RESUMO
BACKGROUND: Little is known about factors associated with emphysema progression in cigarette smokers. We evaluated factors associated with change in emphysema and forced expiratory volume in 1 second (FEV1) in participants with and without chronic obstructive pulmonary disease (COPD). METHODS: This retrospective study included individuals participating in the COPD Genetic Epidemiology study who completed the 5-year follow-up, including inspiratory and expiratory computed tomography (CT) and spirometry. All paired CT scans were analyzed using micro-mapping, which classifies individual voxels as emphysema or functional small airway disease (fSAD). Presence and progression of emphysema and FEV1 were determined based on comparison to nonsmoker values. Logistic regression analyses were used to identify clinical parameters associated with disease progression. RESULTS: A total of 3088 participants were included with a mean ± SD age of 60.7±8.9 years, including 72 nonsmokers. In all Global initiative for chronic Obstructive Lung Disease (GOLD) stages, the presence of emphysema at baseline was associated with emphysema progression (odds ratio [OR]: GOLD 0: 4.32; preserved ratio-impaired spirometry [PRISm]; 5.73; GOLD 1: 5.16; GOLD 2: 5.69; GOLD 3/4: 5.55; all p ≤0.01). If there was no emphysema at baseline, the amount of fSAD at baseline was associated with emphysema progression (OR for 1% increase: GOLD 0: 1.06; PRISm: 1.20; GOLD 1: 1.7; GOLD 3/4: 1.08; all p ≤ 0.03).In 1735 participants without spirometric COPD, progression in emphysema occurred in 105 (6.1%) participants and only 21 (1.2%) had progression in both emphysema and FEV1. CONCLUSIONS: The presence of emphysema is an important predictor of emphysema progression. In patients without emphysema, fSAD is associated with the development of emphysema. In participants without spirometric COPD, emphysema progression occurred independently of FEV1 decline.
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UPMC Health Plan gets a discount if a patient on Brilinta has a heart attack or stroke. The novel sweetener is that UPMC will lower the monthly copay for Brilinta from $45 to $10, which means the patient cost will be about the same as it is for generic Plavix.
Assuntos
Medicamentos Genéricos/economia , Ticagrelor/economia , Clopidogrel , Humanos , SeguroRESUMO
The annual pharmacy costs for single tablet regimens were $6,100 less compared with regimens involving multiple pills, at least among HIV patients who were taking the medicines as intended, according to an Express Scripts analysis. On average, the company found that health plans could save about $4,160 per patient per year.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/economia , HIV , Humanos , Adesão à Medicação , Assistência Farmacêutica/economiaRESUMO
With accumulators, the value of any copay assistance cards or coupons does not count toward out-of-pocket medicine costs that are applied toward deductibles. It's a cost-shifting tool that's facing pushback from patients, providers, and others saying that accumulators will hurt public health.
Assuntos
Alocação de Custos/economia , Dedutíveis e Cosseguros/economia , Custos de Medicamentos/estatística & dados numéricos , Programas de Assistência Gerenciada/economia , Uso de Medicamentos/economia , Humanos , Política Pública , Estados UnidosRESUMO
Many first-year field students and new practitioners enter the "fog of practice" seeking a strong mentor who will teach them to survive and thrive in the practice world. They are armed with much social work-related ideology but perhaps too little organizational knowledge and savvy. This challenge may be traced back to another historical professional debate: the imbalance between micro and macro social work education and training. This article addresses the challenge by introducing the overarching competency of organizational empathy, defined as an understanding of the practice environment one occupies. The major objective of this article is to help bridge an academe-practice knowledge gap, thereby giving the social work practitioner enhanced opportunities for broader organizational influence, collaboration, and leadership.
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Currículo , Empatia , Modelos Organizacionais , Serviço Social/educação , Serviço Social/organização & administração , Competência Clínica , Humanos , Liderança , TutoriaRESUMO
A state senator who describes insulin prices as "outrageous" introduced a transparency bill that requires drugmakers to report pricing, costs, and rebates. Other states might make similar moves, and the pharmaceutical industry is suddenly on edge, with PhRMA and BIO fighting the law in court.
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Indústria Farmacêutica/legislação & jurisprudência , Hipoglicemiantes/economia , Revelação da Verdade , NevadaRESUMO
The CAR-T therapy may pass ICER cost-effectiveness muster, but can the health care system afford more drugs like it?
Assuntos
Antineoplásicos/uso terapêutico , Tomada de Decisões , Custos de Medicamentos/estatística & dados numéricos , Indústria Farmacêutica/economia , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Receptores de Antígenos de Linfócitos T/uso terapêutico , Criança , Análise Custo-Benefício , Humanos , Anos de Vida Ajustados por Qualidade de Vida , Indução de RemissãoRESUMO
The PBM unit of the health giant CVS decided that any new drug exceeding $100,000 per quality-adjusted life year (QALY) may be excluded from the formularies that are maintained by its clients. Patient groups (with the backing of pharma) say that the measure is discriminatory.
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Preparações Farmacêuticas/economia , Anos de Vida Ajustados por Qualidade de Vida , Análise Custo-Benefício , Formulários Farmacêuticos como Assunto , HumanosRESUMO
Lawmakers asked seven companies to explain not only "skyrocketing prices," but a practice known as shadow pricing in which a drugmaker increases the price of an existing medicine to match the price hike or higher price set for a new drug launched by another company.
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Custos de Medicamentos/estatística & dados numéricos , Indústria Farmacêutica/economia , Competição Econômica , Política de Saúde , Humanos , Estados UnidosRESUMO
Harvard Pilgrim's program gives rebates to beneficiaries if Repatha doesn't help them avoid a heart attack or stroke. It's just the latest in a growing number of outcomes-based pricing agreements in which an insurer can get a discount from a drugmaker if a drug doesn't help patients as much as expected.
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Seguradoras , Acidente Vascular Cerebral , Custos e Análise de Custo , HumanosRESUMO
Sales of orphan drugs are forecast to grow 11% over the next five years, to $209 billion. That growth rate is twice as fast as the expected increase in sales of all other prescription medicines. They may account for more than 21% of brand-name prescription drug sales by 2022.
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Custos de Medicamentos , Produção de Droga sem Interesse Comercial , Medicamentos GenéricosRESUMO
The dispute centers on dueling interpretations of the Biologics Price Competition and Innovation Act, which says a company seeking to sell a biosimilar must give the maker of the brand-name biologic at least a 180-day notice before selling its drug.
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Medicamentos Biossimilares/economia , Comércio/legislação & jurisprudência , Indústria Farmacêutica/legislação & jurisprudência , Patentes como Assunto/legislação & jurisprudência , Aprovação de Drogas , Humanos , Fatores de Tempo , Estados Unidos , United States Food and Drug AdministrationAssuntos
Rotulagem de Medicamentos/normas , Controle de Medicamentos e Entorpecentes/legislação & jurisprudência , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Ideação Suicida , Tentativa de Suicídio/prevenção & controle , Adulto , Humanos , Masculino , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Tentativa de Suicídio/psicologia , Estados Unidos/epidemiologiaAssuntos
Custos de Medicamentos/legislação & jurisprudência , Hepatite C/tratamento farmacológico , Seguro Saúde , Combinação de Medicamentos , Compostos Macrocíclicos/economia , Ritonavir/economia , Sofosbuvir/economia , Sulfonamidas/economia , Estados Unidos , Uracila/análogos & derivados , Uracila/economiaRESUMO
Historically, it's rare for commercial payers to have drug formularies for medical benefits, but that's changing. In effect, health plans are, in some ways, choosing drugs they prefer, based on their judgments about safety and efficacy, as well as availability, lowest net cost, and how a drug is administered.
Assuntos
Produtos Biológicos , Formulários Farmacêuticos como Assunto , Custos e Análise de Custo , Custos de Medicamentos , Estados UnidosRESUMO
Current versions by ASCO, and others may not be right for insurers, but they are eyeing new ways to crunch the numbers for cost and outcomes.