This document discusses the high costs associated with pulmonary hypertension (PH) from multiple perspectives, including direct healthcare costs, indirect costs, and costs to individuals and society. Hospitalizations are identified as a major driver of costs. Earlier diagnosis and treatment, risk-guided escalation of therapy, and care at specialized centers can help reduce costs by preventing hospitalizations and disease progression. While medications and care are costly, lack of treatment results in poor outcomes and increased costs over time. Assistance programs help many patients afford needed therapies.
Reducing Readmissions and Length of Stay | VITAS HealthcareVITAS Healthcare
Hospice can help reduce hospital readmissions and lengths of stay for patients with serious illnesses like heart failure. By providing comprehensive care, including nursing support 24 hours a day, palliative care physician support, medications, equipment, and targeted programs for conditions like CHF, hospice can help meet patient goals of comfort and avoiding inappropriate hospitalizations. For the patient with heart failure described in the case study, hospice could help prevent readmissions and allow the patient to focus on quality of life rather than further medical interventions by providing end-of-life care in their home.
This document discusses reducing hospital readmissions and lengths of stay. It notes that over 90% of patients die of a life-limiting condition over an extended period, and that patients with serious illnesses primarily want pain and symptom control and to strengthen relationships. The document discusses how Medicare's Hospital Readmission Reduction Program aims to lower excess readmissions, and identifies components like discharge planning that can impact readmission rates. It presents data showing that hospice can help lower readmissions by providing care in the patient's preferred location.
This document discusses reducing hospital readmissions and lengths of stay. It begins by outlining the Hospital Readmission Reduction Program which aims to lower excess readmission rates for conditions like heart failure and pneumonia. It then discusses that over 90% of patients die of a life-limiting illness over an extended period, and that patients in their final stages primarily want symptom control and time with loved ones. The document advocates that hospice can help lower readmissions by providing comprehensive care for seriously ill patients in their homes or other settings to meet their end-of-life goals.
- Cardiovascular disease is the leading cause of death in Canada, and high blood pressure is the number one modifiable risk factor. However, many Canadians are unaware they have high blood pressure or it is not adequately controlled.
- The document outlines a strategy to improve hypertension management in Canada through initiatives targeted at primary healthcare providers and patients. It involves developing and testing education and management tools.
- An evaluation of the initial pilot phase found improvements in screening, diagnosis and control of high blood pressure among participating providers and patients compared to non-participants. Most providers also reported the strategy was effective and positively impacted their management of hypertensive patients.
My top 5 papers of 2015-2017 about telehealth in copd managementFrancis Thien
Frank Thien reviewed the top 5 papers from 2015-2017 on the role of telehealth in COPD management. The papers included a review finding variable telehealth models for COPD but more evidence is needed. A large Danish RCT found telehealth did not significantly improve quality of life. A Northern Ireland RCT found telemonitoring improved quality of life but was not cost-effective. A Taiwanese RCT found telemonitoring reduced hospital readmissions. A small Norwegian pilot study found telerehabilitation improved outcomes and was feasible for long-term exercise maintenance. Further research is still needed, particularly on cost-benefit analyses and replicating successful studies.
Introduction of the NZ Health IT Plan enables better gout management - Reflections of an early adopter. Presented by Peter Gow, Counties Manukau DHB, at HINZ 2014, 12 November 2014, 11.37am, Plenary Room
Reducing Readmissions and Length of Stay | VITAS HealthcareVITAS Healthcare
Hospice can help reduce hospital readmissions and lengths of stay for patients with serious illnesses like heart failure. By providing comprehensive care, including nursing support 24 hours a day, palliative care physician support, medications, equipment, and targeted programs for conditions like CHF, hospice can help meet patient goals of comfort and avoiding inappropriate hospitalizations. For the patient with heart failure described in the case study, hospice could help prevent readmissions and allow the patient to focus on quality of life rather than further medical interventions by providing end-of-life care in their home.
This document discusses reducing hospital readmissions and lengths of stay. It notes that over 90% of patients die of a life-limiting condition over an extended period, and that patients with serious illnesses primarily want pain and symptom control and to strengthen relationships. The document discusses how Medicare's Hospital Readmission Reduction Program aims to lower excess readmissions, and identifies components like discharge planning that can impact readmission rates. It presents data showing that hospice can help lower readmissions by providing care in the patient's preferred location.
This document discusses reducing hospital readmissions and lengths of stay. It begins by outlining the Hospital Readmission Reduction Program which aims to lower excess readmission rates for conditions like heart failure and pneumonia. It then discusses that over 90% of patients die of a life-limiting illness over an extended period, and that patients in their final stages primarily want symptom control and time with loved ones. The document advocates that hospice can help lower readmissions by providing comprehensive care for seriously ill patients in their homes or other settings to meet their end-of-life goals.
- Cardiovascular disease is the leading cause of death in Canada, and high blood pressure is the number one modifiable risk factor. However, many Canadians are unaware they have high blood pressure or it is not adequately controlled.
- The document outlines a strategy to improve hypertension management in Canada through initiatives targeted at primary healthcare providers and patients. It involves developing and testing education and management tools.
- An evaluation of the initial pilot phase found improvements in screening, diagnosis and control of high blood pressure among participating providers and patients compared to non-participants. Most providers also reported the strategy was effective and positively impacted their management of hypertensive patients.
My top 5 papers of 2015-2017 about telehealth in copd managementFrancis Thien
Frank Thien reviewed the top 5 papers from 2015-2017 on the role of telehealth in COPD management. The papers included a review finding variable telehealth models for COPD but more evidence is needed. A large Danish RCT found telehealth did not significantly improve quality of life. A Northern Ireland RCT found telemonitoring improved quality of life but was not cost-effective. A Taiwanese RCT found telemonitoring reduced hospital readmissions. A small Norwegian pilot study found telerehabilitation improved outcomes and was feasible for long-term exercise maintenance. Further research is still needed, particularly on cost-benefit analyses and replicating successful studies.
Introduction of the NZ Health IT Plan enables better gout management - Reflections of an early adopter. Presented by Peter Gow, Counties Manukau DHB, at HINZ 2014, 12 November 2014, 11.37am, Plenary Room
This case involves a 58-year-old male with a 5-year history of breathlessness on exertion and a cough for the past 10 days. Spirometry showed very severe obstruction with an FEV1 of less than 30% of predicted. The patient has a history of 3 exacerbations requiring hospital admission in the past year. The document discusses diagnostic delays in COPD, under treatment of COPD patients, exacerbation frequency, assessment of risk factors, and the high burden of COPD in India.
The document discusses trends in long term conditions like COPD and diabetes that are increasing healthcare costs and burden. It introduces an innovation to improve pulmonary rehabilitation through online programs that could double recovery rates, correct inhaler errors in 95-98% of patients, and provide outcomes similar to in-person programs at lower costs. The challenges are implementing changes, gaining clinician acceptance, and scaling the program across organizations.
Predicting cancer patients’ quality of life: an analysis of the relationship ...Kerry Sheppard
This document summarizes a study that used data from the Cancer 2015 cohort to analyze the relationship between cancer patients' quality of life (measured by EQ-5D utility scores), treatment regimens, and time. The study found that chemotherapy and radiotherapy had the largest negative effects on quality of life scores, particularly in the 1-2 months after treatment. Surgery had a smaller effect. Baseline quality of life was the strongest predictor of follow-up quality of life. The results provide insights into how different cancer treatments impact patients' quality of life over time.
Treatment Optimization in Heart Failure, Taking responsibility in optimizing patient care in Heart Failure.
Dr Pierre Troisfontaines, President of the BWGHF
C.H.R. de la Citadelle (Liège)
In this global pandemic, IBD patients and their healthcare providers from around the world share similar fears and concerns. SECURE-IBD is an international database to monitor and report on COVID-19 in IBD patients. By working across borders, we are learning how factors like age, other conditions, and IBD treatments impact COVID-19 outcomes. This slide deck also shares information about other research efforts that are ongoing to better understand the impact of COVID-19 on IBD patients.
The Foundation would like to thank AbbVie Inc., Genentech, Inc., Gilead Sciences, Inc., Janssen Biotech, Inc., Shire, and Takeda Pharmaceuticals U.S.A., Inc., sponsors of our COVID-19 materials. Additional support is provided through the Foundation’s annual giving program and individual donors.
Primary medical care settings are ideal for treating chronic illnesses but are underutilized venues for addressing this particular chronic disease. Addiction treatment specialists are too few and many patients find this path to be unacceptable. The question becomes: how to get primary care medical providers to integrate the treatment of patients with opioid use disorders into their practices?
Different ways to accomplish this were the topic of the Louis Kolodner Memorial Lecture at MedChi for the second year in a row. Last year, Dr. Michael Fingerhood described the model that he has developed at Johns Hopkins Medicine. This year, Dr. Richard Schottenfeld, now the Chief of Psychiatry at Howard University, presented research studies done by Yale University and other centers. These studies demonstrated four successful interventions:
Methadone given to already stabilized opioid addiction patients in a primary care setting instead of a specialized opioid treatment program (OTP)
Buprenorphine along with medical counseling given in a primary care setting
An initial dose of buprenorphine given in a hospital emergency department along with a next-day follow up appointment for ongoing treatment
Injectable naltrexone, although more difficult to initiate for patients than was buprenorphine, was effective for those patients who were able to start it
Two barriers that needed to be reduced to achieve these successes were the disinclination of providers to use these medications and general pessimism about the prognosis of opioid use disorders. My hope is that as more successes are demonstrated, these barriers will slowly be lowered. For those interested in more details about these studies, I invite you to access the lecture slides, available here.
Cheshire and Wirral Best Practice event - 8 NovemberInnovation Agency
The document outlines plans for developing integrated care communities across South Cheshire and Vale Royal. Key points include:
- The formation of 5 care community teams to provide coordinated, patient-centered care across the region.
- Initial priority projects include developing the care community teams, improving GP out-of-hours care, and musculoskeletal physiotherapy.
- Achievements so far include aligning staff to the 5 communities, implementing rapid response services, and beginning multidisciplinary team meetings.
- Future goals involve strengthening primary care partnerships, expanding social care support, and using data to better manage patient risk levels.
The Chronic Care Model provides a framework to improve care for patients with chronic illnesses. It emphasizes productive interactions between informed, activated patients and prepared practice teams. The model includes six core elements: community resources, self-management support, delivery system design, decision support, clinical information systems, and organized healthcare systems. Studies show practices that more fully implement the model through interventions experience improved quality of care and patient outcomes. Randomized controlled trials demonstrate the Chronic Care Model is effective across different chronic conditions. While implementation presents challenges, the evidence indicates the Chronic Care Model can successfully redesign care for chronic illness.
The document summarizes research on the benefits of clinical pharmacists participating as members of medical teams. Several studies found that including clinical pharmacists reduced mortality rates in hospitals and improved outcomes across disease states. Pharmacists improved medication management by addressing drug-related problems, which led to decreased mortality for conditions like heart attacks. Their interventions enhanced clinical outcomes for diabetes, cardiovascular disorders, and other conditions. Effective implementation of these pharmacy services requires support from healthcare organizations and infrastructure support within facilities.
This study aims to correlate CT severity scores based on chest CT scans with clinical outcomes in COVID-19 patients admitted to the ICU. The study will collect data on 500 ICU patients including demographics, medical history, lab results, oxygen requirements, treatments, and outcomes at discharge and 6 months. CT severity scores will be assigned by a radiologist based on a previously established 25-point scoring system. The primary objective is to correlate CT scores with mortality, and secondary objectives are to examine relationships between CT scores and other clinical parameters and outcomes. Previous studies have found associations between worse CT findings, older age, comorbidities, and poorer prognosis in COVID-19 patients.
Designing Causal Inference Studies Using Real-World DataInsideScientific
In this webinar, experts provide an overview of causal inference, along with step-by-step guidance to designing these studies using real-world healthcare data.
Causal inference is used to answer cause and effect research questions and yield estimates of effect. Causal study design considerations and statistical methods address the effects of confounding variables and other potential biases and allow researchers to answer questions such as, “Does treatment A produce better patient outcomes compared to Treatment B?”
Causal study interpretations have traditionally been restricted to randomized controlled trials; however, causal inference applied to observational healthcare data is growing in importance, driven by the need for generalizable and rapidly delivered real-world evidence to inform regulatory, payer, and patient/provider decision making. The application of causal inference methods leads to stronger and more powerful evidence. When these techniques are applied to observational data, the results generated are both from and for the real world.
Presenters walk through several real-world case studies including the PCORI-funded BESTMED study and a collaborative study with a prominent pharmacy payer.
Homeopathic medical practice: Long-term results of a cohort study with 3981 p...home
Disease severity and quality of life demonstrated marked and sustained
improvements following homeopathic treatment period. Our findings indicate that homeopathic
medical therapy may play a beneficial role in the long-term care of patients with chronic diseases.
Reducing Stroke Readmissions in Acute Care Setting.docxdanas19
This document discusses factors that contribute to readmissions of stroke patients and interventions to reduce readmissions. It notes that readmissions account for 20.5% of hospital admissions and reviews reasons for readmissions like medication issues, lack of follow-up care, and unhealthy lifestyles. The document outlines programs like TRACS, COMPASS and MISTT that provide post-discharge support through nurse coaching, medication management support and lifestyle counseling to reduce readmissions.
This document summarizes a health economic evaluation of implementing whole exome sequencing (WES) in clinical practice compared to the current diagnostic trajectory for patients with complex pediatric neurology cases.
The current diagnostic trajectory has a low diagnostic yield of 6% but costs an average of €12,475 per patient. WES is estimated to increase the diagnostic yield to at least 22% while lowering costs to €3,600 per patient.
Receiving a diagnosis through either method may improve patients' and parents' health-related quality of life, though more research is needed to quantify this effect. The increased diagnostic power of WES could provide substantial health benefits to patients and cost savings to the healthcare system and society. However, a
Partners’ Care Management Strategy: A 10-Year JourneyHealth Catalyst
Chronic diseases are responsible for seven out of 10 deaths each year, killing more than 1.7 million Americans annually. Additionally, 133 million Americans—approximately 45 percent of the population—have at least one chronic disease. Partners HealthCare believes that chronically ill patients with multiple medical conditions often need the most help coordinating their care, which is why this well-respected health system has spent the last 10 years perfecting an integrated care management program (iCMP).
Key elements of the iCMP at Partners include access to specialized resources (e.g., mental health, palliative care), involvement through the continuum of care, patient self-management, IT-enabled systems to improve care coordination, data-driven analytics to support strategic decision making, a payer-blind approach, and ongoing support and training for its teams and staff.
Attendees will learn how to:
Identify the essential elements of an effective care management program for chronically ill patients
Recognize how care management plays a key role in an effective population health management strategy
Determine how to use information to identify and effectively manage complex, chronically ill patients
The Thailand HiT reports that sustained political commitment to the health of the population since the 1970s has resulted in significant investment in health infrastructure, in particular primary health care, district and provincial referral hospitals, and strengthened the overall functioning of the Thai health system. After Thailand achieved universal health coverage in 2002, public expenditure on health significantly increased from 63% to 77% and out-of-pocket expense was reduced from 27.2% to 12.4% of the total health spending in 2011.
This case involves a 58-year-old male with a 5-year history of breathlessness on exertion and a cough for the past 10 days. Spirometry showed very severe obstruction with an FEV1 of less than 30% of predicted. The patient has a history of 3 exacerbations requiring hospital admission in the past year. The document discusses diagnostic delays in COPD, under treatment of COPD patients, exacerbation frequency, assessment of risk factors, and the high burden of COPD in India.
The document discusses trends in long term conditions like COPD and diabetes that are increasing healthcare costs and burden. It introduces an innovation to improve pulmonary rehabilitation through online programs that could double recovery rates, correct inhaler errors in 95-98% of patients, and provide outcomes similar to in-person programs at lower costs. The challenges are implementing changes, gaining clinician acceptance, and scaling the program across organizations.
Predicting cancer patients’ quality of life: an analysis of the relationship ...Kerry Sheppard
This document summarizes a study that used data from the Cancer 2015 cohort to analyze the relationship between cancer patients' quality of life (measured by EQ-5D utility scores), treatment regimens, and time. The study found that chemotherapy and radiotherapy had the largest negative effects on quality of life scores, particularly in the 1-2 months after treatment. Surgery had a smaller effect. Baseline quality of life was the strongest predictor of follow-up quality of life. The results provide insights into how different cancer treatments impact patients' quality of life over time.
Treatment Optimization in Heart Failure, Taking responsibility in optimizing patient care in Heart Failure.
Dr Pierre Troisfontaines, President of the BWGHF
C.H.R. de la Citadelle (Liège)
In this global pandemic, IBD patients and their healthcare providers from around the world share similar fears and concerns. SECURE-IBD is an international database to monitor and report on COVID-19 in IBD patients. By working across borders, we are learning how factors like age, other conditions, and IBD treatments impact COVID-19 outcomes. This slide deck also shares information about other research efforts that are ongoing to better understand the impact of COVID-19 on IBD patients.
The Foundation would like to thank AbbVie Inc., Genentech, Inc., Gilead Sciences, Inc., Janssen Biotech, Inc., Shire, and Takeda Pharmaceuticals U.S.A., Inc., sponsors of our COVID-19 materials. Additional support is provided through the Foundation’s annual giving program and individual donors.
Primary medical care settings are ideal for treating chronic illnesses but are underutilized venues for addressing this particular chronic disease. Addiction treatment specialists are too few and many patients find this path to be unacceptable. The question becomes: how to get primary care medical providers to integrate the treatment of patients with opioid use disorders into their practices?
Different ways to accomplish this were the topic of the Louis Kolodner Memorial Lecture at MedChi for the second year in a row. Last year, Dr. Michael Fingerhood described the model that he has developed at Johns Hopkins Medicine. This year, Dr. Richard Schottenfeld, now the Chief of Psychiatry at Howard University, presented research studies done by Yale University and other centers. These studies demonstrated four successful interventions:
Methadone given to already stabilized opioid addiction patients in a primary care setting instead of a specialized opioid treatment program (OTP)
Buprenorphine along with medical counseling given in a primary care setting
An initial dose of buprenorphine given in a hospital emergency department along with a next-day follow up appointment for ongoing treatment
Injectable naltrexone, although more difficult to initiate for patients than was buprenorphine, was effective for those patients who were able to start it
Two barriers that needed to be reduced to achieve these successes were the disinclination of providers to use these medications and general pessimism about the prognosis of opioid use disorders. My hope is that as more successes are demonstrated, these barriers will slowly be lowered. For those interested in more details about these studies, I invite you to access the lecture slides, available here.
Cheshire and Wirral Best Practice event - 8 NovemberInnovation Agency
The document outlines plans for developing integrated care communities across South Cheshire and Vale Royal. Key points include:
- The formation of 5 care community teams to provide coordinated, patient-centered care across the region.
- Initial priority projects include developing the care community teams, improving GP out-of-hours care, and musculoskeletal physiotherapy.
- Achievements so far include aligning staff to the 5 communities, implementing rapid response services, and beginning multidisciplinary team meetings.
- Future goals involve strengthening primary care partnerships, expanding social care support, and using data to better manage patient risk levels.
The Chronic Care Model provides a framework to improve care for patients with chronic illnesses. It emphasizes productive interactions between informed, activated patients and prepared practice teams. The model includes six core elements: community resources, self-management support, delivery system design, decision support, clinical information systems, and organized healthcare systems. Studies show practices that more fully implement the model through interventions experience improved quality of care and patient outcomes. Randomized controlled trials demonstrate the Chronic Care Model is effective across different chronic conditions. While implementation presents challenges, the evidence indicates the Chronic Care Model can successfully redesign care for chronic illness.
The document summarizes research on the benefits of clinical pharmacists participating as members of medical teams. Several studies found that including clinical pharmacists reduced mortality rates in hospitals and improved outcomes across disease states. Pharmacists improved medication management by addressing drug-related problems, which led to decreased mortality for conditions like heart attacks. Their interventions enhanced clinical outcomes for diabetes, cardiovascular disorders, and other conditions. Effective implementation of these pharmacy services requires support from healthcare organizations and infrastructure support within facilities.
This study aims to correlate CT severity scores based on chest CT scans with clinical outcomes in COVID-19 patients admitted to the ICU. The study will collect data on 500 ICU patients including demographics, medical history, lab results, oxygen requirements, treatments, and outcomes at discharge and 6 months. CT severity scores will be assigned by a radiologist based on a previously established 25-point scoring system. The primary objective is to correlate CT scores with mortality, and secondary objectives are to examine relationships between CT scores and other clinical parameters and outcomes. Previous studies have found associations between worse CT findings, older age, comorbidities, and poorer prognosis in COVID-19 patients.
Designing Causal Inference Studies Using Real-World DataInsideScientific
In this webinar, experts provide an overview of causal inference, along with step-by-step guidance to designing these studies using real-world healthcare data.
Causal inference is used to answer cause and effect research questions and yield estimates of effect. Causal study design considerations and statistical methods address the effects of confounding variables and other potential biases and allow researchers to answer questions such as, “Does treatment A produce better patient outcomes compared to Treatment B?”
Causal study interpretations have traditionally been restricted to randomized controlled trials; however, causal inference applied to observational healthcare data is growing in importance, driven by the need for generalizable and rapidly delivered real-world evidence to inform regulatory, payer, and patient/provider decision making. The application of causal inference methods leads to stronger and more powerful evidence. When these techniques are applied to observational data, the results generated are both from and for the real world.
Presenters walk through several real-world case studies including the PCORI-funded BESTMED study and a collaborative study with a prominent pharmacy payer.
Homeopathic medical practice: Long-term results of a cohort study with 3981 p...home
Disease severity and quality of life demonstrated marked and sustained
improvements following homeopathic treatment period. Our findings indicate that homeopathic
medical therapy may play a beneficial role in the long-term care of patients with chronic diseases.
Reducing Stroke Readmissions in Acute Care Setting.docxdanas19
This document discusses factors that contribute to readmissions of stroke patients and interventions to reduce readmissions. It notes that readmissions account for 20.5% of hospital admissions and reviews reasons for readmissions like medication issues, lack of follow-up care, and unhealthy lifestyles. The document outlines programs like TRACS, COMPASS and MISTT that provide post-discharge support through nurse coaching, medication management support and lifestyle counseling to reduce readmissions.
This document summarizes a health economic evaluation of implementing whole exome sequencing (WES) in clinical practice compared to the current diagnostic trajectory for patients with complex pediatric neurology cases.
The current diagnostic trajectory has a low diagnostic yield of 6% but costs an average of €12,475 per patient. WES is estimated to increase the diagnostic yield to at least 22% while lowering costs to €3,600 per patient.
Receiving a diagnosis through either method may improve patients' and parents' health-related quality of life, though more research is needed to quantify this effect. The increased diagnostic power of WES could provide substantial health benefits to patients and cost savings to the healthcare system and society. However, a
Partners’ Care Management Strategy: A 10-Year JourneyHealth Catalyst
Chronic diseases are responsible for seven out of 10 deaths each year, killing more than 1.7 million Americans annually. Additionally, 133 million Americans—approximately 45 percent of the population—have at least one chronic disease. Partners HealthCare believes that chronically ill patients with multiple medical conditions often need the most help coordinating their care, which is why this well-respected health system has spent the last 10 years perfecting an integrated care management program (iCMP).
Key elements of the iCMP at Partners include access to specialized resources (e.g., mental health, palliative care), involvement through the continuum of care, patient self-management, IT-enabled systems to improve care coordination, data-driven analytics to support strategic decision making, a payer-blind approach, and ongoing support and training for its teams and staff.
Attendees will learn how to:
Identify the essential elements of an effective care management program for chronically ill patients
Recognize how care management plays a key role in an effective population health management strategy
Determine how to use information to identify and effectively manage complex, chronically ill patients
The Thailand HiT reports that sustained political commitment to the health of the population since the 1970s has resulted in significant investment in health infrastructure, in particular primary health care, district and provincial referral hospitals, and strengthened the overall functioning of the Thai health system. After Thailand achieved universal health coverage in 2002, public expenditure on health significantly increased from 63% to 77% and out-of-pocket expense was reduced from 27.2% to 12.4% of the total health spending in 2011.
Similar to The Cost of PH - How Do We Manage This? (20)
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
low birth weight presentation. Low birth weight (LBW) infant is defined as the one whose birth weight is less than 2500g irrespective of their gestational age. Premature birth and low birth weight(LBW) is still a serious problem in newborn. Causing high morbidity and mortality rate worldwide. The nursing care provide to low birth weight babies is crucial in promoting their overall health and development. Through careful assessment, diagnosis,, planning, and evaluation plays a vital role in ensuring these vulnerable infants receive the specialize care they need. In India every third of the infant weight less than 2500g.
Birth period, socioeconomical status, nutritional and intrauterine environment are the factors influencing low birth weight
Lecture 6 -- Memory 2015.pptlearning occurs when a stimulus (unconditioned st...AyushGadhvi1
learning occurs when a stimulus (unconditioned stimulus) eliciting a response (unconditioned response) • is paired with another stimulus (conditioned stimulus)
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdfrightmanforbloodline
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
1. The Cost of PH- How do we
Manage this?
Terry Fortin MD
Duke Pulmonary Vascular Disease Center
Laura Nowicki RN
UNC Pulmonary Hypertension
2. Case TS Flashback to 1/2003
• Presented with syncope age 29 and had full work up
• Cath RA 15, Mean PAP 60, Index of 1.6L/min/m2 PVR 14
• Echo severely enlarged RV, Severe TR and hypokinesis
with pericardial effusion
• Walk 400 meters but only 50% predicted (actually post
med) due to syncope need for pressor
• pBNP did not exist.
• Admitted and started on IV prostacyclin. Later addition of
PDE 5 inhibitor and endothelin antagonist
• Had WU for transplant to accrue time then listing changed
and stopped seeing
• No hospitalizations since, On thyroid medication
3. Case TS Updated
• Repeat cath in 2016 with plans to convert IV to oral
prostacyclin PVR 4.3 WU and CI 2.7
• Most recent cath 2021 on triple oral therapy PVR 3.8 but still
with moderately enlarged RV only mild dysfunction
• Walk 560 meters 91% predicted Now age 50
• Normal pBNP since about 2005
• Although good, Not perfect and does he need more
• Has worked full time since mid 2003. Changed jobs 2 times.
Once because had used up lifetime insurance allotment of
policy. Once as Promotion. Now manager
• Married , 2 kids in their 20s PRICELESS
4. Cost Effects Many
• Cost to Society
• Cost to Health Care System ( Local/State/National)
• Effect on Pulmonary Hypertension Community
• Cost to the Individual PAH Center/ Health Center
– Takes a village and not necessarily reimbursable
• Cost to the Individual Patient and Family
• Not All COST Monetary
5. What Drives/Controls Cost
• Pharmaceutical or Biologic Companies Developing
Compounds
• Research Enterprise (Private or Governmental)
• Pharmaceutical Companies Manufacturing, Marketing
Products
• Health Systems, Hospitals and MD, RN, CMA,
• Insurance Companies
• Pharmacies/ Specialty Pharmacies
• Ancillary Services- Oxygen/ Sleep Companies
• Medicare/ Medicaid (Government/State)
6. Costs: Direct Health Care and Indirect
• Direct
• Cost of Diagnostic
Testing
• Walks, echos, caths,
PFDs, MRI, CT scans
• CXRs, ECGs
• Clinic visits/ED visits
• Hospitalizations
• Medications/Supplies/
• Indirect
• Disability
• Days Missing Work
• Family members
missing work
• Loss of productivity
• Death
• End of employment
• Other
7. Health Care Terms
• Quality Adjusted Life Years (QALY)
– One value to combine quality of Life (QoL) and length of Life due to
some treatment/procedure
• Disability adjusted Life years (DALY) ( 1- QUALY)
– Loss of healthy life, premature mortality plus years of healthy life lost
secondary to disability
Health Care Resource Utilization (HCRU)
• HRQoL Health Related Quality of Life
– Includes disease and physical symptoms
– Function status (ability to do ADLs
– Psychological and emotional statu
– Social factors
8. Managing Cost
• In PAH have Data to Support
• Getting earlier Diagnosis
– Early Initiation of Appropriate Therapy
– Education Important
• Referral to Specialized Treatment Centers
• Using Guidelines, Risk Sores to adjust therapy
• Combination therapy early in Treatment
• Escalation to Higher levels of therapy when Risks increase
• More is not always Better (Triton Study)
• Risk Scores may reflect illness not related to PAH
9. What is the Burden Of PAH Exposto, F
• Retrospective study in England 2012 to 2018 Using
National Health Services Data. 2500 pts
• Mean annual Hospitalization 2.9 to 3.2 (25% had 5
admissions)
• 9-10 yearly OP visits and ED visits 0.8 to 0.9
• Incident Patients Highest cost first Year with most
admissions for PAH related issues
• 79% cost inpt admissions, PH admissions more
costly(3x)
• Cost of medications was not addressed
• 20% of pts accounted for 55% of costI
• Data captured mixed etiology as top 20% far more likely to
have CV disease or Heart failure (not clear if right or left)
10. Economic Burden of PAH
• Cost and resource utilization in US Managed Care Group
• 2004 to 2010 Had to have >2 PAH claims or > 2 claims
with PAH diagnosis and1 + claims for prescribed med
• Followed once med prescribed and look at annualized
• 500 pts. Costs lower once treatment period started
compared to prior 98,000$ compared to 116,000$
• Much higher than other disease states
• Meds cost more in post treatment 38,000 vs 6400
• Other medical costs went down 60,000 post and 110 pre
• This included less clinic or OP visits and hospitalizations
Sikirico, M. Economic burden of PAH in the US on payers and patients.
BMC Health Serv Res 2014 Dec
24;14
11. Real World Treatment Patters HRU and Cost among
adults with PAH in US
• Oct 2015 to Nov 2020
• 21% initial combination therapy
• 54% Combination therapy
• 58% Hospitalized and 41% others ED visits
• Hospitalization costs pre PAH diagnosis vs post therapy
$14,200 down to 6350 per person per month
• Costs of medications 909 to 7800
12. Hospitalization Burden France
• 384 Incident PH patients Hospitalized
• Next 12 months 1270 Hospital stays
• Hospitalization to start meds much less costly than
Hospitalization for worsening disease
• Bergot, E Hospital burden of PAH in France Plos One
:2019 Sep 19(9) year studied 2013
13. Economic Burden 2022 Spain
• Direct and indirect cost to society for PAH
• Divided into functional class (incident and prevalent)
• Total costs Functional class I-II 65,000 Euros per pt
• FC III 61 % of patients. Cost was 103,000 Euros
• FC IV 208,000 Small % total pts only 7% but 14% ot
total cost
• Direct Health care costs 64% Indirect 24% and non health
care costs 12%
• Zozoya, N Economic burden of PAH in Spain, BMC Pulm
Med 2022 Mar 26: 22(1)
14. Hospitalization Increased in High Risk Patients
• What Happens when we Hospitalize June 2014 to 2019
• Look at meds 30 Days prior to admission and 90 days Post
• 43 monotherapy on admission only 17% went to double
therapy
• 3%
• Joszt, L PAH Treatment Patterns Cost Related to
Hospitalization. AJMC Clinformatic Data
15. Multiple studies confirm Hospitalization drives
largest component of cost
• Studies above show Hospitalization Majority of cost
• REVEAL data base that one Hospitalization increases risk
of further hospitalization
• Hospitalization is a negative prognostic factor
• In Griphon hospitalization for worsening PH portended
increased mortality
• Reveal Risk score also includes extra point for all cause
hospitalization within 6 months
• One study despite this cost and risk there was no change
in therapy in most cases post hospitalization
16. PAH in scleroderma
• Screening Australian Scleroderma interest group
• Algorithm using pBNP rather than an echo for yearly
screening of Scleroderma patients
Using new algorithm would save Australia between
367 and 725,000 $ annually
Quinlivan, A, Cost savings with a novel algorithm for early detection of
systemic sclerosis-related PAH: alternative scenario analysis. Intern Med
J 2019Jun 49(6) 781-85
Combination therapy is Cost Effective from Simulated Costs comparing
real pts on mono Cost higher is combo or dual therapy 20,000 vs 16
Mean life years 7.1 for mono and 9.2 for dual. QALY increased form
3 to 3.9 from mono to dual ( Tran Duy) 2021
17. CTEPH Cost = Mortality
• Cost of Refusal of Pulmonary thromboendarterectomy
• Worse long term survival
• Late Diagnosis, Lack of surgery facility, Referrals
Inoperable
• Registry 3 year survival 89% vs 70% ( Europe and Canada
• Operated majority had class 1-2 symptoms at one year
• Those eligible for surgery and refused 5 yr survival 53% vs
83% for those that opted for surgery
• Kim, N ERJ 2018 52Pulmonary endarterectomy and the
cost of patient refusal
18. Worldwide Practice
• Challenges in Middle and Low Income Regions
• Late presentation and more severe disease at diagnosis
and other untreated comorbidities.
• PAH/PH Etiology is Different
• Unrepaired congenital heart disease, More HIV,
Schistosomiasis, Group 2 related to valvular heart disease,
High Altitude, Smoke inhalation/COPD
• Less Access to therapy, and testing
• Barbar, H. Challenges and Special Aspects of PH in Middle to Low
income regions. JACC state of the art review. JACC 2020 May
19:75(19)
19. Make Research more Cost effective
• Enriched groups for increased risk in event driven trials
using risk scores /receiver operating curves
• Pooled data from Ambition (ambrisentan plus tadalafil),
Seraphin (macitentan morbidity /mortality) and Griphon
(Selexipag)
• can use lower sample size and and treatment time if use
pts with higher risk
• Easier or less waste in screening.
• Current study with sotatercept using similar theory
• Scott, JV Enrichmeny Benefits of Risk Algorithms for PAH
Clinical trials Am J Respir Crit Care med 2021 Mar 15: 203
20. Non Monetary Costs
Psychosocial Burdens
• Patient, Family, caregiver
• Impact of Physical Limitations
• Emotional Strain ( all parties)
• Loss of Confidence or Purpose
• Financial Strain
• Social Isolation
• Change in Relationship, Loss of intimacy
Doyle-Cox, C. Psychosocial burdens of PAHDiscussion paper Can J
Cardiovasc nursing 2016 Winter 26(1)
21. SF-36 Score Higher is Better
• Literature is dated
• What do we do with triple therapy
• Quadruple Therapy Who needs this.
• How to assess short term vs long term costs
• As we add new medications where do they fit in.
• Shuld we get early . Only after optimized
• How will insurance companies see this
• If many people getting fourth medication and aid pool is
same then who misses out
22. PAH Impact on quality of life
• Adverse effect of severe incurable disease on physical ,
emotional and social factors
• More PAH specific HR QoL Instruments such as Emphasis
10 and PAH-SYMPACT
• Medical therapies do improve HR QoL
• Also benefit to HR QoL with social support
– emotional support
– Physical therapy / or Rehab
Delcroix, M PAH:the burden of disease and impact on quality
of life Eur Respir Rev 2015 Dec 24(138)
23. Impact of PAH on Patients and caregivers
• Physical limitations
• Limited ability to carry out normal daily activity ADLs thus
need help from caregivers
• Social isolation of patient and caregivers
• Financial impact to patient and caregivers who may lose
time at work as well
• Physical , emotional, social, Practical Needs
• informational needs
• Mental health including depression, anxiety, stress.
Guillevin, L Understanding the impact of pulmonary arterial hypertension on
patients’ and carers’ lives. Eur Respir Rev. 2013 Dec 22(13)
• Gu, S. Systematic Review of health-related quality of life in patiens with PAH.
Phamacoeconomics. 2016 Aug:34(8)
24.
25. Optimize Cost Effective Care
• PAH High economic cost but also devastating outcomes
• Managed care providers must balance optimal care with
efficient use of healthcare resources
• Later diagnosis means more severe disease , poor prognosis
and more costs and more burden on system.
• Facilitate care through excellence centers to stream line and
use evidence based care to help lower costs
Studer, S. Considerations for optimal management of patients with PAH:
a multi-stakeholder roundtable discussion. Am J Manag Care 2017 May
23(6 Supp
26. Comparing one drug to another
• Effficacy/Side effects
• Means of Administration
• Safety
• Economic Aspects
• Is Combination Safe and Effective
• Direct Comparison Difficult as studies/ Data/Guidelines
have changed over time. Length of Follow up.
• Costs change with generic forms/Insurance coverage
• Efficacy within Functional Class must be considered
• Prostacyclins had greatest Life Years Gained and QALY
but may or may not be cost effective
27. PH Community Needing AID for Health COSTs
• Group1 PAH
• Group 2 Left Heart . Some Pre and Post Capillary patients
being enrolled in studies
• Group 3 ILD Patients now getting inhaled prostacyclin
– Prevalence of ILD 120-130/ 100,000
– 46% had PA pressures > 25
• Group 4 CTEPH Surgery/BPA/ Meds incidence 2.3% at 2
years post PE
• Group 5 Anemias, ESRD, Sarcoid…
• More potential patients for the same AID resources
29. Addition of Other Classes of Medications
• Hopeful Additions to Therpy
• Where will they fit
– Order of Therapy Early / Late
– Combinations
– For all comers or FC?
• What will they cost
Prior Authorization
Insurance Coverage
Assistance and AID
How do we add more choices and greater number of meds
per patient into already limited Resource Funds
30. How Can We Manage Cost
• Diagnose Early
• Treat with Combination Therapy
• Careful Use of Risk Scores to Guide additional therapy
• Aggressive treatment may prevent Hospitalization where
Cost is greatest.
• Treat Appropriate patients
• Participate in Research to Find better therapy, CURE
• Personalized /Targeted Therapy
• Fiscally Responsible Prescribing Meds and Assisting
Patients in Obtaining Them
31. Assistance Funds > 50% get AID
• Manufacturers Patient Assistance Programs (PAPs)
• Specialty Pharmacy Assistance
• Accredo, Alliance Rx , Briova now Optum, Cigna,
CVS/Caremark, Humana
• Assistance Fund
• Good Days
• Healthwell Foundation
• PAN Foundation
• Patient Advocate Foundation
Other Strategies, Good Rx, Cost Plus Pharmacy
32. Resources
• Ogbomo, A et al. Direct and Indirect Health Care Costs
Associated with PAH in commercially insured Patients in
US. J Managed Care Spec Pharm 2022 June:28(6)
• Roman, A. et al. Cost effectiveness of prostacyclins in
pulmonary arterial hypertension. Applied Health Econ
Health Policy 2012 May1:1-(3) 175-88
• Valerio, L. CTEPH and impairment after PE: the FOCUS
study. Eur Heart J. 2022 Sep 21:43
• Dong, W Cost effectiveness analysis of selexipag for he
combined treatment of PAH.Front Pharm 2023 Aug 11:14
• Bruger, C. Early Intervention in the management of PAH
:clinical and economic outcomes
33. Resources
• Scott, J.Enrichment benefits risk algorithms for PAH clinical
trials. Am J Respir Crit Care 2021 Mar15:203(6)
• Tran-Duy, A. Cost Effectivenes of Combination therapy for
patients with systemic sclerosis related PAH. J Am Heart
Assoc 2021 Apr 6:10(7)
• Exposto, F. Burden of PAH in Respir Dis 2021 Jan-Dec:15
• Meng-Chien, W. Potential application and promising role of
targeted therapy in PAH. Biomedicines 2022 Jun 15:10(6)