Research Awards and Updates
Study Finds Better Treatment, Not More Spending, Saves Heart Attack Patients
Researchers from The Dartmouth Institute and the University of Michigan Institute for Healthcare Policy and Innovation led a study that looked at long-term heart attack care and spending in the U.S. since the turn of the century. The team analyzed data from nearly 480,000 people covered by traditional Medicare who were treated for acute myocardial infarction (heart attack) at 1,220 hospitals nationwide between 1999 and 2014. The percentage of heart attack patients who survive in the first six months after their attack has gone up since 1999—from 73 percent to 78.5 percent. Spending on the care of heart attack patients has gone up in that time too—nearly 14 percent across the 15 years of the study, with a plateau in costs in the last six years.
But, in a paper recently published in JAMA Cardiology, the researchers note that these across the board numbers mask huge variation in both mortality and dollars depending on which hospitals patients were treated at, and what kind of care they received. And, while some of the spending appears to be paying off—on rapid angioplasty to open clogged arteries—a lot of the money spent in the six months after a heart attack don’t seem to be making much of a difference in long-term death rates. The research team, who included Jonathan Skinner and Weiping Zhou from The Dartmouth Institute, suggest that providing hospitals and individual providers regular reports on their patterns of care their patients are receiving across all health care settings and the related costs may be one way to improve care and increase value.
This research was supported by the National Institutes of Health and the Agency for Healthcare Research and Quality.
Restasis: Why Did U.S. Consumers Paid Billions for a Drug Deemed Ineffective in Other Countries?
Restasis, a blockbuster drug sold by Allergan to treat chronic dry eye, did $8.8 billion in U.S. sales between 2009 and 2015, including over $2.9 billion in public monies through Medicare Part D. In a recently published article in JAMA IM, “A Clear-Eyed View of Restasis and Chronic Dry Eye Disease,” Dartmouth Institute’s Lisa Schwartz and Steven Woloshin, question why Americans, both as patients and taxpayers, are paying billions of dollars for a drug that’s not approved in the European Union, Australia or New Zealand? Schwartz and Woloshin point to the extensive marketing campaign to sell chronic dry eye (CDE) as a disease—and Restasis as the only viable treatment option. From 2016-2017, Allergan spent $645 million advertising Restasis, including its mydryeyes.com website. The website, Schwartz and Woloshin say, recasts the merely unpleasant experience of itching or watery eyes (often caused by allergies, weather, or other common irritants) as disease. Restasis might not have become such a blockbuster drug, Schwartz and Woloshin argue if consumers, doctors, and payers had easy access to independent drug information.
“When you think of all the good that could have been done with the billions spent on Restasis in the U.S., it reminds us how high the stakes are for better independent information about how well drugs work,” Schwartz says.
National Study Examines Regional Variation in NICU Admissions, Relationship to Bed Supply
The highly specialized care provided in the neonatal intensive care unit (NICU) is largely responsible for a four-fold reduction in the neonatal mortality rate since the first NICU opened in 1960. NICU care is expensive, however, costing on average more than $3,000 for each day in the NICU. Past studies have shown that the use of NICU for infants of low birth weight is among the most cost-effective interventions in medicine due to the magnitude of benefit realized over the course of a lifetime. However, with the expansion in the use of NICUs during the past 50 years, today the most common admission to the NICU is a newborn of normal weight. Larger newborns, who are on the average less sick, are often less likely to benefit from such care, yet they are still exposed to the same risks, such as iatrogenic injury, psychological distress, and altered parental roles.
In a national, population-based study, Dartmouth Institute researchers David Goodman and Jared Wasserman along with researchers from the University of Utah School of Medicine examined geographic variation in NICU rates for nearly the entire U.S. birth cohort and the relationship with regional bed supply. They specifically tested the hypothesis that greater variation exists among larger and more mature newborns and that greater bed supply is associated with increased likely of admission to a NICU. Their findings reported in The Journal of Pediatrics included evidence of persistent underuse of NICU care for newborns of very low birth rate that is not associated with regional bed supply. Among larger newborns, they found evidence of supply-sensitive care, raising concerns about the potential overuse of expensive and unnecessary care.
This research was supported by funding from provided by the Charles H. Hood Foundation.