Managed care-led interventions can effectively improve medication adherence and reduce acute hospitalizations in high-risk Medicaid populations.
objeCtives: In 2012 United States Food and Drug Administration (FDA) created a new expedited pathway of 'Breakthrough Therapy Designation' (BTD) to enable early approval of therapies, which have shown substantial activity in early trials. The objective of this study was to understand the impact on BTD on patients and payers. Methods: The data for number of granted BTDs was obtained from FDA. gov. The data for publically disclosed BTDs was obtained from sponsor's press releases. For all products the information for their mechanism of action, type of molecule, trial design, clinical efficacy and safety, and pricing and time to approval (for approved products) were obtained from peer-reviewed publications, conference abstracts, FDA and sponsor websites. Results: Since the establishment of the BTD pathway, 37 products have been granted breakthrough therapy designations (2012-2013), of which, 28 have been publically disclosed by the manufacturers and 3 have been approved by the FDA. In terms of indications, 12 (43%) are for cancer, 5 (18%) are for genetic diseases and 4 (14%) are for Hepatitis C Genotype 1. The three approved drugs with BTD are Gazyva, Imbruvica and Sovaldi. The median time to approval for these three drug was ~5 years, significantly shorter than the 2012 median time to approval for priority review applications (6 years). However, the price premium was 30-50% compared to other drugs in the same category. Two of the drugs with BTD did not meet primary endpoint in their pivotal trial. While the BTD pathway promises to reduce development time, the high price is a major concern for payers and patients. ConClusions: BTD is a promising pathway to shorten development time and provides early access, however, high price could pose challenges for payers and patients.
The 2008 financial crisis raised concerns over the probability of rise in death, illness and disability in European OECD countries, with increased 'Unmet needs for medical examination ' from 3.1 to 3.4 percent between 2008-2012. As the concave relationship between income and health gradually flattens out with lowered effectiveness for an additional dollar of income, improving health on a decreasing scale, finding measures to address increasing unmet health needs is pivotal. This study aims to investigate whether the General Practitioners (GPs), as healthcare service providers, can mitigate the impacts of economic crisis on health outcomes. MethOdS: The data for 20 high-income European OECD countries (2006 -2013), extracted from Eurostat, were analyzed using panel data analysis, and the variables for different cross-sections over a time span were observed using random effects and fixed effects model(s). F-test, calculated using R2 values adjusted for number of covariates in different models, was used to test the nested models and results were analyzed using Stata-v11. ReSultS: The long-term unemployment, resulting from crisis, is significantly associated, strongly and positively, with 'Unmet needs for medical examination' for all levels of income (p < 0.05 to p < 0.01). The supply of an additional GP per 1,000 population reduces the unmet health needs, but gradually decreasing, from 0.27, 0.22, 0.15 percent across the 1st, 2nd and 3rd income quintiles to 0.18, 0.12 and 0.12 percent, respectively. But this doesn't hold true for the 4th income quintile. cOncluSiOnS: During economic crises, the supply of GPs can mitigate the adverse effects of long-term unemployment, but for the lower income people only. However, such mitigating effects diminished with increasing income, and had no significance for the highest income population. The presence of GPs significantly contributes in controlling the access to tertiary care, by addressing the health issues at primary level.
A171 Objectives: To compare the rate of inpatient admissions of pediatric patients with acute asthma that came through the emergency department (ED) visits and mean charges per ED visit between Medicaid patients and privately insured patients. To identify factors associated with hospital admissions through the ED among pediatric patients with asthma. MethOds: A retrospective analysis using 2010-2011 National Emergency Department Sample (NEDS), the largest all-payer hospital based ED database in the United States (US), was conducted. All ED visits with a primary diagnosis of acute asthma for patients aged 2-17 years were identified using ICD-9-CM codes of 493.XX. ED visits with unknown destination were excluded. Multivariable logistic regression and Generalized Linear Mixed Model were used to compare the rate of hospital admissions through the ED and mean ED charges between asthma children with Medicaid vs private insurance. Results: A total of 110,964 pediatric asthma related ED visits from 1,713 US EDs was identified (Medicaid patients: n= 69,410 (63%), mean age= 7yrs, 39.86% female; Private insured patients: n= 41,554 (37%), mean age= 7yrs, 39.79% female). Of these occurrences, 96,307 (87%) were discharged and 14,657 (13%) were admitted to hospital after ED visits. After adjusting for demographic and clinical factors, privately insurance patients were 12% more likely to be admitted to hospital after ED visits compared to Medicaid patients. (Odds ratio= 1.12, [95% confidence interval: 1.13-1.32]). The mean charge per ED visit for Medicaid insured patients was $1,330, compared to $1,380 among private insured patients (p< 0.01). Other factors associated with hospital admissions through ED were younger age, severity, weekday visits, and urban-rural location of patient's residence. cOnclusiOns: Compared to asthma children with Medicaid, privately insured pediatric patients had increased hospital admissions through ED and ED charges. In addition to insurance type, factors relating to severity and hospital characteristics were related to hospital admissions through the ED.
A167age group (< 18, 18-34, 35+), race, ethnicity, number of high-risk diagnosis codes, and zip codes. High-risk diagnoses-including prior history of preterm delivery, insulin-dependent diabetes, hypertension, multiple gestations, and incompetent cervix-are known predictors of low birth weight and premature delivery. Results: Thirty-one participants at high-risk for premature delivery received cell phones and text-messaging services. Twenty-six mothers (84%) successfully delivered babies to term (< 31 days from expected delivery date). Babies born in the IG had higher birth weights than those born in the CG (mean, 38.71g), lower rates of low birth weight babies (-0.12%) and very low birth weight babies (-0.06%), and delivered almost a full week later (mean, 0.96 wk). Participants reported high program-satisfaction rates. ConClusions: Members at high risk for preterm delivery participating in Moms2B had superior pregnancy outcomes compared to nonparticipants; program satisfaction was favorable.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.