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Glockman demands better data and payer policies to nurture a CV based on value

Ty J. Gluckman, MD, FACC, FAHA, is the medical director of the Center for Cardiovascular Analytics, Research, and Data Science at Providence St. in Louisville, Kentucky.

With health care costs in the United States already at 20% of GDP, every stakeholder in the system—patients, providers, the drug industry, and payers—not only has a role in bending the cost curve, but will also be faced with what Ty called J. Gluckman, MD, FACC, FAHA, “Tsunami” costs are coming thanks to COVID-19.

Glockman, MD, medical director of the Center for Cardiovascular Analytics, Research, and Data Science at Providence St. Is it too much?”

He said the economic toll from atherosclerotic cardiovascular disease (ASCVD) is “staggering.” It’s the number one killer in the United States, “so it’s no surprise that it has significant direct and indirect costs.”

During 2018, the annual direct costs of CVD were $225 billion, and the indirect costs are even higher. One approach might be to look for ways to cut that spending, Gluckman said, or “one could have the opposite view, and [ask] How do we invest more to be able to bend the risk curve and thus mitigate the risk of final costs? “

Unfortunately, Gluckman said, the fallout from COVID-19 could create a healthcare “tsunami,” according to 1 recent article. The post-lockdown period will be characterized by an increase in admissions for the destitute, higher costs to maintain health care workers, and an increase in the number of people with cardiovascular disease.

The loss of workplace health programs and lack of activity during the pandemic have already led to high blood pressure and obesity, Gluckman said. He shared charts with data on these points, and added, “The trends are very inauspicious.”

Results by pandemic, based on a cohort registered in MESA studyIt turns out that over 10 years, low-risk patients accumulated less than $7,700 in direct costs, but high-risk patients could pay more than $35,800 in costs.

Thanks to the pandemic, the United States will likely have more high-risk patients.

New treatments, higher OOP costs

The central balancing act that cardiologists face today is how to prescribe enough medications to patients – and the right ones – without preparing them so they can’t afford out-of-pocket (OOP).

“We have a range of pharmacological treatments that aim to move the needle on the risk factors we treat,” he said, noting how other speakers have discussed the need for more use, not less, of glucose co-transporter 2 (SGLT2) inhibitors or peptide receptor 1 agonists. (GLP-1) is similar to glucagon.

In many cases, patients may benefit from several medications, but OOP cannot be afforded.

Until now Back in 2014The American College of Cardiology and the American Heart Association have provided guidance on how to address the cost-value equation, but the primary barrier has been a lack of data to demonstrate cost-effectiveness.

In the class of SGLT2 inhibitors, for example, cost-effectiveness studies are being re-run in light of clinical trials showing that drugs first approved to treat type 2 diabetes can also treat heart failure and chronic kidney disease. a Just published study In Japan he argues that for all their indications, SGLT2 inhibitors are cost-effective when started without metformin – a departure from longstanding first-line treatment.

Gluckman also noted that clinical trials are increasingly dividing how new treatments work into specific high-risk subgroups. This was seen in Experience Fourier for the PCKS9 inhibitor evolocumab; Pharmacy benefits managers refrained from the original pricing, above $14,500 per year, and imposed onerous pre-licensing requirements. Prices are now around $5,850 for these treatments, and some doctors at an ASPC meeting reported that they rarely face any rejection these days.

Although trials may indicate an average effect, for an individual patient, “there is no such thing as an average treatment effect,” he said. “Instead, as many have suggested today, we should research our populations to see how we are disproportionately using treatments – especially therapies that may be more expensive.”

Just as clinicians must demand approval of treatments for patients who will see the most benefit, they should withhold treatment if little benefit is seen. Such an approach will require collaboration between stakeholder groups, including industry and payers.

Glockman concluded with a call for better healthcare plan design to ensure access not only to treatment but to all high-value health services. “I think our insurance companies — our advocates — have a special responsibility for that,” he said, citing principles developed at the University of Michigan. Value Based Insurance Design Center. (A. Mark Fendrick, MD, co-editor of American Journal of Managed Care®, director of the V-BID Center.)

Glockman shared an excerpt from a piece he co-authored with ACC قيادة Command Forum on this topic:

“While many insured patients with ASCVD are ostensibly ‘covered’, they often face high out-of-pocket costs, in part to ensure they have ‘looking good in the game.’ An unintended consequence of this cost-sharing is that it limits randomly from the use of all clinical services, including high-value and low-value services.

“Unlike some preventive services, which are often excluded from deductibles, co-costs, and co-insurance, current health plan designs do not provide comparable access to many of the evidence-based treatments known to reduce the risk of adverse cardiovascular events. Even for high-risk patients, where it is likely to To be more impactful use, these remedies paradoxically remain subject to traditional non-value-based plan designs.”

Little wonder, then, that this commitment is being compromised, and “the promise of high-value care to those most in need is lost”.

Both the prevalence and cost of cardiovascular disease will continue to rise, Gluckman said, with “no end in sight.” Thus, the benefits of prevention should be “more comprehensively realized in high or very high risk groups”.

As the availability of new treatments increases, more and better data are needed to drive discussion of the value, so that the right patients receive treatment. “Finally, insurance plans must be redesigned to ensure access to affordable, high-quality and easily accessible health care.”

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