ACP recommends policies to stem rising prescription drug costs

1. ACP recommends policies to stem rising prescription drug costs
Free content: http://www.annals.org/article.aspx?doi=10.7326/M15-2768
URL goes live when the embargo lifts

The American College of Physicians (ACP) calls for changes that could slow the rising cost of prescription drugs. The policy paper, Stemming the Escalating Cost of Prescription Drugs, is published in Annals of Internal Medicine.

ACP president, Wayne J. Riley, MD, MPH, MBA, MACP, says that rising prescription drug costs can be detrimental to patients, causing them to forgo filling important prescriptions or not taking drugs on the schedule that they are prescribed. But addressing the issue is complex because the research, development, regulatory and payment systems for prescription medication are deeply intertwined. As such, competition alone may not be effective in encouraging innovation or controlling costs, especially without the price transparency required for true price competition.

ACP's paper offers a series of recommendations aimed at addressing and slowing down the rate of price increase for prescription drugs. In brief, ACP calls for:

• transparency in the pricing, cost, and comparative value of all pharmaceutical products;
• the elimination of restrictions on using quality adjusted life years in comparative effectiveness research;
• use of novel approaches, including allowing price negotiation by Medicare and other publicly-funded health programs;
• approaches that encourage value-based decision making;
• patient cost-sharing that is not set at a level that imposes a substantial economic barrier to patients; and
• policies on biosimilar drugs that limit patient confusion between originator and biosimilar products.

ACP opposes extending market or data exclusivity periods beyond what is currently granted.

Note: For an embargoed PDF, please contact Cara Graeff. For an interview with someone from ACP, please contact David Kinsman at dkinsman@acponline.org or 202-261-4554.

2. Personalized doctor office interventions show small potential for preventing depression
Abstract: http://www.annals.org/article.aspx?doi=10.7326/M14-2653
URL goes live when the embargo lifts

Personalized primary care-delivered interventions may hold some promise for preventing major depression in adults, according to an article published in Annals of Internal Medicine.

Major depression, an important cause of human suffering, is projected to rank as the greatest contributor to disease burden in high-income countries within the next 15 years. It is possible to prevent depression, however, little is known about the effectiveness of such prevention efforts. Because of its prevalence and because so many people receive treatment in primary care, researchers sought to evaluate the effectiveness of a depression prevention intervention for adult patients implemented in primary practice.

More than 3,000 patients at 70 primary care centers in several cities in Spain were randomly assigned to receive either usual care or a depression intervention. For each patient, the primary care provider communicated individual risk for depression based on characteristics, such as marital status, living situation, occupation, and health history. The physicians then developed a tailored psychosocial program to prevent depression.

At 18 months, about 7.4 percent of patients in the intervention group developed major depression compared with about 9.4 percent in the control group. Based on this modest but statistically insignificant reduction in depression, the researchers suggest that additional study of this approach may be warranted.

Note: For an embargoed PDF, please contact Cara Graeff. To reach the lead author, Dr. Juan Ángel Bellón, please contact Elena Martín at elena.martin@ibima.eu or +34 671598903.

3. Ticks carrying CRT may infect wider regions of China than previously thought
Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-2572
URL goes live when the embargo lifts

Ticks carrying Candidatus R tarasevichiae (CRT) may cause human infection in wider regions of China than previously thought, according to a case series published in Annals of Internal Medicine.

Severe fever with thrombocytopenia syndrome (SFTS), a tick-borne viral disease, is endemic in eastern China. Another tick-borne infection caused by CRT was reported in northeastern China in 2012. Researchers wondered if the newly recognized pathogenic Rickettsia species in the Northeast were present in SFTS-endemic region of eastern central China as well.

Researchers extracted DNA from anticoagulated blood specimens collected from 733 patients who were treated for suspected SFTS at a hospital located in an area where a severe epidemic had occurred. They found that 56 of the patients were infected with CRT and 37 were coinfected with SFTS virus. A review of medical records for those patients showed that CRT symptoms were largely nonspecific.

The researchers concluded that since symptoms are similar to those experienced with SFTS and coinfection is possible, patients presenting with SFTS-like illness in endemic areas should also be assessed for CRT.

Note: For an embargoed PDF or author contact information, please contact Cara Graeff.

Also in this issue:
Diaphragmatic Cardiac Compression Mimicking Defecation Syncope: A Case Report
Yalcin Velibey, MD; Tolga S. Guvenc, MD; Murat Ugur, MD; Ozge Guzelburc, MD, Mehmet Eren, MD
Case Report
http://www.annals.org/article.aspx?doi=10.7326/L15-0594

###