ASH Clinical News July 2017 V2 - Page 17

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] ASH Clinical News 15