Health Policy Updates: November 4 2017

The newly-reported results of the ORBITA clinical trial caught my eye this week. Patients with chronic, stable angina with severe coronary blockages were randomized to angioplasty+stenting vs. ongoing medical therapy alone. Interestingly, the medical therapy patients also received a “sham” cardiac procedure, so the patients were blinded to whether or not they had actually received PCI. There was no significant improvement in angina symptoms with PCI, as measured by exercise duration. Does this mean that the huge number of stents placed annually in the US for angina symptoms is not money well-spent?


This is the 21st Century. Why does the US health care system still communicate via fax? Vox.com’s Sarah Kliff reports:

“The story of the fax machine’s dominant role in medicine is also the story of a government incentive program that badly misread the economics of American health care. The Obama administration spent upward of $30 billion encouraging American hospitals and doctor offices to switch from paper to electronic records…But the program didn’t account for a critical need: sharing. Hospital and doctor offices generally remain unable to transfer electronic information to other hospitals and doctor offices. Billions of dollars later, they are left printing out documents and faxing them…Obama officials believed competing health systems would volunteer to share patient data. They now admit that was naive.”


More data out this week that physician relationships with the pharmaceutical industry tend to lead to greater prescribing of more expensive, brand-name drugs over generic alternatives. Is this an important component of growing US health care costs?
“Gifts had a dose-response effect on the average cost per claim and the proportion of branded claims. Even small gifts may have a large impact on prescribing practices. Our results show that healthcare providers who received gifts totaling less than $500 a year prescribed more expensive medications than prescribers who did not receive gifts ($114 vs. $85), with even higher cost and proportion of branded drugs prescribed by those receiving larger gifts.”

 This is an area in which I had never thought about conflicts of interest with industry before – pathology diagnosis of cancer. Many of the expensive new cancer immunotherapy drugs are only indicated for cancers with certain levels of expression in certain genes. Pathologists can face pressure to say that given tumor specimens meet those thresholds in order to qualify patients for therapy – which is what the pharmaceutical companies want.
“The biomedical industry, however, is not a careless investor. Given the high cost of drugs like Keytruda and others whose use depends on companion diagnostics, even a small influence over the pathologists who may act as gatekeepers for them can produce an enormous return on investment for the industry…Previous research has shown that even meals worth $20 or less may affect physician decision-making.”

 

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