“Pay more for drugs that do more.” Although few would argue with the concept of paying for value, the mechanism for doing so has thus far eluded our multi-payer, market-based system. The Gant Precision Cancer Medicine Consortium at the University of Pennsylvania looked past US borders to learn about mechanisms in other countries, in its quest to recommend sustainable frameworks for valuing precision cancer drugs.
We recently convened an expert roundtable to tackle how health systems, payers, and providers can spur the ‘de-adoption’ of medical practices and technologies no longer considered valuable. This got us thinking - while the process by which ineffective practices or technologies are abandoned is neither simple nor automatic, even the language used to describe it is not clear. And language matters. It often reflects an unstated focus on one mechanism or one level of decision-making. Here we review, and potentially clarify, the terminology.
The eye-popping price tags on some new cancer drugs pose two fundamental questions: are the drugs worth their cost, and if they are, how can we afford them? The Penn Precision Cancer Medicine Consortium considered cost trends and drivers in the second of its conference calls leading up to an in-person conference in May.
[cross-posted from the Health Cents blog on Philly.com]
In a recent panel discussion at Penn, Leana Wen, MD, MSc, Baltimore City Health Commissioner, spoke about the role of public health in Baltimore and how academic institutions can work with public health departments. I spoke with Dr. Wen before her panel about how policymakers use economic evidence, and how we can make evidence more useful to policymakers. What follows is an excerpt from our conversation, edited for length and clarity.
Recent months have seen a flood of stories about drug prices, from Martin Shkreli’s dramatic price hikes on generic drugs to Sovaldi's eye-watering introductory price. But woven within these stories are different storylines, each with its own set of complications and policy solutions. Here we present five distinct drug pricing storylines.
Storyline 1: New, highly effective drugs that are extraordinarily expensive
Example: Sovaldi (Hepatitis C treatment)
This Issue Brief discusses treatments for opioid use disorders and summarizes a new systematic review of economic evaluations of these interventions. The review reveals strong evidence that methadone maintenance therapy is an economically advantageous form of treatment; the economic evidence for buprenorphine and naltrexone treatments is more limited.
In the Journal of the American College of Surgeons, M. Kit Delgado and colleagues evaluate the cost-effectiveness of field trauma triage practices (the criteria used to decide whether to transport an injured patient to a major trauma center). The authors compare current triage practices with alternatives that meet national policy benchmarks set by the American College of Surgeons Committee on Trauma (a high-sensitivity field triage strategy that would miss no more than 5% of seriously injured patients) and a moderate sensitivity, high-specificity approach (in which at least 65% of...
In PharmacoEconomics, Sean Murphy and Daniel Polsky review the literature on economic evaluations of opioid use disorder interventions. Evidence of effectiveness does not always lead to adoption of a given therapy. Economic evaluations can provide evidence that will help stakeholders efficiently allocate their resources. Murphy and Polsky conducted a systemic review of major electronic databases from inception until 2015. Forty-nine studies were included in the study. They find that the economic literature on methadone maintenance therapy (MMT) supports previous findings that MMT...
Cost-effectiveness of an internet-delivered treatment for substance abuse: Data from a multisite randomized controlled trial
In Drug and Alcohol Dependence, Sean Murphy and colleagues, including Daniel Polsky investigate the cost-effectiveness of an internet-based intervention for the treatment of substance use disorders. The authors analyzed the cost-effectiveness of the Therapeutic Education System (TES), an internet-based version of the community reinforcement approach with contingency management. They find that usual treatment paired with TES cost the provider an additional $278 over 12 weeks. While quality-adjusted life years did not differ between...
[cross-posted with the Toward Health blog]