Unbiased Analysis of Today's Healthcare Issues

After 190 failed tries…

Written By: Jason Shafrin - Jun• 29•16

Why are pharmaceuticals so expensive?  One reasons is that there is a lot of research that goes into developing a drug.  Most of that research results in drugs that don’t work.  One example is the search for Alzheimer’s treatment.  As Bloomberg reports:

Drug companies have long focused on a different protein called amyloid that clumps in the brains of Alzheimer’s patients and is thought to trigger the disease. Companies have poured billions into amyloid-blocking drugs with little success. In 2010, Eli Lilly halted trials of semagacestat after patients on the drug deteriorated more quickly than those on a placebo. In 2012, Pfizer and Johnson & Johnson released results of large trials that showed their amyloid treatment didn’t slow progression of the disease. All told, at least 190 Alzheimer’s drugs have failed in human trials, according to Bernard Munos, a senior fellow at FasterCures, a health nonprofit.

Clearly, Alzheimer’s is one of the most important diseases where treatments have largely failed.  Incentivizing innovation–through higher drug prices, prizes, the patent system, basic research funding, and other avenues–is key to ensure that the fight for effective Alzheimer’s treatments continues.

Measuring Quality in Cancer Care

Written By: Jason Shafrin - Jun• 28•16

Identifying high-quality, cancer care is a laudable goal.  However, a recent article by Alvarnas (2016) says the way many are trying to measure quality of cancer care currently is inadequate.  Specifically:

  1. Quality and value are multidimensional, but the narrow focus of many quality measures undermines their effectiveness and meaningfulness. (Porter 2010)
  2. Quality and value measures are all too often based upon isolated care transactions, rather than based upon the continuum-of-care model that is an essential part of effective cancer care.(Porter 2010)
  3. Few quality/cost/value measures include risk as part of their formulation or expression. (Spinks 2011, CIBMR 2016)
  4. Electronic Health Records do not facilitate capture or assessment of key outcomes data.(Klumpp 2013)
  5. Few quality measures are linked to care strategy, healthcare facility/provider strategic planning, or the development of more effective care systems.(Porter and Lee 2015)
  6. Our measures for assessing patient-reported outcomes are weak, and rarely measure those things which matter most to patients.(Johnson 2016, de Boer et al. 2008)

So what’s the alternative to administrative quality measurement?  Porter and Lee 2015 recommend the following:

The failure to prioritize value improvement in health care delivery and to measure value has slowed innovation, led to ill-advised cost containment, and encouraged micromanagement of physicians’ practices, which imposes substantial costs of its own. Aligning reimbursement with value in this way rewards providers for efficiency in achieving good outcomes while creating accountability for substandard care.

That sounds like a better vision to me.


Brexit = upheaval for drug makers

Written By: Jason Shafrin - Jun• 27•16

Will the European Medicines Agency (EMA) need to re-located after Brexit? According to a Reuters story, the answer is yes.

The EMA is a London-based organization that approves treatments for all EU countries. As the UK leaves the EU, however, EMA is expected to have to relocate. 600 individuals work for EMA.

More important is how Brexit would affect patients.

Although Britain could continue to take part in the EMA system if it remains in the European Economic Area, like Norway, many of those supporting its exit from the EU oppose that option.

As a result, British patients could move to the back of the queue for new medicines as companies prioritize the larger EU market, and some medicines could be left in regulatory limbo.

Where will EMA go?  Healthcare officials in Sweden, Denmark, Italy and Germany have expressed interest in hosting EMA, but EMA’s future destiation–or if any move at all will be needed–is still influx.

Doctors with Borders

Written By: Jason Shafrin - Jun• 26•16

Although I believe that a lot of the pundits claims of economic downturns due to the Brexit are overblown, there are clearly many uncertainties to resolve.  The Telegraph reports on how Brexit will affect doctors working in the UK.

As a result of the country’s decision to leave the EU, health regulators may have to change the way information about medics is shared across European borders when concerns are raised about doctors or nurses.

At present, there are European directives on sharing disciplinary records and fitness to practise hearings.

Niall Dickson, chief executive of the General Medical Council, said: “Withdrawing from Europe will have implications for the way that we regulate doctors but we understand that the vote to leave the EU will have no impact on the registration status of any doctor already on the register.

“We will now explore how doctors from the EU will be granted access to the UK medical register and how any concerns about those doctors will be shared between us and other countries.

“We will also seek to understand the implications for UK doctors wishing to work in the EU once the UK is no longer a member state.”

Will the cost of health care rise in the UK due to an inability to hire less expensive foreign physicians and health workers. Perhaps, but my guess is that the effect is fairly modest, especially after immigration rules within the UK have been ironed out.


Written By: Jason Shafrin - Jun• 24•16

Prioritizing vaccine development

Written By: Jason Shafrin - Jun• 22•16

For which diseases should vaccines be developed?  Although ideally the answer is “all of them”, given that there are limited resources in the world, which diseases should be prioritized?  The Institute of Medicine’s Strategic Multi-Attribute Ranking Tool for Vaccines (SMART Vaccines) tool is one effort to make such prioritization explicit based on fixed attributes.   The attributes are the following.

Health Considerations
  • Premature Deaths Averted per Year
  • Incident Cases Prevented per Year
  • QALYs Gained or DALYs Averted
Economic Considerations
  • Net Direct Costs (Savings) of Vaccine Use per Year
  • Workforce Productivity Gained per Year
  • One-Time Costs
  • Cost-Effectiveness ($/QALY or $/DALY)
Demographic Considerations
  • Benefits Infants and Children
  • Benefits Women
  • Benefits Socioeconomically Disadvantaged
  • Benefits Military Personnel
  • Benefits Other Priority Population
Public Concerns
  • Availability of Alternative Public Health Measures
  • Potential Complications Due to Vaccines
  • Disease Raises Fear and Stigma in the Public
  • Serious Pandemic Potential
Scientific and Business Considerations
  • Likelihood of Financial Profitability for the Manufacturer
  • Demonstrates New Production Platforms
  • Existing or Adaptable Manufacturing Techniques
  • Potential Litigation Barriers Beyond Usual
  • Interests from NGOs and Philanthropic Organizations
Programmatic Considerations
  • Potential to Improve Delivery Methods
  • Fits into Existing Immunization Schedules
  • Reduces Challenges Relating to Cold-Chain Requirements
Intangible Values
  • Eradication or Elimination of the Disease
  • Vaccine Raises Public Health Awareness
Policy Considerations
  • Interest for National Security, Preparedness, and Response
  • Advances Nation’s Foreign Policy Goals
User-Defined Attributes
  • Up to Seven Attributes

Users can prioritize which attributes are the most important.  Do you agree with this list?  Which attributes would be most important to you if you were a policymaker?

John Oliver on Retirement Plans

Written By: Jason Shafrin - Jun• 21•16



ICER and drug prices

Written By: Jason Shafrin - Jun• 20•16

The Institute for Clinical and Economic Research aims to measure the value of drugs and aims to reduce the price of treatments that they deem to be low-value.  Is this simply an academic exercises, or are payers paying attention?  An article in CNBC sheds some light on the topic:

Asked about that analysis, Miller said: “We used the ICER report in our negotiations. Did we receive the ICER price? The answer is no, we didn’t.”

The ‘Miller’ above refers to Dr. Steve Miller, senior vice president and chief medical officer of Express Scripts.

It should not come as a surprise that insurance companies and pharmacy benefit managers are using all evidence at their disposal to try to drive down the price of prescription drugs.

Does defensive medicine work?

Written By: Jason Shafrin - Jun• 19•16

According to a paper by Jena, Schoemaker, Bhattacharya, and Seabury (2015), the answer is yes.

Across specialties, greater average spending by physicians was associated with reduced risk of incurring a malpractice claim. For example, among internists, the probability of experiencing an alleged malpractice incident in the following year ranged from 1.5% (95% confidence interval 1.2% to 1.7%) in the bottom spending fifth ($19 725 (£12 800; €17 400) per hospital admission) to 0.3% (0.2% to 0.5%) in the top fifth ($39 379 per hospital admission). In six of the specialties, a greater use of resources was associated with statistically significantly lower subsequent rates of alleged malpractice incidents.

Policymakers and health policy wonks aim to reduce the practice of defensive medicine; this study, however, indicates that defensive medicine may be incentive compatible for physicians.


Friday Links

Written By: Jason Shafrin - Jun• 16•16