Magnet hospital is associated with improved outcomes for patients with ischemic stroke. METHODS AND RESULTS: We performed a cohort study of patients with ischemic stroke from 2009 to 2013, who were registered in the New York Statewide Planning and Research Cooperative System database...
April 18, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28418451/cost-effectiveness-of-common-diagnostic-approaches-for-evaluation-of-asymptomatic-microscopic-hematuria
#19
Joshua A Halpern, Bilal Chughtai, Hassan Ghomrawi
Importance: Asymptomatic microscopic hematuria (AMH) is highly prevalent and may signal occult genitourinary (GU) malignant abnormality. Common diagnostic approaches differ in their costs and effectiveness in detecting cancer. Given the low prevalence of GU malignant abnormality among patients with AMH, it is important to quantify the cost implications of detecting cancer for each approach. Objective: To estimate the effectiveness, costs, and incremental cost per cancer detected (ICCD) for 4 common diagnostic approaches evaluating AMH...
April 17, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28418263/systematic-bias-in-predictions-of-new-drugs-budget-impact-analysis-of-a-sample-of-recent-us-drug-launches
#20
Michael S Broder, Jenelle M Zambrano, Jackie Lee, Richard S Marken
OBJECTIVE: Expectations about the budget impact of new drug launches may affect payer behavior and ultimately consumer costs. Therefore, we evaluated the accuracy of pre-launch US budget impact estimates for a sample of new drugs. METHODS: We searched for publicly available budget impact estimates made pre-launch for drugs approved in the US from 1(st) September 2010 to 1(st) September 2015 and compared them to actual sales. Accuracy was calculated as the ratio of pre-launch estimate to actual sales...
April 18, 2017: Current Medical Research and Opinion
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