Unbiased Analysis of Today's Healthcare Issues
In drug development, clinical trials typically aim for a population that is representative of the patients who would be eligible for the treatment. While randomized controlled trials (RCTs) typically focus on measuring the average health impact of a drug across this population, a paper Basu and Gurjal (2020) argue that treatment effect heterogeneity and self-selection…
Antibiotic resistance is a problem. One study from Europe found that in 2015 there were 33,110 deaths attributable to antibiotic resistance; accounting for morbidity as well, antibiotic resistance lead to a a decrease of 874,541 disability-adjusted life years. CDC data show that antibiotic resistant bacteria and fungi caused 35,900 deaths in 2019, 12,800 deaths due…
A recent paper in BMJ Open by Moore et al. (2020) aims to estimate the cost of pivotal trials for recently approved drugs. The authors use the IQVIA CostPro Mid-Level Tool to estimate the cost of these trials. Note that a pivotal trials is one that provides ‘substantial evidence’ of benefit to justify marketing approval,…
From Cahan, Kocher, and Bohn in the Health Affairs blog: Since passage of the 2010 “Biosimilars” Act aimed at stimulating non-inferior innovation and competition in therapeutics markets, only 17 agents have been approved, and only seven have made it to market. Why haven’t biosimilars been more attractive? Blackstone et al. (2013) cites 3 key issues:…
Pharmacists are typically paid for dispensing drugs. They receive a fee to cover the price for acquiring a given drug and a dispensing fee. In general, however, pharmacists are not paid based on patient outcomes. Will that change? Troy Trygstad (2020) argues that value-based reimbursement for pharmacists through accountable pharmacy organizations (APOs) may be the…
Tomorrow, Monday, May 18, I will be moderating a panel with Dr. Bapu Jena of Harvard University, Elizabeth Oyekan of PRECISIONvalue and Michael Barr of National Committee for Quality Assurance (NCQA). The topic is: WILL ALTERNATIVE PAYMENT MODELS INCENTIVIZE HEALTH SYSTEMS TO PRESCRIBE HIGH VALUE MEDICATIONS AND SUPPORT BETTER CLINICAL OUTCOMES? ISSUE:Recent decades have seen…
Is it clinical benefit? Cost? Value? The availability of treatment alternatives? To answer this question, a paper by Wranik et al. (2019) conducted a discrete choice experiment DCE to determine HTA stakeholders stated preferences. The sample consisted of HTA stakeholders from 5 countries: Australia, Canada, Germany, Poland, and the United Kingdom. The stakeholders included not…
Drug prices are high. We should only be paying high prices for drugs that have a major impact on patient health and quality of life. Ergo, we should be paying for drugs with value-based agreements (VBAs), right? It turns out the answer is not so simple. A paper by Dubois, Westrich and Buelt (2020) argue…
Of course, clinical trials demonstrate whether a drug is efficacious or not, but are new drugs effective in the real world on average? Have they improved health outcomes at the country level? And do they provide good value? A series of recent paper by Frank Lichtenberg (see Lichtenberg 2019, Lichtenberg 2020a, Lichtenberg 2020b) aims to…
I have written about the 340b program a number of times on this blog in the past (e.g., “The 340B Program: An Overview“, “340B Facts and Figures“). A new commentary by Thomas and Schulman (2020) in Health Services Research provides some additional information. For instance, why was 340B originally enacted? Blame the Medicaid Drug Rebate…