The American journal of managed care
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Comparative Study
Differentiating characteristics and evaluating intravenous and subcutaneous immunoglobulin.
Clinicians have a range of options for treating patients with disease states that require the use of immunoglobulin (Ig). Traditionally, intravenous immunoglobulin (IVIG) administration has provided effective therapy for a variety of disease states. More recently, subcutaneous immunoglobulin (SCIG) administration has become available for patients with primary immunodeficiencies and chronic inflammatory demyelinating polyneuropathy (CIDP). ⋯ SCIG infusions are typically administered more frequently (ie, biweekly, weekly, and even daily based on patient need), resulting in steady state concentrations with fewer fluctuations in Ig plasma levels. The route of administration plays a major role in the types of AEs seen in patients receiving Ig therapy, with systemic AEs associated with IV administration and local reactions more commonly seen with SC administration. By understanding the differences in IVIG and SCIG products, which are not interchangeable, and the patient characteristics that guide product selection, clinicians and managed care providers can better serve patients with immunodeficiency disorders and other disease states.
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To quantify the burden of illness of chronic hepatitis C virus (HCV) infection and estimate the impact of interferon-free direct-acting antiviral treatment on healthcare costs in Medicaid. ⋯ The introduction of interferon-free HCV treatments enables the avoidance of significant healthcare costs previously associated with treating the disease year after year, producing annual cumulative Medicaid savings beginning in 2019. A main finding from this study is that the cost of a complete DAA treatment course, at 2018 estimated net prices, can be expected to be fully offset by healthcare cost savings after only 16 months, on average, on a per-person basis. Given the tremendous value provided by these curative drugs, Medicaid policies aimed toward restricting access to these treatments based on disease severity or other requirements would be shortsighted.
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To compare cancer care spending and utilization by site of provider-administered chemotherapy in Medicare. ⋯ Differences in cancer care spending by site of chemotherapy (HOPDs vs POs) vary by service type. Those differences are partially driven by utilization differences. As the site of chemotherapy shifts from POs to HOPDs, spending and utilization patterns in both settings need to be monitored.
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To assess the association of a clinical decision support (CDS) algorithm for hospital discharge disposition with spending, readmissions, and postdischarge emergency department (ED) use. ⋯ Following the recommendation of a CDS algorithm for hospital discharge disposition was associated with lower spending, fewer readmissions, and no change in ED use over a 90-day episode of care.
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To update an ongoing assessment of care pathway development, implementation, and evaluation, and to evaluate the emerging relationship between care pathways and other components of value-based care. ⋯ This study identified growing use of high standards of evidence and adoption of other best practices in the development, implementation, and evaluation of care pathways. As the influence of care pathways on patient care continues to expand, additional efforts are needed to increase transparency, disclose conflicts of interest, engage with patients, effectively align care pathways with improvements in patient outcomes, and integrate efficiently with other value-based care initiatives.