The American journal of managed care
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Treatment of multiple myeloma (MM) remains highly individualized, with multiple factors that play a role in determining the best course of therapy. Patient-specific criteria such as age of onset, whether the patient is symptomatic at the time of diagnosis, and any detected high-risk cytogenic abnormalities are all considerations when selecting a regimen. Newer agents such as bortezomib and lenalidomide in combination with low-dose steroids have replaced more toxic chemotherapeutic regimens for primary induction and have led to significant increases in progression-free survival. ⋯ In addition, the availability of orally active agents may decrease the need for outpatient infusions, thus decreasing the overall costs associated with treatment and improving patient satisfaction. Finally, combination regimens that use lower doses may prove to be less toxic as well as more effective. Even though MM only accounts for approximately 1% of all cancers in the United States, with 75 million “baby boomers” now reaching the median age of diagnosis, the increased number of cases could have a substantial impact on healthcare costs.
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To determine whether participation in a value-based insurance design (VBID) program was associated with improved medication adherence in 8 drug classes 2 years after implementation and to examine whether adherence changes varied by baseline adherence. ⋯ Population-based implementation of VBID can improve adherence to medications to treat cardiometabolic conditions, particularly for previously nonadherent patients. VBID guidelines being developed in response to healthcare reform should account for the heterogeneity in patient response to VBID programs.
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Oral oncolytics are an increasingly important treatment option for cancer. These agents often fall within the pharmacy benefit, with the potential for increased out-of-pocket (OOP) cost burden for patients. The purpose of this study was to evaluate patient OOP payments for oral oncolytic therapies in US managed care plans. ⋯ Among 21 oral oncolytics, average OOP cost ranged from $15 to >$500. These results confirm previous findings showing OOP payments differing widely among oral oncolytic options. As cost for therapy becomes a greater part of treatment decisions, an understanding of patient OOP cost will be critical in informing choices.
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To examine the characteristics of patients with cancer and their visits to outpatient, office-based physicians; to analyze any differences between visits to oncologists and visits to other physicians; and to examine the effect of patient, practice, visit, and geographic characteristics on the length of time patients with cancer spend with physicians during office-based visits. ⋯ Higher use of performance-based payment mechanisms and capitated arrangements is associated with a decrease in the amount of time physicians spend with their patients with cancer. It is unclear whether shorter visit times impact the quality of medical care provided or whether physicians in these settings have become more proficient in caring for their patients.
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To estimate the economic outcomes associated with routine use of bioimpedance spectroscopy (BIS) to aid in the assessment of lymphedema following breast cancer (BC) treatment. ⋯ Over 1 year, BIS-aided assessment of lymphedema for patients following treatment for BC results in cost savings, even without considering potential cost savings associated with averted downstream sequelae.