Ty J. Gluckman, MD, FACC and FAHA, Medical Directors of Cardiovascular Analysis, Research and Data Science Center in Providence St. Joseph Health, Portland, Oregon, addressed the 2022 American Society for Preventive Cardiology Conference. .. In Louisville, Kentucky.
Since US health care costs have already reached 20% of gross domestic product (GDP), each stakeholder in the system (patients, providers, pharmaceutical industry, payers) is not only responsible for bending the cost curve. , You will also face it. What Ty J. Gluckman, MD, FACC and FAHA called the “tsunami” of the costs incurred thanks to COVID-19.
Gluckman, Medical Director of the Center for Cardiovascular Analysis, Research and Data Science in Providence St. Joseph Health, Portland, Oregon, attended the 2022 American Society for Preventive Cardiology (ASPC) meeting in Louisville, Kentucky. I made a speech. He said, “The cost of prevention-how much?”
He said the financial sacrifice of atherosclerosis (ASCVD) is “amazing.” It’s the top killer in the United States, “so it’s not surprising that it has considerable direct and indirect costs.”
By 2018, the direct annual cost of CVD will be $ 225 billion, and the indirect cost will be even higher. One approach might be to look for ways to reduce that spending, Gluckman said. [ask] How do you increase your investment to bend the risk curve and reduce the risk of downstream costs? “
Unfortunately, according to a recent article, Gluckman said fallout from COVID-19 could cause a “tsunami” in healthcare. The post-blockage period is characterized by an increase in hospitalizations for the poor, increased costs for maintaining health care workers, and an increase in the number of people with cardiovascular events.
Already, Gluckman said the loss of workplace wellness programs and lack of activity during a pandemic are causing increased hypertension and obesity. He shared data and charts on these points, adding that “the trend is pretty ominous.”
Pre-pandemic results based on a cohort enrolled in the MESA study showed that in 10 years, low-risk patients had a direct cost of less than $ 7,700, while high-risk patients could incur costs of $ 35,800 or more. Indicates that there is.
The pandemic could increase the number of high-risk patients in the United States.
New treatments, higher OOP costs
The central balancing act faced by cardiologists today is to prescribe enough and appropriate medications to patients without setting them up so that they cannot afford to pay their object-oriented (OOP) costs.
“There is a series of drug therapies aimed at moving the needle among the risk factors we treat,” he said, with other speakers saying sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like. Peptide-1 (GLP-1) receptor agonist.
Patients often benefit from multiple medications, but OOP is not affordable.
Back in 2014, the American College of Cardiology and the American College of Cardiology have provided guidance on how to deal with cost-effectiveness equations, but the main barrier is the data to demonstrate cost-effectiveness. It was a lack.
For example, the SGLT2 inhibitor class is revisiting cost-effective studies in the light of clinical trials showing that the first approved drug for the treatment of type 2 diabetes can also treat heart failure and chronic kidney disease. A study just published in Japan argues that SGLT2 inhibitors are cost-effective when started without metformin, given all indications. This is a departure from long-standing first-line therapy.
Gluckman also noted that clinical trials subdivide how new therapies work in certain high-risk subgroups. This was seen in the Fourier study of the PCKS9 inhibitor evolocumab. Pharmacy benefit managers resisted initial pricing of over $ 14,500 per year and imposed tedious pre-approval requirements. Currently, these treatments are priced at around $ 5,850, and some clinicians at the ASPC conference have recently reported that they rarely encounter refusals.
The trial may report an average effect, but for individual patients, “there is no such thing as an average therapeutic effect,” he said. “Rather, as many today suggest, we need to survey the population to find out how to use treatments, especially more expensive ones, in an imbalanced manner.”
Just as doctors claim approval for treatments for the most effective patients, treatment should be withheld if there is little effect. Such an approach requires collaboration between industry and stakeholder groups, including payers.
Gluckman ended with a call for better medical planning to ensure access to all high-value medical services, not just treatment. Citing the principles developed at the University of Michigan’s Value-Based Insurance Design Center, “I think our insurer, the payer, has a special responsibility for this,” he said. rice field. (A. Mark Fendrick, MD, Co-Editor American Journal of Managed Care® is the director of the V-BID Center. )
Gluckman shared an excerpt from an article co-authored at the ACC Leadership Forum on this topic.
“Many ASCVD insureds are” covered “on the surface, but often have a higher out-of-pocket cost to ensure” in-game skin. ” The unintended consequence of this cost sharing is to indiscriminately limit the use of all clinical services, both high-value and low-value.
“Beyond some preventative services that are often exempt from deductions, out-of-pocket, and co-insurance, current health insurance designs are known to reduce the risk of adverse cardiovascular events. It does not provide similar access to many of the treatments based on these treatments, paradoxically, traditional non-value-based planning designs, even in patients at the highest risk of their use being most likely to be impacted. Will continue to be the subject of, “they write.
So it’s no wonder that adherence is compromised and “for those who need the most valuable care the most, the promise of valuable care is lost.”
Both the prevalence and cost of cardiovascular disease continue to rise, “the end is invisible,” Gluckman said. Therefore, the benefits of prevention need to be “more fully realized at the highest or very high risk”.
As the availability of new therapies increases, more and better data will be needed to drive value discussions so that the right patients can be treated. “Finally, insurance plans need to be redesigned to ensure low cost, high quality, and access to out-of-the-box health care.”
