JAMA network open
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Immune checkpoint inhibitor combination therapy has recently become the standard of care for first-line treatment of metastatic nonsquamous non-small cell lung cancer. The implications of these first-line treatments are considerable, given the potential population of patients eligible to receive them and their high cost. ⋯ In this simulated model economic analysis, atezolizumab combination was not cost-effective compared with bevacizumab, carboplatin, and paclitaxel and provided suboptimal incremental benefit compared with cost vs pembrolizumab combination for first-line treatment. Although atezolizumab combination therapy provides clinical benefits, price reductions may be necessary for this treatment strategy to become cost-effective.
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With increasing efforts to create a diverse physician workforce that is reflective of the demographic characteristics of the US population, it remains unclear whether progress has been made since 2009, when the Liaison Committee on Medical Education set forth new diversity accreditation guidelines. ⋯ Black, Hispanic, and AIAN students remain underrepresented among medical school matriculants compared with the US population. This underrepresentation has not changed significantly since the institution of the Liaison Committee of Medical Education diversity accreditation guidelines in 2009. This study's findings suggest a need for both the development and the evaluation of more robust policies and programs to create a physician workforce that is demographically representative of the US population.
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Diagnostic low-dose ionizing radiation has great medical benefits; however, its increasing use has raised concerns about possible cancer risks. ⋯ This study found an association of increased incidence of cancer with exposure to diagnostic low-dose ionizing radiation in a large cohort. Given this risk, diagnostic low-dose ionizing radiation should be limited to situations in which there is a definite clinical indication.
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Understanding geographic and community-level factors associated with suicide can inform targeted suicide prevention efforts. ⋯ This study found that suicide rates have increased across the nation and most rapidly in rural counties, which may be more sensitive to the impact of social deprivation than more metropolitan counties. Improving social connectedness, civic opportunities, and health insurance coverage as well as limiting access to lethal means have the potential to reduce suicide rates across the rural-urban continuum.
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Strategic planning to curb increasing suicide rate among US youths requires unbiased measures of suicide mortality, as the unadjusted suicide mortality rates conventionally used in describing time trends and sex patterns are confounded by the differences in chronological age and year of birth. ⋯ Findings of this study indicate a more rapid increase and smaller male-female difference in suicide rates among US youths since 1999 than those shown by the unadjusted suicide mortality rates. The adjusted rates provide unbiased data that are needed for evidence-based decision-making and strategies to curb the increasing suicide rates among US youths.