The Biden Administration has indicated an intent to explore the creation of a government-operated health technology assessment (HTA) agency to engage in some form of review of biopharmaceuticals and other medical technologies.
In this blog entry, we briefly review where we are at now, one year after all of this started.
In many ways the arrival of the COVID-19 pandemic globally was met with sub-optimal levels of preparedness on the part of health care providers and provider systems, such as integrated delivery networks (IDNs).
This blog covers the presentation given as part of the ISPOR pre-conference plenary session on HEOR in the era of COVID-19 which was held on 14 May 2020.
Economic Cycles and Product Development in Life Sciences May 11, 2020 By John Schneider, PhD and Mirela Sima, MD, MBA The humanistic and economic consequences of the 2020 COVID-19 pandemic will not be completely understood for years. The humanistic toll has been well documented; as of early May 2020, the global death toll attributable to…
In this blog entry we explore some of the potentially important issues surrounding the role of EMRs in litigation, where the discovery of medical documents and records increasing involves digitally stored data.[1-4]
In this blog entry we report on a good example of HEOR analytics: our recent study of covariate-adjusted analysis of trial data of lenvatinib versus sorafenib in hepatocellular carcinoma.
We define epidemiology broadly, including an up-to-date review of the key published medical literature on COVID-19. Following that, our discussion of costs focuses in part on the direct medical costs (which probably for good reasons has been relatively under-reported) and in part on the broader costs to the economy.
By: The Avalon Health Economics Team March 13, 2020 Within a few months we’ve gone from worrying about holiday shopping to worrying about global pandemics and watching the world shut down around us. It started with news from China on the rapid spread of an insidious virus initially called a coronavirus.[1] Once the virus was…
Cara Scheibling and John Schneider, PhD February 7, 2020 A common challenge in economics and business is determining the fair-market value of products and services that have not yet “entered” the market. If consumers have not yet signaled a “willingness to pay” for the product or service, it is difficult to predict the fair market…
John Schneider, PhD and Alexis Doyle, MA Avalon Health Economics December 23, 2019 In recent years in the U.S., there has been an increase in the use of cost-effectiveness analysis (CEA) for drug and medical device coverage decisions. While the Center for Medicare and Medicaid Services (CMS) remains considerably behind European countries in the use…
This blog is written by John Schneider, PhD, Sabrina Chmelir, Jacie Cooper, and Shawn Davies, MA Advances in technological innovation and access to capital have recently resulted in a wave of new medical devices, including more accurate diagnostic tools, remote monitoring systems, and automated surgical tools. This next generation of medical devices has the…
This blog was written by John Schneider, PhD, Katherine Dick, Cara Scheibling Recently, the crypto-currency company Bitcoin has been in the news, mainly for its combination of volatility in valuation coupled with its impenetrable technological foundation. The virtual currency is perhaps the most well-known application of a technology now commonly referred to as “blockchain.”[1] Each…
Andrew Briggs, DPhil Chair of Health Economics, University of Glasgow, Glasgow UK. Senior Scientist, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Director and Principal, Avalon Health Economics, Morristown, NJ, USA. This blog was created from a presentation given at the ISPOR Annual Meeting in New Orleans, May 21st, 2019 as part…
In our work in health economics and outcomes research (HEOR) for the life sciences, including biotechnology, pharmaceuticals, and medical devices, we must maintain close ties with our colleagues and stay up to date with the latest thinking on methods of technology assessment, trends in coverage decisions, and relevant changes in the policy and economic environment…
There have been some negative reports recently regarding the pricing practices of some pharmaceutical companies. However, it is important to give at least equal consideration to the value derived from the intensive level of research and development undertaken by the biopharmaceutical industry in the U.S. The invention of new products and processes has been shown…
Although there are a large number of public and private payers in the U.S., medical device and pharmaceutical manufacturers generally focus on two types of payers: (1) Medicare, which is administered by the Centers for Medicare and Medicaid Services (CMS) and covers individuals ages ≥ 65; and (2) private commercial payers (e.g., Blue Cross and…
In recent years, there has been a shift in U.S. health care markets to a broader, population-based perspective when assessing the costs and benefits of medical innovation. Cost effectiveness analysis and budget impact analysis results can look quite different when viewed from the perspective of a health system or an accountable care organization, and can…
Hospitals in the U.S. spend an estimated 40% of their annual budgets on supplies, medical devices and equipment alone.[1, 2] According to the American Hospital Association, in 2015 total expenditures by U.S. hospitals was $808 billion.[3] That implies that if the 40% supply and equipment estimate is correct, hospitals are spending more than $320 billion…
Cancer care is a large part of overall health care expenditures. Of the approximately 18% of U.S. gross domestic product spent on healthcare, more than 5% is attributed to cancer treatments.[1] Considering the premature mortality associated with cancer, the humanistic and economic toll is enormous. Consequently, in recent years there has been increasing attention devoted…
Although the U.S. lacks a centralized health technology evaluation agency, as many of the European countries maintain, in recent years there has been considerable pressure to control the rising costs of new biopharmaceuticals and medical devices.[1-5] After relatively slow growth in the 1960s, U.S. health care expenditures grew intensely in the decades between 1980 and…
Prices in health care vary widely even within the same local market and for similar tests and treatments. This reflects differences among providers in their ability and willingness to leverage bargaining power against private insurers. For their part, consumers and patients often have been indifferent to price since they have been well covered by insurance….
In an earlier blog, we reviewed the recent book by one of Avalon’s directors, James Robinson. Robinson’s book, entitled “Purchasing Medical Innovation: The Right Technology, for the Right Patient, at the Right Price” seeks to unpack the often precarious relationships among medical device makers, the purchasers of those devices, the insurers, who are often the…
Much of the public media and even a substantial part of the medical literature operates on the assumption that there is a shortage of physicians in the U.S., including those specializing in primary care, intensive care, and surgery. One study, for example, estimated that the physician shortfall in the U.S. would reach 90,000 by 2025.[1]…
Today’s clinical laboratory can do much more than you think. Advances in molecular diagnostics, genetics and biomarkers have ushered in a new era of clinical laboratory capabilities. Along with these advances, however, are higher laboratory expenditures. The U.S. Medicare program spent $6.5 billion annually on laboratory in 2006. By 2010, the program was spending $8.2…
In recent years, the food industry has seen a boom in the “free from” category, including a myriad of ingredients such as high fructose corn syrup, artificial flavors, toxic pesticides, artificial hormones, antibiotics, and GMOs. One such product that has been particularly demonized recently is gluten. Celebrities from Miley Cyrus to former president Bill Clinton…
In recent years, there has been a small but measurable slowdown in the rate of increase in health expenditures, both here in the U.S. and abroad. The slowdown is largely attributable to a higher level of commitment on the part of payers to increase enrollee cost sharing and control access to high cost treatments.[1-3] If…
According to the American Cancer Society, the financial costs of cancer are high for both the person with cancer and for society as a whole. The National Institutes of Health (NIH) estimated the 2009 overall annual costs of cancer in the U.S. to be $216.6 billion, consisting of $86.6 billion in direct costs and $130…
Similar to drug and device markets, a critical part of the success of novel diagnostics is educating providers on clinical and therapeutic utility. However, unlike pharmaceutical drugs, the ordering of a diagnostic test does not necessarily imply a change in provider behavior or a change in treatment strategy. It’s a bit like whether a tree…
During the U.S. “State of the Union” address this past week, President Obama devoted some time to emphasizing the importance of “personalized medicine,” referring to the rapid pace of innovation and the high expectations for the role molecular diagnostics in the U.S. health care system: “I want the country that eliminated polio and mapped the…
There was a time when we did not spend a lot of time worrying about the quality of the health care services we received. Our families went to the doctor who was known as a “good doctor” and we received treatment in the nearby hospital known as a “good hospital.” An endorsement or two from…
As a follow-up to our previous blog (October 2014), we are revisiting the topic of Ebola because this public health crisis has drawn attention to two very important public health issues: (1) the ever-present global danger of infectious diseases, and (2) the critical role of the public health and health system infrastructures in preventing and…
The recent Ebola epidemic in Africa has served as a reminder of the vulnerability of public health systems in handling unexpected health problems, especially when basic access to care and day-to-day health problems remain a challenge. Unlike its northern counterpart, Sub-Saharan Africa (SSA) continues to experience a disproportionate burden of disease, influenced by the intersection…
For over 50 years, the food industry has used Expanded Polystyrene (EPS) food service products for a variety of food and beverage service needs. EPS, commonly known as Styrofoam, is cheap and durable, so it seems ideal for takeout food or your hot cup of to-go coffee. But you might want to rethink drinking your…
Over the past 50 years, 95% of the country’s state psychiatric hospital population have been closed down, leaving fewer than 200 hospitals to provide care to those living with mental illnesses (Fisher et al. 2009). Between 2009 and 2011 alone, states cumulatively cut more than $1.8 billion from their budgets for services for children and…
After suffering from a nasty cold for more than a few days, many of us think about checking in with our doctor just to be sure that it’s not something worse. The result on those visits is, all too often, a simple confirmation of what you already knew: you have a cold. You’ll get better….
Recent healthcare reforms in the U.S. and abroad have emphasized the value of meaningful and effective preventative care and health promotion. Corporations are taking note, and, as a result, there has been a significant rise in the number of corporate wellness programs popping up. Under recent healthcare legislation in the U.S., there are tax incentives…
1. What is an E-Cig? The “e-cig” is an electronic cigarette that is used to simulate the experience of smoking that has a cartridge with a heater that vaporizes liquid nicotine instead of burning tobacco. Having become a seemingly overnight sensation, governments in both Europe and the United States are struggling with how to regulate…
The high cost of adverse events has been estimated to be at least US$177 billion per year in the U.S., and prescription drugs overall have efficacy only approximately 50% of the time, representing a potential waste of approximately $350 billion of the worldwide $700 billion or more drug spending (Miller et al., 2011). The wide…
The Organic and natural food industry has boomed in the last few decades, moving from a small niche market to a $30 billion dollar industry. Across the United States, people are growing more concerned by the possibility that their food choices could negatively affect their health and are responding by buying more products with labels…
Heroin has a new face. According to statistics from the National Institute on Drug Abuse, it’s a white male in his 30s and 40s. Surprisingly, heroin use has grown in recent years, sounding alarms among community leaders, public health officials and law enforcement. According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National…
According to estimates from the World Health Organization, 8.3 million people worldwide died from cancer and other neoplasms in 2008—about 14% of all deaths. In the same year, the overall costs of cancer care in the United States amounted to $228.1 billion– $93.2 billion direct medical costs, $18.8 billion in indirect morbidity costs, and $116.1…
The Center for Medicare and Medicaid Services (CMS) Value-Based Purchasing (VBP) program is an incentive-based repayment plan linked to the quality of care hospitals provide to Medicare patients. With VBP, hospitals are held accountable for both the quality and cost of their services, and must reach specified performance measures to be rewarded. CMS continues to…
In recent years there has been renewed attention devoted to coordination of medical care services across the continuum of care, particularly in the area of prevention, monitoring, diagnostics, and disease management. This is not entirely new to the U.S. In the early 1990s, as managed care began to widen its reach and increase market share,…
According to the National Health Care Anti-Fraud Association (NHCAA) and the Blue Cross and Blue Shield Association, the estimated annual costs of health care fraud in the U.S. are more than $70 billion, or about 3% of total national health care expenditures. This is an amount large enough to wipe out the savings from many…
During the health reform discussions leading up to the passage of the Affordable Care Act (“ACA”), there was a lot of talk about the costs of health care services in the U.S. Some argued that the legislation did not go far enough in controlling the underlying upward trends in health care costs, while others argued…
Women make about 80% of the health-care decisions for their families, utilize more health care than men, and are the more likely to be the care givers when a family member becomes sick. Females of all ages accounted for 60% of all expenses incurred at doctors’ offices in 2004. According to the Bureau of Labor…
During the recent debates over the Affordable Care Act (“ACA,” or Obamacare) a commonly raised issue was that U.S. health care does not offer much in the way of “value for money.” The argument, generally, is that we spend a lot more in the U.S. relative to comparable countries but in turn receive poor quality…
Tobacco product litter is one of the most ubiquitous forms of litter, accumulating in increasingly large numbers on streets, highways, sidewalks, beaches, storm water drains, waste treatment plants, parks and other public places. Tobacco product litter (“TPL”) is not simply unattractive; it has been shown to be toxic and costly to clean up. More than…
The health care landscape in the U.S. has been changing rapidly in the past 20 years, a phase of evolution that began with the reluctance of private employers to continue to fund double-digit growth in employee health care costs, thereby creating incentives for third-party payers to develop “managed” insurance products. The next phase of those…
A large proportion of our nation’s health care infrastructure is located in urban markets with declining population. For example, according to the U.S. Census, cities with the largest population decline in recent years include New Orleans, Detroit, Cleveland, Pittsburgh, Toledo, and Buffalo. These very same cities, however, are home to some of the most reputable…
In most markets and in most industries, the prices paid by consumers (or businesses, in the case of business-to-business transactions), are not randomly made up by sellers. To be sure, in less competitive markets, where information is “fuzzy” or sellers have monopolistic power, a seller might be able to name a price and get it….
In the United States, a variety of “usual, customary and reasonable” (UCR) databases are used by health care entities to benchmark their fees (in the case of health care providers) and to create prospectively determined fee schedules (in the case of health care payers). Both of these exercises have essentially the same objective: to assign…
