3 interesting articles in JAMA today:
- Bad news for Roche. Avastin (bevacizumab) is associated with increased treatment-related mortality, according to a meta-analysis of 16 RCTs (RR of 1.46; 95% CI, 1.09-1.94; P = .01; incidence, 2.5% vs 1.7%). The risk was especially high in patients receiving taxanes or platinum agents (RR, 3.49; 95% CI, 1.82-6.66; incidence, 3.3% vs 1.0%). (See recent TIE coverage of Avastin’s recent woes at the FDA from Aaron and Kevin)
- For-profit incentives in hospices: for-profit hospices are more likely to accept patients who cost less to treat and stay longer. Medicare pays hospice on a per diem, so the incentives are obvious, but this study provides empirical support for the position. My one concern with this study is the relatively small sample, although the selection process was sound. It’s hard to get a large database sample of hospice discharges.
- Access to expensive arthritis drugs: disease-modifying antirheumatic drugs (DMARDs) are important for treatment of rheumatoid arthritis, but are used less frequently than evidence-based guidelines suggest. This study finds that factors associated with lower DMARD use in the Medicare population include demographic factors (older age, male, black race), socioeconomic status (low personal income, lowest zip code based SES), geography (Middle and South Atlantic regions), and health plan tax status (for-profit). The study covers clinical years 2005-2008, so Part D was operative for most of the study years. Nevertheless, socioeconomic and other factors clearly are impeding access to this class of drugs.