CLINICAL NEWS
ACA Saves
After 3 years in existence, the Affordable Care Act (ACA) led to increased numbers of low-income adults
with health-care insurance and reduced their out-of-pocket spending, according to a report published in
Health Affairs.
Authors looked at survey data collected from low-income adults living in three states – two that ex-
panded Medicaid and private insurance through the federal marketplace (Kentucky and Arkansas) and
one that did not (Texas).
100
90
Through the end of 2016, the rates of uninsured people
dropped by more than 20% in Kentucky and Arkansas,
relative to rates in Texas. For people gaining coverage in
these states, researchers observed a:
80
70
60
41 %
50
40
23 %
30
12 %
20
10
0
increase in people
who had a usual
source of care
increase in people
who self-reported
“excellent” health
When the Pharma Reps
Are Away …
When academic medical centers adopt policies to limit
pharmaceutical marketing (or “detailing”) and the interac-
tions between physicians and pharmaceutical representa-
tives, doctors prescribe fewer marketed drugs and more
generic drugs, according to a comparison of physicians’
prescribing behaviors for eight common drug classes before
and after policy implementation.
increase in people
who had annual
check-ups
People also reduced their annual out-of-pocket spending by an average of $337.
Source: Sommers BD, Maylone B, Blendon RJ, et al. Three-year impacts of the Affordable Care Act: improved medical care
and health among low-income adults. Health Aff. 2017 May 17. [Epub ahead of print]
Pre-policies, prescriptions for the included detailed and
nondetailed drugs accounted for an average of 19.3% and
14.2% (respectively) of physicians’ monthly prescriptions.
But, 3 years after these policies were introduced:
Double-Hit Me With Your Best Shot
New research shows that consolidation with autologous hematopoietic cell transplantation (AHCT) has little
value for patients with double-hit lymphoma in first complete remission following frontline chemotherapy.
After 3 years, most of the 159 patients included in the study (62 AHCT and 97 non-AHCT) remained in
remission, and rates of relapse-free survival (RFS) and overall survival (OS) were similar between the AHCT
and non-AHCT patients:
RFS
89 %
75 %
OS
85 %
0
10
20
30
40
50
60
70
80
Though these were modest changes, the authors noted,
they affected prescribing in a way that has substantial cost
implications.
91 %
90
prescriptions of detailed
drugs decreased
1.67 % , to 17.6 %
prescriptions of non-
detailed drugs increased
0.84 % , to 15.04 %
100
The changes were not universal; however, the shift was only
statistically significant in nine of the 19 academic medical
centers.
None of these differences were found to be statistically significant.
“Once these patients achieve remission, they are likely to stay in remission,” said Daniel J. Landsburg, MD,
lead author of the study. “The evidence shows there’s no clear benefit to these patients undergoing AHCT.”
Source: Larkin I, Ang D, Steinhart J, et al. Association between academic
medical center pharmaceutical detailing policies and physician prescribing.
JAMA. 2017;317:1785-95.
Source: Landsburg DJ, Falkiewicz, Maly J, et al. Outcomes of patients with double-hit lymphoma who achieve first complete remission.
J Clin Oncol. 2017 May 5. [Epub ahead of print]
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