scholarly journals Impact of innovation in oncology: more questions than answers

2021 ◽  
pp. 030089162110276
Author(s):  
Gianpiero Fasola ◽  
Maria Carla Barducci ◽  
Giordano Beretta
Keyword(s):  
Health Care ◽  
Death Rate ◽  
The United States ◽  
Healthcare Systems ◽  
Cancer Drug ◽  
Organizational Complexity ◽  
Number Of Patients ◽  
Sharp Growth ◽  
History Of ◽  
Consequent Increase

Oncology is going through the fastest innovation period in the history of medicine and a growing number of patients improve or experience increased chances of survival. The declining death rate, starting from 1991, resulted in 2.9 million deaths avoided in the United States so far. A growing prevalence of patients is observed in all Western countries. New cancer drug approvals between 2000 and 2016, linked to other diagnostic, surgical, and health care improvements, were significantly associated with death reduction for the most common cancers. Alongside many positive aspects, other effects of innovations in oncology also deserve attention, especially challenges associated with the substantial increase of knowledge volume, the sharp growth of prevalence, and a concomitant or consequent increase in clinical, social, and organizational complexity. We analyse some of the consequences of oncology innovation on healthcare systems and professionals and present some suggestions on how these could be addressed by healthcare systems.

Continental Divide? The Attitudes of US and Canadian Oncologists on the Costs, Cost-Effectiveness, and Health Policies Associated With New Cancer Drugs

2010 ◽  
Vol 28 (27) ◽  
pp. 4149-4153 ◽  
Author(s):  
Scott R. Berry ◽  
Chaim M. Bell ◽  
Peter A. Ubel ◽  
William K. Evans ◽  
Eric Nadler ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Cost Effectiveness ◽  
Health Care Systems ◽  
The United States ◽  
Drug Costs ◽  
Cancer Drug ◽  
Cancer Drugs ◽  
Care Systems ◽  
Effective Treatments

Purpose Oncologists in the United States and Canada work in different health care systems, but physicians in both countries face challenges posed by the rising costs of cancer drugs. We compared their attitudes regarding the costs and cost-effectiveness of medications and related health policy. Methods Survey responses of a random sample of 1,355 United States and 238 Canadian medical oncologists (all outside of Québec) were compared. Results Response rate was 59%. More US oncologists (67% v 52%; P < .001) favor access to effective treatments regardless of cost, while more Canadians favor access to effective treatments only if they are cost-effective (75% v 58%; P < .001). Most (84% US, 80% Canadian) oncologists state that patient out-of-pocket costs influence their treatment recommendations, but less than half the respondents always or frequently discuss the costs of treatments with their patients. The majority of oncologists favor more use of cost-effectiveness data in coverage decisions (80% US, 69% Canadian; P = .004), but fewer than half the oncologists in both countries feel well equipped to use cost-effectiveness information. Majorities of oncologists favor government price controls (57% US, 68% Canadian; P = .01), but less than half favor more cost-sharing by patients (29% US, 41% Canadian; P = .004). Oncologists in both countries prefer to have physicians and nonprofit agencies determine whether drugs provide good value. Conclusion Oncologists in the United States and Canada generally have similar attitudes regarding cancer drug costs, cost-effectiveness, and associated policies, despite practicing in different health care systems. The results support providing education to help oncologists in both countries use cost-effectiveness information and discuss drug costs with their patients.

Abstract TMP8: The New Alteplase Package Insert: What is the Potential Impact?

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Harn Shiue ◽  
Karen Albright ◽  
Kara Sands ◽  
April Sisson ◽  
Michael Lyerly ◽  
...  
Keyword(s):  
Health Care ◽  
Ischemic Stroke ◽  
Health Care Costs ◽  
Lifetime Cost ◽  
Package Insert ◽  
Cost Savings ◽  
Number Of Patients ◽  
History Of ◽  
Potential Impact ◽  
Care Costs

Background: Alteplase (tPA) contraindications for acute ischemic stroke (AIS) were originally derived from the 1995 NINDS trial. Recently, a history of intracranial hemorrhage (ICH) and recent stroke (within 3 months) were removed as contraindications from the drug package insert, which could increase the number of patients eligible for IV thrombolysis. We sought to define the potential impact on outcomes and health care costs in this newly eligible population. Methods: Consecutive patients (March 2014 - April 2015) who presented with AIS to our Comprehensive Stroke Center (CSC) were retrospectively analyzed. Demographics and tPA exclusions were recorded. The annual number of discharges with primary diagnosis of ischemic stroke in the U.S. was estimated from the National Inpatient Sample (2006 - 2011). A previously reported value of $25,000/patient was utilized to calculate lifetime cost savings in patients receiving tPA. Results: During the study period, 776 AIS were admitted to our CSC (median age 64; 55,74, 51% men, 62% white). Seventy-six percent of our patients (n=590) had ≥1 tPA exclusions according to the NINDS trial. Among these patients, 11 excluded had history of ICH, 15 with recent strokes, and 1 both. Following the new package insert, the proportion of patients with ≥1 tPA exclusion fell to 73% (n=563). Given the 432,000 ischemic stroke discharges annually, a 3% increase in patients eligible for tPA could translate to treatment of 12,960 more patients annually and a lifetime cost savings of $324,000,000. Furthermore, we estimate that 1,685 of these newly eligible patients will experience a favorable functional outcome based on the results of the NINDS trial (13% shift analysis for mRS 0-1). Conclusions: Our results suggest that the new tPA package insert has the potential to increase national tPA treatment rates, decrease U.S. health care costs, and improve functional outcomes in eligible AIS patients. National guidelines need to be updated to reflect these changes.

scholarly journals Empowering Health Care Professionals: An Interprofessional Education Model Implementation and Evaluation

2019 ◽  
Author(s):  
Jessica Shank Coviello
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Interprofessional Education ◽  
Healthcare Professionals ◽  
The United States ◽  
Healthcare Systems ◽  
World Health ◽  
Institute Of Medicine ◽  
Care Needs ◽  
Ensure Patient Safety

In 2016, the Institute of Medicine (IOM) reported medical error as the 3rd leading cause of death in healthcare systems in the United States. Effective communication of patient care needs across healthcare disciplines is critical to ensure patient safety, quality of care, and to improve operational efficiencies in healthcare systems. Ineffective collaboration and communication among healthcare professionals within the procedural areas increases the potential of harm as a patient moves from one healthcare professional to another. Health care systems are thus encouraged to train employees with a focus on interprofessional education (IPE) and collaborative practice. IOM and World Health Organization (WHO) recommend the use of IPE to help improve communication and collaboration. However the current educational structure in many institutions does not include IPE. As such, healthcare professionals work in silos, with little or no collaboration with one another, which may result in service duplication, increased service cost, and poor health outcomes for patients.

A Perspective on the Corporate Transformation of Health Care

1995 ◽  
Vol 25 (1) ◽  
pp. 11-42 ◽  
Author(s):  
J. Warren Salmon
Keyword(s):  
Health Care ◽  
Service Providers ◽  
Care Delivery ◽  
Mode Of Delivery ◽  
Health Sector ◽  
The United States ◽  
Dominant Mode ◽  
For Profit ◽  
Health Service Providers ◽  
History Of

The ever-increasing ownership of health service providers, suppliers, and insurers by investor-owned enterprises presents an unforeseen complexity and diversity to health care delivery. This article reviews the history of the for-profit invasion of the health sector, linking corporate purchaser directions to the now dominant mode of delivery in managed care. These dynamics require unceasing reassessment while the United States embarks upon implementation of national health care reform.

Resettlement as Securitization

2020 ◽  
pp. 74-89
Author(s):  
Fadi Saleh
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care System ◽  
The United States ◽  
Gay Marriage ◽  
Hiv Positive ◽  
Publicly Funded ◽  
The West ◽  
Conviction Rate ◽  
History Of

This first-person activist reflection discusses the author’s experience immigrating to Canada as a queer AIDS activist. The author situates his experience navigating HIV-positive-exclusionary immigration policies where the only avenue for immigrating while HIV-positive is through gay marriage. Canada maintains a draconian set of discriminatory laws regarding the so-called “excessive demand” HIV-positive immigrants put on the publicly funded health care system in Canada. This piece briefly looks at the history of HIV travel and immigration bans as well as proposed HIV quarantine legislation across Canada. While Canada is often regarded as more progressive than the United States in many ways, its HIV immigration ban and high prosecution and conviction rate for HIV nondisclosure make Canada one of the most legally precarious countries for HIV-positive people in the west.

Diabetic Data Warehouses

2011 ◽  
pp. 359-363
Author(s):  
Joseph L. Breault
Keyword(s):  
United States ◽  
Health Care ◽  
The United States ◽  
Massive Data ◽  
Data Sets ◽  
National Academy Of Sciences ◽  
Massive Data Sets ◽  
Number Of Patients ◽  
Indicator Variables ◽  
Academy Of Sciences

The National Academy of Sciences convened in 1995 for a conference on massive data sets. The presentation on health care noted that “massive applies in several dimensions . . . the data themselves are massive, both in terms of the number of observations and also in terms of the variables . . . there are tens of thousands of indicator variables coded for each patient” (Goodall, 1995, paragraph 18). We multiply this by the number of patients in the United States, which is hundreds of millions.

scholarly journals Cancer Drugs: An International Comparison of Postlicensing Price Inflation

2017 ◽  
Vol 13 (6) ◽  
pp. e538-e542 ◽  
Author(s):  
Philip Savage ◽  
Sarah Mahmoud ◽  
Yogin Patel ◽  
Hagop Kantarjian
Keyword(s):  
United States ◽  
Health Care ◽  
United Kingdom ◽  
The United States ◽  
Cancer Drug ◽  
Cancer Drugs ◽  
Price Inflation ◽  
Drug Prices ◽  
The United Kingdom ◽  
Price Increases

Purpose: The cost of cancer drugs forms a rising proportion of health care budgets worldwide. A number of studies have examined international comparisons of initial cost, but there is little work on postlicensing price increases. To examine this, we compared cancer drug prices at initial sale and subsequent price inflation in the United States and United Kingdom and also reviewed relevant price control mechanisms. Methods: The 10 top-selling cancer drugs were selected, and their prices at initial launch and in 2015 were compared. Standard nondiscounted prices were obtained from the relevant annual copies of the RED BOOK and the British National Formulary. Results: At initial marketing, prices were on average 42% higher in the United States than in the United Kingdom. After licensing in the United States, all 10 drugs had price rises averaging an overall annual 8.8% (range, 1.4% to 24.1%) increase. In comparison, in the United Kingdom, six drugs had unchanged prices, two had decreased prices, and two had modest price increases. The overall annual increase in the United Kingdom was 0.24%. Conclusion: Cancer drug prices are rising substantially, both at their initial marketing price and, in the United States, at postlicensing prices. In the United Kingdom, the Pharmaceutical Price Regulation Scheme, an agreement between the government and the pharmaceutical industry, controls health care costs while allowing a return on investment and funds for research. The increasing costs of cancer drugs are approaching the limits of sustainability, and a similar government-industry agreement may allow stability for both health care provision and the pharmaceutical industry in the United States.

scholarly journals Prevalence of Fistulizing Crohn’s Disease in the United States: Estimate From a Systematic Literature Review Attempt and Population-Based Database Analysis

2019 ◽  
Vol 25 (11) ◽  
pp. 1773-1779 ◽  
Author(s):  
David A Schwartz ◽  
Ignacio Tagarro ◽  
Mary Carmen Díez ◽  
William J Sandborn
Keyword(s):  
United States ◽  
Health Care ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Literature Review ◽  
Systematic Literature Review ◽  
The United States ◽  
Population Based ◽  
Number Of Patients ◽  
Reported Data

Abstract Background Fistulas may arise as a relevant complication of Crohn’s disease (CD). Despite their clinical significance and the substantial burden imposed on patients, limited data are available on the epidemiology of fistulizing CD in the United States. Methods A systematic literature review was conducted to identify data published between 1970 and 2017 on the epidemiology of fistulas in patients with CD, with the aim to estimate the number of prevalent cases in the United States. Retrieved titles and abstracts were screened by 2 independent researchers for inclusion criteria (US population-based studies reporting data on the epidemiology of fistulizing CD). To validate the literature-based estimate, data from a US claims database (Truven Health MarketScan database) were analyzed. This database has broad geographic coverage, with health care data for >60 million patients during the period of the analysis. Results The literature search retrieved 7 articles for full-text review, and only 1 met the criteria for inclusion. This study described the cumulative incidence of fistulas in a CD population from Minnesota over 20 years. From the reported data, the estimated number of prevalent cases with fistulizing CD in the United States was ~76,600 in 2017 (~52,900 anal, ~7400 rectovaginal, ~2300 enterocutaneous, and ~14,100 internal). Analysis from the US health care database resulted in an estimated number of ~75,700 patients, confirming the robustness of the original estimate from the literature. Conclusions Based on 2 separate analyses, the estimated number of patients with fistulizing CD in the United States is ~77,000 patients.

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