Research Roundup: Conflicts Of Interest; Drug Resistant Bacteria; Medicaid For Prisoners
Each week, KHN compiles a selection of recently released health policy studies and briefs.
PLOS Medicine:
Financial Relationships Between Organizations That Produce Clinical Practice Guidelines And The Biomedical Industry: A Cross-Sectional Study
We conducted a cross-sectional survey and review of websites of 95 national/international medical organizations that produced 290 clinical practice guidelines ... In all, 63% (60/95) of organizations producing clinical practice guidelines reported receiving funds from a biomedical company; 80% (76/95) of organizations reported having a policy for managing conflicts of interest. ... Among all guidelines, 6% (18/290) disclosed direct funding by biomedical companies, 40% (117/290) disclosed financial relationships between committee members and biomedical companies (38% of guideline committee members, 773/2,043), and 1% (4/290) disclosed financial relationships between the organizations producing the guidelines and biomedical companies. (Campsall et al., 5/31)
Annals of Internal Medicine:
Progress In The Fight Against Multidrug-Resistant Bacteria? A Review Of U.S. Food And Drug Administration–Approved Antibiotics, 2010–2015
A weak antibiotic pipeline and the increase in drug-resistant pathogens have led to calls for more new antibiotics. Eight new antibiotics were approved by the U.S. Food and Drug Administration (FDA) between January 2010 and December 2015 .... This study evaluates the development course and pivotal trials of these antibiotics for their innovativeness, development process, documented patient outcomes, and cost. ... Seven had similar mechanisms of action to those of previously approved drugs. ... The drugs spent a median of 6.2 years in clinical trials ... and 8 months in FDA review .... Seven of the drugs are substantially more expensive than their trial comparators. ... Recently marketed antibiotics are more expensive but have been approved without evidence of clinical superiority. (Deak et al., 5/31)
The Kaiser Family Foundation/Harbage Consulting:
Connecting The Justice-Involved Population To Medicaid Coverage And Care: Findings From Three States
This brief provides an overview of initiatives to connect the justice-involved population to Medicaid coverage and care in three states—Arizona, Connecticut, and Massachusetts. These states are leading efforts in these areas and provide key lessons about how to coordinate across health care and corrections and the potential of such initiatives to better link individuals to physical and behavioral health services. ... Each of the case study states is connecting individuals to Medicaid coverage at multiple points within the justice system. ... The study states also connect individuals to health care in the community as they are released from jail or prison. ... effects on criminal justice outcomes have not been measured. (Ryan et al., 6/1)
Center for American Progress:
Re-Evaluating The Patient-Centered Outcomes Research Institute
The [Affordable Care Act] established PCORI [the Patient-Centered Outcomes Research Institute] with a clear mandate to carry out the “funding of comparative clinical effectiveness research” over 10 years. PCORI was to focus distinctly on CER [comparative effectiveness research] and not duplicate the types of research funded by the Agency for Healthcare Research and Quality, the National Institutes of Health, or other entities. However, a Center for American Progress analysis in 2014 found that only one-third of PCORI’s funding was going toward CER. (Emanuel, Spiro and Huelskoetter, 5/31)
The New England Journal of Medicine:
Integrating Randomized Comparative Effectiveness Research With Patient Care
Clinical trials that are embedded into usual care have the potential to yield outcomes of great relevance to the institutions where they are performed and at the same time to yield information that may be generalizable to the health care system at large. In this article, we review four clinical trials that were conducted in three health care systems using their extant electronic health record (EHR) systems. We find that EHR-based clinical trials are feasible but pose limitations on the questions that can be addressed, the processes that can be implemented, and the outcomes that can be assessed. We think that the current requirements for ethics review should be reconsidered for such trials, in which the risk for participants that can be attributed to research is low. (Fiore and Lavori, 6/2)
American Journal of Managed Care:
Medicaid Managed Care Penetration And Drug Utilization For Patients With Serious Mental Illness
State Medicaid programs are under increasing pressure to contain pharmaceutical spending. Many states have attempted to limit spending through greater Medicaid managed care penetration, which rose nationally from 54.5% in 1999 to 74.9% in 2011. It is not clear how this expansion has affected beneficiaries with serious mental illness .... Our cross-sectional analyses suggested that carve-out states with greater managed care penetration spend significantly less per enrollee on pharmaceuticals for the treatment of mental disorders: our panel data analyses did not generate statistically meaningful results. (Schwartz et al., 5/17)
Here is a selection of news coverage of other recent research:
Reuters:
Better-Trained Doctors Would Improve Healthcare For Trans Youths: Study
Pediatricians rarely receive training in gender-affirming health care, and as a result, few transgender youths who are eligible for such healthcare actually receive it, experts say. (Seaman, 5/31)
Reuters:
Healthcare Costs Nosedive When Smokers Quit
When cigarette smokers quit, societal healthcare costs immediately plunge, a new study shows. If 10 percent of American smokers gave up cigarettes and the rest cut back by 10 percent, the U.S. could shave $63 billion off medical costs the next year, the analysis found. (Cohen, 5/27)
Houston Chronicle:
Texas Uninsured Rate Drops To 1990s Level
A study released Tuesday shows that the rate of Texans without insurance has dropped to its lowest point since the late 1990s because of the Affordable Care Act, Rice University's Baker Institute for Public Policy and the Episcopal Health Foundation reported. Prior to the implementation of the ACA in September 2013, the uninsured rate in Texas was about 26 percent - more than one in four. By this March, that rate had dropped to about 18 percent, the study said. Researchers found declines in every age group, ethnic and racial demographic, and across income levels. Texans between the ages of 50 and 64 showed the steepest decline, dropping to 10 percent from 21 percent during that time period. (Deam, 5/31)