Electronic health records (EHR) are moderns marvels. The ability to communicate and safely store patient information has the potential to greatly improve quality of care. Implementing EHR, however, is not costless. There is of course the cost of the EHR system itself and the cost of training staff on how to use the EHR system. patient. But one underappreciated aspect of EHR…

The cost to bring a drug to market is a hotly debated topic. The costs include not only the costs for basic science and clinical trials. However, one must also take into account the cost of capital (since most cost are incurred up front, but revenue begins only after drug approval) and the likelihood of success (since most drugs fail. The most widely cited paper from DiMasi et al….

Here are a few highlight’s from the March 2021 report on Medicare Payment Policy from the Medicare Payment Advisory Commission (MedPAC). Leading causes of death The leading cause of death are heart disease, cancer, and respiratory disease. Note that these figures are from 2018. MedPAC notes that the 3rd leading cause of death in 2020 was COVID-19. Coverage…

That is the title of a recent study I published with Michael Halasy in Mayo Clinic Proceedings. The subtitle is Establishing a Theoretical Model to Evaluate the Value of Second Opinion Visits. The abstract is below: In order to produce a mathematical model for better understanding of the benefits and utilization of second opinions and to understand the contradiction between…

Cost effectiveness analysis aims to capture identify (and monetize) all of a treatments benefits, risk and costs and then determine if the treatment is worth the money. Traditionally, however, benefits, risk and costs only related to benefits that accrue to the health care system. Many studies in the academic literature have advocated for a societal perspective (e.g, Jonsson, 2009;…

Given the incredible speed in which vaccine development for COVID-19 is occurring, it merits thinking back on the typical development and approval time of previous vaccines. Puthumana et al. (2020) reviews 21 vaccines approvals since 2010. They find that: …most novel vaccines approved by the FDA required about 8 years of clinical development and were based on evidence from a…

The 21st Century Cures Act required the Food and Drug Administration (FDA) establish a program for evaluating the use of real-world data (RWD) to support the approval of new indications for drugs. Real-world data is typically data from either health insurance claims, electronic health records (EHRs), patient registries, or mobile devices. But how has FDA used RWD in practice? A…

Prior authorization is a requirement that health plans require physicians to obtain plan approval in order to prescribe a patient a given medication. Prior authorizations may be put in place to insure medications are not used inappropriately or for payers to try to reduce cost. While prior authorization may help save money, delays in the prior authorization approvals frustrate…

That is the title of an article in AJMC co-authored with Meena Venkatachalam. An excerpt is below: While decision-makers traditionally have ignored the issue of inequality, academic researchers have already developed tools to quantify a treatment’s value from reductions in inequality. Two common methods for doing so are distributional cost effectiveness analysis (DCEA) and…