Overcoming obstacles to effective care of type 2 diabetes.

Type 2 diabetes mellitus affects more than 24 million people in the United States. The healthcare system up to this point has not been able to combat the diet and lifestyle trends that have led to the prevalence of this disease. Even though many excellent options exist for patients with diabetes, most are not meeting their glycemic goals. Despite all of the obstacles, with the proper attention, education, and current practice modifications, optimal patient-centered diabetes care in the United States can become a reality.

Myelodysplastic syndromes: health care management considerations.

Costs associated with treating cancers such as MDS are increasing as new medicines are developed and combination regimens gain hold. This trend presents an important challenge to MCOs who must respond to changing protocols and rising costs. Whereas the new oncology medications offer a unique opportunity to improve outcomes in patients with MDS, they also demand high financial outlay, which in turn necessitates adjustments in benefits programs. As payers look to manage expenses in ways that satisfy all stakeholders, increasing importance is placed on scientific evidence, survival and QoL benefits, tolerability factors, and evidence-based standards of care. In the treatment of higher-risk MDS, this means weighing those differences between the two hypomethylating agents approved for this indication--azacitidine and decitabine--in terms of proven effectiveness, safe delivery, and survival gains validated in clinical trials as well as potentially reduced costs related to administration method and fewer treatment-related toxicities. The future of MDS treatment in the managed care setting will require complex decision making to determine new treatment guidelines, benefit design, reimbursement plans, ethical considerations, and formulary development. Economic and clinical strategies must aim to make optimal use of novel treatment approaches while meeting the financial objectives of MCOs. The goal is improved patient outcomes at reasonable cost, a challenge that will be addressed only with continued discussion and study. The therapies azacitidine and decitabine may offer a good model for decision making to drive best treatment for MDS while moderating cost.

Translating cancer trial endpoints into the language of managed care.

Oncology endpoints are an essential component of cancer trials, but often they are confusing, making it difficult to evaluate cancer therapies based on trial data. As more oncology agents hit the market and as indications expand for existing products, familiarity with these endpoints is critical for payers when making coverage decisions.