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News Article | December 12, 2016
Site: www.eurekalert.org

(PHILADELPHIA) Dec. 12, 2016 - In one of the first studies to examine priorities in recovery identified by trauma patients, family members and clinicians over time, an international research partnership that was launched from the University of Pennsylvania School of Nursing (Penn Nursing) and Griffith University School of Nursing & Midwifery in Australia has helped advance the importance of patient-reported outcome measures for improved trauma care and research. The study, "Indicators of Injury Recovery Identified by Patients, Family Members and Clinicians," was recently published in the journal Injury and is available here in digital format. "While it is recognized that focusing on what patients envision to be good outcomes is an important part of patient-centered care, asking trauma patients and their families what they consider to be the priorities of care and recovery has been neglected," said Penn Nursing's Therese S. Richmond, PhD, FAAN, CRNP, the Andrea B. Laporte Professor of Nursing and Associate Dean for Research & Innovation. Richmond, and study's lead author Leanne M. Aitken, PhD, RN, Professor of Nursing, now at the City, University of London, conceived the research while Aitken was undertaking a Fulbright Senior Scholarship at the University of Pennsylvania. The study focused on two areas: learning what patients, family members and clinicians considered to be the indicators of successful recovery from an acute hospitalization after traumatic injury; and understanding if these indicators differed between these groups of stakeholders or changed over time, from during hospitalization to three months after discharge. Thirty-three trauma patients, 22 family members and 40 clinicians were recruited from trauma departments in two Australian teaching hospitals. Stakeholders in the study identified five specific Indicators of recovery, including returning to work, resuming family roles, achieving independence, recapturing normality and achieving comfort. Trauma patients articulated the most detail in these indicators, compared to the responses from the study's other stakeholders. "Understanding different perceptions in relation to outcomes is particularly important in trauma, where patients may not be able to participate in decision making for a period of their hospitalization," said Aitken. Perceptions of indicators of injury recovery changed for some participants over the three months after they were discharged. These changes fell into three broad groups: increasing recognition that activities of daily living were important; increasing realization of the impact of the injury; and unfolding appreciation that life could not be taken for granted. While in the hospital, trauma patients in the study often noted the desire to be able to care for themselves. The practical implications of their physical limitations, however, did not fully reveal themselves until after discharge. Instead, the ripple effects of limitations in their abilities to undertake basic self-care activities or have full range of movement of their limbs became increasingly apparent within the first month of being at home. "Changes in expectations and priorities over time have implications for how we provide education and support that should be tailored to different phases in the recovery trajectory," said Richmond. "As patients and family members change their expectations over time, appropriate care needs to be provided across the care continuum." The study's findings indicate a further need to explore recovery priorities using quantitative techniques to determine relevance to a broad cross-section of trauma patients and to develop an appropriate set of outcome measures that patients consider to be important. Although some differences between stakeholder groups were identified, similarities and differences should be tested further in larger groups. "It is expected that by understanding what matters to patients and family members will help us empower patients to be active participants in the healthcare process and will underpin development of patient-reported outcomes that should be used in practice and research in trauma care," said Aitken. "This information will also inform future trauma outcome research to ensure these priority areas are appropriate for a broader range of participants." In addition to Aitken and Richmond, the research team included: Wendy Chaboyer, RN, PhD, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland & School of Nursing and Midwifery, Griffith University, Australia ; Carol Jeffrey, RN, MHSc, Princess Alexandra Hospital, Australia, and School of Nursing and Midwifery, Griffith University, Australia; Bronte Martin, RN, MNurs, National Critical Care Trauma Response Centre, Royal Darwin Hospital, Australia; Jennifer A. Whitty, BPharm(Hons) GradDipClinPharm PhD, Health Economics, Norwich Medical School, University of East Anglia, Norwich, UK, Menzies Health Institute Queensland & School of Medicine, Griffith University, Australia and School of Pharmacy, The University of Queensland, Australia; Michael Schuetz, FRACS, Dr.med. Dr.med.habil., Charité Hospital, Humboldt University Berlin, Germany. Editor's Note: The team of researchers report no conflicts of interest. About the University of Pennsylvania School of Nursing The University of Pennsylvania School of Nursing is one of the world's leading schools of nursing and is ranked the #1 graduate nursing school in the United States by U.S. News & World Report. Penn Nursing is consistently among the nation's top recipients of nursing research funding from the National Institutes of Health. Penn Nursing prepares nurse


News Article | February 27, 2017
Site: motherboard.vice.com

Seema Verma, President Donald Trump's nominee to head the Centers for Medicare and Medicaid Services, has built a career on finding ways to break down the government's role in health care. So it wasn't all that surprising when, at her nomination hearing, Verma said she doesn't think insurance companies should be required to provide maternity care coverage. "Some women might want maternity coverage and some women might not want it, might not choose it, might not feel like they need that," Verma told senator Debbie Stabenow (D-Michigan). "So I think it's up to women to make the decision that works best for them and their families." The comment offered a glimpse of how the Trump administration may impact women's health care in the US. Trump and Republican members of Congress have pledged to repeal the Affordable Care Act which, among many other provisions, made maternal health and reproductive health coverage mandatory. But they haven't been very clear on what they plan to introduce to replace the ACA. Comments from Verma, along with executive moves from the White House, and a spattering of bills that have been introduced, give us an idea of what to expect when it comes to women's healthcare. "This gives us an idea of what that plan might look like," said Nadereh Pourat, the director of the Health Economics and Evaluation Research Program at the UCLA Center for Health Policy Research. "You cannot replace [the ACA] with something cheaper that gives you the same benefits or more. That's not possible." Pourat said it's been clear from the beginning that repealing and replacing the ACA would mean some cuts to health care, but there's a lot of uncertainty of what that looks like. Part of the problem is that many Republicans think the ACA is too costly, both for the government and individuals, and want to reel it in. But Pourat told me many of these cuts actually end up costing taxpayers more in the long run, including removing mandatory maternity coverage which can cost families up to $50,000 for one birth. Having maternity coverage mandatory does mean a slight increase in insurance costs across the board, but making it optional means those who need it most might not be able to afford this "extra" coverage. If they then get pregnant, even middle class Americans may not be able to afford paying out of pocket for maternity care, which puts the pregnancy at risk, Pourat said. In most other developed countries, including Canada, the UK, and France, maternal health is covered and guaranteed. "Maternity benefits are not something anyone should think about making optional. It's shortsighted and it could have huge negative implications," Pourat told me. "All you need is to have a few children born with disabilities and you're talking about long-term suffering and costs, very big costs, for the taxpayer. It's a fallacy in this argument that we're going to save money by not providing it." Meanwhile, it's not just expecting mothers who could be impacted. The GOP has continued to threaten to cut federal funding for Planned Parenthood, which provides reproductive health care like birth control to millions of women and men. And while President Trump and his cabinet can't single-handedly change a lot of these laws, they're signalling their mandate to a GOP congress that's already starting to follow suit. Bills have been introduced to allow states to withdraw funding from Planned Parenthood and repeal the ACA. Some of this is par for the course when it comes to the Republican party. GOP congresses typically mean a shifting of more power back to the state level, and state governments can potentially protect some women's healthcare by introducing their own laws—like the three states that now allow pharmacists to prescribe birth control—to counteract the action in the capitol. In the meantime, there's a lot of uncertainty, and the few hints we're getting of what's to come could mean far higher health care price tags for women. Get six of our favorite Motherboard stories every day by signing up for our newsletter .


News Article | March 1, 2017
Site: www.businesswire.com

Onxeo S.A. (Euronext Paris, NASDAQ Copenhagen: ONXEO), a biotechnology company specializing in the development of innovative drugs for the treatment of orphan diseases, in particular in oncology, is pleased to announce the appointments of Françoise Bono, PhD, to the role of Chief Scientific Officer and Olivier de Beaumont, MD, MBA, to the role of Chief Medical Officer. Their very specialized expertise will enable the Company to carry out its various projects, notably development activities on AsiDNA™, a first-in-class molecule acting as a tumor cell DNA repair inhibitor, as well as ongoing work to demonstrate belinostat’s potential in association with other anti-cancer agents in various types of tumor. It also represents a key asset just months before the interim results of the Livatag® Phase III trial. “Françoise and Olivier bring Onxeo a rare combination of extensive experience in the development of new treatments and an in-depth understanding of a biotech business model," commented Judith Greciet, Chief Executive Officer of Onxeo. "As a biotech company, our challenge is to bring our programs to major value inflection points as rapidly as possible on the basis of pertinent and attractive data, and thus drive the Company’s value. This is particularly important for AsiDNA™, which has substantial potential and for which the preclinical and clinical data generated over the coming months will be pivotal within this context. Francoise and Olivier’s arrival to lead our thought process and head our teams represents an undeniable asset for the implementation of our strategy." Previously, Françoise Bono spent over 25 years with Sanofi and Evotec and was, until late 2016, Evotec Executive Vice-President, Oncology. A prominent cancer biologist, she has brought several innovative compounds from early clinical development through to IND filing and Phase I trials. Françoise Bono has led over 20 major projects, notably in the field of immune-oncology, and developed extensive experience in science, people management and project leadership and evaluation, as well as recognized expertise in translational and development strategy in oncology. Françoise Bono received her PhD in Cellular Biology from Toulouse University. “I am delighted to be able to contribute to the development of Onxeo, which has successfully put together a promising and diverse portfolio based on innovative approaches liable to be a paradigm shift in the treatment of cancer. This is, for example, the case for the DNA repair inhibition technology that is behind AsiDNA™ and is one of the most exciting and promising of these novel approaches,” declared Françoise Bono. Since 2005, Olivier de Beaumont was with Stallergenes Greer as Senior Vice President, Head of Global Clinical Development, Pharmacovigilance and Medical Affairs, and a member of the Executive Committee. Prior to that, he led various clinical development programs and strategic marketing activities at Quintiles and Aventis, addressing a wide range of therapeutic areas and leading teams, notably in oncology. Dr. de Beaumont is a medical doctor and also holds a MBA from ESCP Business School and a Masters degree in Public Health & Health Economics. “I am thrilled to be joining Onxeo at this critical and transformative stage, and am extremely impressed by their tremendous drive to become an innovation engine in oncology. I am proud to be joining this experienced and dedicated team to help develop pioneering solutions that will address the unmet needs of cancer patients,” said Olivier de Beaumont. Prior to these appointments, preclinical and clinical operations were a single department. Former CSO Graham Dixon left the Company to pursue other opportunities. Under this new structure, Françoise Bono and her team will now focus on preclinical activities in collaboration with Olivier de Beaumont’s teams, who will henceforth be responsible for clinical development. Both Dr. Bono and Dr. de Beaumont are members of the Executive Committee and will be active participants in the Company’s strategic planning, partnering discussions, and presentations to investors and other key stakeholders. Onxeo is a biotechnology company developing innovative drugs for the treatment of orphan diseases in oncology, driven by high therapeutic demand in one of the fastest growing segments of the pharmaceutical industry. Onxeo’s objective is to become a major international player in the field of rare cancers. Its growth strategy is founded on the development of innovative, effective, and safe drugs based on breakthrough technologies that can make a real difference in the treatment of orphan oncology diseases and considerably improve the quality of life of patients affected by rare or resistant cancers. Onxeo’s comprehensive portfolio features a broad orphan oncology pipeline, with 3 major products in several on-going preclinical and clinical programs, alone or in combination for various cancer indications. The Company is headquartered in Paris, France with offices in Denmark and in New York, and has approximately 60 employees. Onxeo is listed on Euronext in Paris, France and Nasdaq Copenhagen, Denmark (Ticker: ONXEO, ISIN Code: FR0010095596). This communication expressly or implicitly contains certain forward-looking statements concerning Onxeo and its business. Such statements involve certain known and unknown risks, uncertainties and other factors, which could cause the actual results, financial condition, performance or achievements of Onxeo to be materially different from any future results, performance or achievements expressed or implied by such forward-looking statements. Onxeo is providing this communication as of this date and does not undertake to update any forward-looking statements contained herein as a result of new information, future events or otherwise. For a discussion of risks and uncertainties which could cause actual results, financial condition, performance or achievements of Onxeo to differ from those contained in the forward-looking statements, please refer to the Risk Factors ("Facteurs de Risque") section of the 2015 Reference Document filed with the AMF on April 29, 2016, which is available on the AMF website (http://www.amf-france.org) or on the company’s website (www.onxeo.com).


Danzon P.M.,University of Pennsylvania | Towse A.,Health Economics | Mulcahy A.W.,RAND Corporation
Health Affairs | Year: 2011

Finding better mechanisms to enable differential pricing that reflects different degrees of willingness to pay across countries with different income levels is an important challenge for drug manufacturers and policy makers. Drug prices must be high enough to meet manufacturers' needs-covering costs and ensuring adequate investment in research and development, as well as producing a profit-but low enough to allow consumers access to medicines that they need. Examining drug pricing, we found that in rich countries, insurance coverage can make consumers insensitive to price, which means that manufacturers' prices are largely unrestrained unless payers intervene. In middle- and low-income countries, where most consumers pay for drugs out of pocket, we found that the poorest countries face the highest prices, relative to their mean per capita income. We recommend that countries and payers set their own cost-effectiveness thresholds to reflect how much they are willing to pay for "health gain"-in other words, for a measured improvement in the health of a person or a population. Adopting this approach broadly should lead to appropriate price differences across and within countries, benefiting consumers and manufacturers alike. © 2011 Project HOPE-The People-to-People Health Foundation, Inc.


News Article | February 22, 2017
Site: www.businesswire.com

INCHEON, South Korea--(BUSINESS WIRE)--Celltrion Healthcare today announced that the European Commission has approved Truxima™ (biosimilar rituximab) for all indications of reference rituximab in the European Union (EU). Truxima™ is the first biosimilar monoclonal antibody (mAb) approved in an oncology indication worldwide. The approval of Truxima™ builds on Celltrion Healthcare’s strong global clinical biosimilar programme. “ We are excited to offer the first biosimilar mAb in oncology. With our partners across Europe, we will work together to ensure that Truxima is available to the many patients who can benefit from this treatment”, said Jung-Jin Seo, Chairman of Celltrion Group, speaking at a meeting of their European partners in Paris. “ For healthcare systems burdened with high cost oncology treatments, we are pleased to provide an option that has the potential to offer significant savings whilst ensuring patients retain access to high-quality and effective treatments”. Truxima™ is approved in the EU for the treatment of people with non-Hodgkin’s lymphoma (NHL), chronic lymphocytic leukaemia (CLL), rheumatoid arthritis (RA), granulomatosis with polyangiitis and microscopic polyangiitis.1 This approval is based on the totality of evidence submitted to the European Medicines Agency showing compelling similarity between Truxima™ and reference rituximab in terms of efficacy, safety, immunogenicity, pharmacodynamics (PD) and pharmacokinetics (PK) in patients with RA and advanced follicular lymphoma, a type of NHL.2 These trials were conducted in over 600 patients and include data up to 104 weeks.1 Dr Bertrand Coiffier, the global principle investigator of the advanced follicular lymphoma study, Head of the Department of Hematology at Hospices Civils de Lyon and Professor at the University Claude Bernard, Lyon, France said, “ Biosimilar rituximab has been shown to have comparable efficacy and safety to reference rituximab in a large program of trials providing convincing evidence for the similarity of the two products. This has been recognised by the regulatory authorities, and hopefully this will pave the way for further innovation in this area”. Biosimilars have the potential to offer cost savings for healthcare systems and therefore the potential to increase patient access to biological therapies.2,3 “ Assuming the price of biosimilar rituximab is 70% compared to reference rituximab, and the market share of biosimilar rituximab is 30% (first year), 40% (second year) and 50% (third year), over this three-year time period the budget savings across the 28 countries of the EU would be around €570 million”, said Prof. László Gulácsi, Head of Department of Health Economics, Corvinus University of Budapest; HTA Consulting Budapest, Hungary. “ This equates to 49,000 new RA, NHL and CLL patients who could be receiving life-changing treatment which is clearly a huge aggregate health-gain at both a national and EU level”. Hematological cancers begin in blood-forming tissue or cells of the immune system. There are three common types of hematological cancers: lymphoma, leukaemia and myeloma. There are many types of NHL, the most common group is B cell lymphomas, of which follicular lymphoma and diffuse large B cell lymphoma are the most common. CLL is a type of leukaemia and is characterised by accumulation of monoclonal B cells (a type of white blood cell). In Europe more than 2.9 million people have RA, many of whom are of working age. On average, every third person with RA becomes work disabled and up to 40 per cent leave work completely within 5 years of diagnosis.4 Although there is no cure for RA, there are many treatments that can reduce inflammation and ease pain. As with all rheumatic diseases early diagnosis and intervention is key. Truxima™ is a mAb that targets CD20, a protein found on the surface of most B cells. Overactive B cells can stimulate attack of healthy cells in immune-related diseases such as RA. B cells are also implicated in some types of hematological cancer including NHL and CLL. B cells express CD20 at many stages of their development making the protein a good target for treatments. Truxima™ is approved in the EU for the treatment of people with NHL, CLL, RA, granulomatosis with polyangiitis and microscopic polyangiitis. Further details of the approved indications and safety information for Truxima™ are available in the summary of product characteristics (SmPC).1 Phase 1 clinical data demonstrated the PK of Truxima™ and reference rituximab were statistically equivalent over 24 weeks after a single course of treatment, and that their efficacy, PD, immunogenicity and safety were similar up to 2 courses of treatments (up to 72 weeks).2 A phase 1 open label extension study showed that switching to Truxima™ from reference rituximab was similarly effective with comparable safety to continuing Truxima™ for two years.2 Three phase 3 studies in patients with RA, advanced follicular lymphoma and low-tumor-burden follicular lymphoma (LTBFL) are ongoing: Celltrion Healthcare conducts the worldwide marketing, sales and distribution of biological medicines developed by Celltrion, Inc. through an extensive global network that spans more than 120 different countries. Celltrion Healthcare’s products are manufactured at state-of-the-art mammalian cell culture facilities, designed and built to comply with the US Food and Drug Administration (FDA) cGMP guidelines and the EU GMP guidelines. For more information please visit: http://www.celltrionhealthcare.com/ 2 European Commission. What you need to know about biosimilar medicinal products. Available at ec.europa.eu/DocsRoom/documents/8242. [Last accessed February 2017]. 3 World Health Organisation. Access to biotherapeutic products including similar biotherapeutic products and ensuring their quality, safety and efficacy. 2014. WHA67.21. Available at: apps.who.int/gb/ebwha/pdf_files/WHA67/A67_R21-en.pdf. [Last accessed February 2017]. 4 NRAS, European Fit for Work Report. Available at www.nras.org.uk/european-fit-for-work-report. [Last accessed February 2017].


Objective: To assess the cost-effectiveness of solifenacin vs other antimuscarinic strategies commonly used in UK clinical practice, based on the Results of a recent published review. METHODS Overactive bladder (OAB) syndrome is characterized by symptoms of urgency, frequency, incontinence and nocturia. Pharmacological treatment comprises oral antimuscarinic agents, which are divided into older-generation treatments, including oxybutynin, and new-generation treatments, comprising solifenacin, tolterodine, darifenacin and fesoterodine. The latter have reduced central nervous system penetration and have better selectivity for the M3 subclass of acetylcholine receptors, resulting in improved tolerability. A recent systematic review and meta-analysis of the efficacy and safety of antimuscarinics provided an opportunity for an economic evaluation of these agents using a rigorous assessment of efficacy. A cost-utility analysis was undertaken using a 1-year decision-tree model. Treatment success was defined separately for urgency, frequency and incontinence, with efficacy data taken from the recent review. Treatment persistence rates were taken from the Information Management System database. Utility values for the calculation of quality-adjusted life-years (QALYs) were taken from published sources. The analysis included costs directly associated with treatment for OAB, i.e. antimuscarinic therapy, consultations with general practitioners, and outpatient contacts. Resource use was based on expert opinion. Costs were reported at 2007/2008 prices. Extensive deterministic and probabilistic analyses were conducted to test the robustness of the base-case Results. Results: Solifenacin was associated with the highest QALY gains (per 1000 patients) for all three outcomes of interest, i.e. urgency (712.3), frequency (723.1) and incontinence (695.0). Solifenacin was dominant relative to fesoterodine, tolterodine extended-release (ER) and tolterodine immediate-release (IR), and cost-effective relative to propiverine ER for urgency, frequency and incontinence. Solifenacin was not found to be cost-effective relative to oxybutynin IR for the frequency and incontinence outcomes, with an incremental cost-effectiveness ratio of >£30 000/QALY threshold. Conclusions: Solifenacin provided the greatest clinical benefit and associated QALYs for all three outcomes of interest across all therapies considered, and to be either dominant or cost-effective relative to all other new-generation agents, but not cost-effective relative to oxybutynin for frequency and incontinence. Journal Compilation © 2009 BJU International.


SAN DIEGO--(BUSINESS WIRE)--XIFIN Inc., the healthcare information technology company revolutionizing the business of healthcare diagnostics, will co-present a session with the University of Chicago on collaborative diagnostic workflows at the Cambridge Healthtech Institute’s Fifth Annual Digital Pathology conference, a track at the 24th International Molecular Medicine Tri-Conference being held February 20-22 at the Moscone Convention Center in San Francisco. David McClintock, M.D., Medical Director, Pathology Informatics, University of Chicago, and Chrystal Adams, associate vice president, XIFIN, Inc., will present “Improving Patient Care Through a Diagnostic Collaboration Workflow.” The session, scheduled for Monday, Feb. 20th at 4:10 PM PST, will highlight the need for collaborative and coordinated patient care and discuss how to leverage technology to facilitate an aggregated workflow and communication among diagnostic specialists to inform clinical decision making and support value-based care. Kyle Fetter, MBA, vice president & general manager of diagnostic services operations, XIFIN, Inc. will also present a session on Thursday, February 23 at 10:00 AM titled, “Novel Diagnostic Technologies: Coverage Today and Coverage in the Future.” The session will highlight how early stage and wearable diagnostic device companies can overcome hurtles to commercialization and reimbursement and position themselves for success. The Fifth Annual Digital Pathology conference will offer a range of topics that demonstrate the current activities and effectiveness of digital alternatives for pathology practices, and share insights from distinguished faculty. Technology developments and implementation strategies will be presented in a forum that encourages collaboration and knowledge sharing. With its Health Economics Optimization platform as a foundation, XIFIN ProNet MDT facilitates the cloud-based exchange of diagnostic images, clinical data and other patient encounter information to support real-time multi-disciplinary collaboration through a shared clinical workflow. This live shared environment helps clinicians collaborate on complex cases, expedite treatment decisions and increase efficiency. XIFIN ProNet also provides an Internet exchange and turnkey online tool that provides pathologists key capabilities and a powerful consultation platform. Digital slide scanner- and viewer-independent, pathologists can upload whole slide, DICOM, and other medical images to the cloud where they are available on-demand from a single access point, saving both time and money. Representatives from XIFIN will be available at booth #500 throughout the conference to meet with attendees and discuss how the company is helping healthcare organizations leverage diagnostic information for connected health. XIFIN is a healthcare information technology company that leverages diagnostic information to improve the quality and economics of healthcare. The company’s health economics optimization platform is a connected health solution that facilitates connectivity and workflow automation for accessing and sharing clinical and financial diagnostic data, linking healthcare stakeholders in the delivery and reimbursement of care. To learn more, visit www.XIFIN.com or follow XIFIN on Twitter and LinkedIn.


News Article | December 8, 2016
Site: www.eurekalert.org

Linking GPs' pay to their performance has no discernible effect on their job satisfaction, a University of Manchester study of almost 2,000 UK doctors over a four-year period has found. Based on a belief that income is a key motivating factor, many countries have introduced performance related pay for GPs. In the UK this is known as the Quality and Outcomes Framework (QOF). There have been concerns that this payment method can have adverse effects on GP morale and the UK scheme has been watered-down and may be withdrawn. But there has been no research to back up this claim. The new findings provide evidence that performance related pay does not reduce morale. A linked blog by the study authors is available here or from here. For the first time the University of Manchester study links levels of payment through the QOF to the GP Worklife Survey (also carried out by Manchester) at three time points - 2004 before the QOF was introduced, 2005 and 2008. This group comprised 1,920 GPs who were assessed on overall satisfaction and 12 other measures including hours of work and levels of autonomy, recognition and responsibility. Dr Thomas Allen, from the University's Manchester Centre for Health Economics, led the study. He said: "Policy makers have experimented with a number of ways to prevent GPs leaving their jobs, but dropping the link between pay and performance is not one that will work." The time-frame covered a point (2004) when GP satisfaction was very low, and the introduction of performance-related pay was one measure that tried to address this. The findings from the year after introduction and four years later in 2008, showed satisfaction had improved across the board and was not related to the proportion of income at risk. Further changes to QOF were made in 2013, outside of this study period, which reduced the exposure of GPs to performance related pay and returned more to an older model of payment per patient. Maintaining high satisfaction is an important issue, not just for retaining GPs, but also for ensuring the best possible quality of care is provided. The authors of the study believe that their findings have important implications for further changes to the source of GP income. "Policymakers should not believe that dropping performance-related pay for GPs will increase their satisfaction," Dr Allen said. The paper, 'Does the proportion of pay linked to performance affect the job satisfaction of general practitioners?' was published in the journal Social Science & Medicine. DOI: 10.1016/j.socscimed.2016.11.028


CHICAGO - "Opting-out" of the Medicare rule that requires anesthesia to be administered with physician supervision has little or no impact on access to either inpatient or outpatient surgery, according to a study published in Health Economics Review. Researchers also found the opt-out policy does not reduce costs, and in some cases may be associated with higher costs related to inpatient surgical care. The study did not address why opting-out might increase costs. The researchers said several factors may contribute to this unexpected finding, including that nurse anesthetists may take longer to perform the same services, and working without physician supervision may lead to worse surgery outcomes, which requires additional treatment. "The findings of this study underscore the point that before we make a policy or pass a new rule, we first need to rigorously study what the potential effects might be," said study lead author John Schneider, Ph.D., CEO of Avalon Health Economics. "A lot of states thought that by opting-out of the federal requirement, they would be increasing access to care. It turns out that simply opting-out is not a guarantee of increased access." Since 2001, 17 state governors have exercised the option to opt-out of a federal rule that physicians supervise the administration of anesthesia by nurse anesthetists, most citing increased patient access to anesthesia care as the rationale for the decision. The "opt out" provision was created due to a concern about a potential shortage of physician anesthesiologists, at least in some regions and states. The presumption was that allowing nurse anesthetists to practice without physician supervision would alleviate potential shortages, and enhance access to anesthesia care. Additionally, a lower professional service cost for nurse anesthetists practicing without physician supervision was presumed to lower anesthesia care costs. This is the fourth study in just over a year that looked into whether the adoption of the opt-out rule impacted access to anesthesia care. All four studies found that opt-out does not increase access to anesthesia care. One study found that across urgent diagnoses, opt-out was not associated with increased access to anesthesia services. Another study found opt-out was associated with little or no increased access to anesthesia care for common procedures. "The new study extends the literature on the impact of state opt-out policy by adding an assessment of its impact on costs of surgeries, and by assessing its impact on a wider variety of procedures requiring anesthesia services than in prior studies," the researchers wrote. To analyze the effect of the opt-out rule on inpatient surgery, researchers used the largest publicly available all-payer (including all types of public and private insurance) health care database in the United States, which included many opt-out and non-opt-out states. For outpatient surgery, they used a database of outpatient surgery and services provided by hospital-owned and nonhospital-owned surgery facilities. The outpatient analysis included three opt-out states (California, Colorado and Kentucky) and three non-opt-out states (Florida, Maryland and New Jersey). The analysis used data from multiple years of U.S. inpatient hospital discharges and outpatient surgeries. The outpatient database did not provide cost estimates for outpatient procedures, so the researchers were unable to evaluate the opt-out rule's effect on outpatient surgery costs. "Unlike previous opt-out studies, the design of this study allowed us to better isolate the effect of the opt-out policy across states and over time," said Dr. Schneider. "The primary intent of the opt-out rule was to improve access to anesthesia services by reducing barriers to utilize nurse anesthetists and increasing their scope of practice. In turn, the hypothesis is that the reduction in barriers will increase access to surgical care. In our study, we did not find evidence to support this belief," the researchers concluded. The study, "Assessing the Impact of State 'Opt-Out' Policy on Access to and Costs of Surgeries and Other Procedures Requiring Anesthesia Services," was funded by the American Society of Anesthesiologists. Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 52,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring that physician anesthesiologists evaluate and supervise the medical care of patients before, during, and after surgery to provide the highest quality and safest care that every patient deserves. For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/WhenSecondsCount.


Reich K.,Dermatologikum Hamburg | Burden A.D.,Western Infirmary | Eaton J.N.,Health Economics | Hawkins N.S.,Health Economics
British Journal of Dermatology | Year: 2012

Background Ustekinumab, a novel monoclonal antibody for the treatment of moderate to severe plaque-type psoriasis, has recently received regulatory approval in Europe, bringing the total number of biologic agents licensed in this indication to five. To assist treatment selection in daily practice it is essential to understand the benefit/risk profile of these agents and in the absence of a clinical trial comparing all available biologics a number of reviews have used statistical techniques to generate estimates of the comparative effectiveness of these therapies through the available network of randomized clinical trials. These estimates have previously been published for a limited range of psoriasis biologic treatments, although, to date no review has compared all the currently available agents in Europe. Objectives To estimate the comparative effectiveness of all biologic agents indicated in the treatment of moderate to severe psoriasis currently available in Europe based on the primary trial endpoints. Methods A number of databases were searched for details of randomized controlled trials of available biologics in the treatment of plaque-type psoriasis in adults. Comparative effectiveness was estimated based on the reported Psoriasis Area and Severity Index (PASI) 50, 75 and 90 response rates. A network meta-analysis conducted on the ordered probit scale and implemented as a Bayesian hierarchical model provided estimates for the probability of response and relative risk vs. placebo, based on all observed comparisons. Results Twenty trials were included in the meta-analysis including patients with a mean disease duration of 18-22 years. Based on the indirect comparison and given a placebo PASI 50 response of 13%, infliximab had the highest predicted mean probability of response at PASI levels 50 (93%), 75 (80%) and 90 (54%), followed by ustekinumab 90 mg at 90%, 74% and 46%, respectively, and then ustekinumab 45 mg, adalimumab, etanercept and efalizumab. Conclusions The ordered probit model allowed a quantitative comparison of all currently licensed biologics, providing estimates on comparative effectiveness and a suggested ranking of treatments that is of potential use to decision-makers. However, the analysis is based on indirect comparisons of the primary endpoint reported from short-term randomized trials. © 2011 British Association of Dermatologists.

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