Research Roundup: Drug Costs; Doctors’ Choices On Care; The 3 Rs; Zika Outbreak

JAMA: The High Cost Of Prescription Drugs In The United States
Per capita prescription drug spending in the United States exceeds that in all other countries, largely driven by brand-name drug prices .... prescription medications now comprise an estimated 17% of overall personal health care services. The most important factor that allows manufacturers to set high drug prices is market exclusivity .... The availability of generic drugs after this exclusivity period is the main means of reducing prices in the United States, but access to them may be delayed by numerous business and legal strategies. The primary counterweight against excessive pricing during market exclusivity is the negotiating power of the payer, which is currently constrained by several factors .... Another key contributor to drug spending is physician prescribing choices when comparable alternatives are available. (Kesselheim, Avorn and Sarpatwari, 8/23)

JAMA: Association Of Integrated Team-Based Care With Health Care Quality, Utilization, And Cost
[Researchers sought to] evaluate the association of receiving primary care in integrated team-based care (TBC) practices vs traditional practice management (TPM) practices ... [among patients] who received primary care at 113 unique Intermountain Healthcare Medical Group primary care practices .... In this observational study, receipt of primary care in TBC practices compared with TPM practices was associated with significantly higher rates of some quality of care measures, reductions in some measures of acute care utilization, and decreased actual payments to the delivery system from all payers and patients. Compared with TPM, TBC also was associated with improved quality of care for patients with depression and diabetes, but with decreased quality for patients with hypertension. (Reiss-Brennan et al., 8/23)

JAMA Internal Medicine: Physician-Driven Variation in Nonrecommended Services Among Older Adults Diagnosed With Cancer
Interventions to address overuse of health care services may help reduce costs and improve care. Understanding physician-level variation and behavior patterns can inform such interventions. ... [Researchers used] retrospective study of patients 66 years and older diagnosed with cancer between 2004 and 2011, using population-based Surveillance, Epidemiology, and End Results (SEER)-Medicare data to assess physician-level variation in 5 nonrecommended services. ... The total proportion of patients receiving each service varied from 14% for imaging in staging early breast cancer to 41% in early prostate cancer. ... Physicians’ utilization of nonrecommended services that tend to be overused exhibit patterns that suggest consistent behavior more than personalized patient care decisions. (Lipitz-Snyderman et al., 8/15)

The Kaiser Family Foundation: Explaining Health Care Reform: Risk Adjustment, Reinsurance, And Risk Corridors
The Affordable Care Act’s risk adjustment, reinsurance, and risk corridors programs were designed to work together to mitigate the potential effects of adverse selection and risk selection [on insurers]. ... while the programs have similar goals, they are designed to be complementary. Specifically, risk adjustment is designed to mitigate any incentives for plans to attract healthier individuals and compensate those that enroll a disproportionately sick population. Risk corridors were intended to reduce overall financial uncertainty for insurers, though they largely did not fulfill that goal following congressional changes to the program. Reinsurance compensated plans for their high-cost enrollees .... Premium increases are expected to be higher in 2017 in part due to the end of the reinsurance program. (Cox et al., 8/17)

The Kaiser Family Foundation: The 2015-2016 Zika Outbreak
This infographic offers key facts about the Zika virus, tracks the increasing number of countries reporting local transmission over the past year, and breaks down how key U.S. government agencies are responding to Zika. (8/9)

Here is a selection of news coverage of other recent research:

Reuters: Fewer Dementia Patients In Nursing Homes Get Feeding Tubes
Fewer U.S. nursing home patients with dementia are getting feeding tubes as mounting evidence suggests it may not help them live longer or make them more comfortable, new research suggests. Researchers focused on the sickest dementia patients who tend to have difficulty chewing and swallowing as they near the end of life, a point when they may also struggle to speak, recognize loved ones, get out of bed or go to the bathroom independently. The proportion of these advanced dementia patients who got feeding tubes when they couldn’t eat on their own dropped from 12 percent in 2000 to 6 percent in 2014, according to an analysis of data on 71,000 nursing home residents published in JAMA. (Rapaport, 8/16)

NBC News: More Moms Are Breastfeeding Their Babies — But Not For Long Enough, Experts Say
More than 80 percent of U.S. mothers breastfeed their newborns, a new survey finds, but fewer than a third keep doing so for the recommended minimum of one year, a new survey finds. Many studies support breastfeeding for as long as possible, and the American Academy of Pediatrics recommends that babies get nothing but human breast milk until the age of six months — and that they continue to breastfeed for at least a year. (Fox, 8/22)

Stat: Using DNA Tests To Let Women With Breast Cancer Skip Chemo
It’s a dilemma more and more cancer patients will face as genetic testing becomes part of everyday health care: When a DNA test indicates low risk of a tumor spreading, but traditional tests show a high risk, which do you believe? According to a large European study of 6,693 patients published on Wednesday, many women with early breast cancer can safely believe the genetic test. (Begley, 8/24)

CBS News: ADHD In Black And Latino Children Not Diagnosed, Treated As Often As Whites
While a higher percentage of black children show the symptoms of attention-deficit/hyperactivity disorder (ADHD) than white kids, they are less likely to be diagnosed or treated for the disorder, researchers report. The new study showed a similar trend when it came to Latino children: They were as likely as their white peers to exhibit the signs of ADHD, but less likely to be diagnosed or treated for it. (Bernstein, 8/24)