1. ACP recommends use of generic medications over branded drugs whenever possible
Using generics supports High Value Care, can help to reduce $325 billion spent annually in U.S. on prescription drugs
HD video soundbites of ACP's president discussing generic medications are available to download at http://www.dssimon.com/MM/ACP-generics.
Free content: http://www.annals.org/article.aspx?doi=10.7326/M14-2427
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The American College of Physicians (ACP) says that prescribing generic medications whenever possible can improve adherence to therapy, improve outcomes, and reduce costs for patients and the health care system. ACP's best practice advice paper is published in Annals of Internal Medicine.
Generic medications represent an opportunity for reducing the high costs associated with prescription drugs. ACP reviewed available evidence to determine how often brand name drugs are used when generic versions are available, how the use of generics influences adherence, whether brand names and generics have similar clinical effects, the barriers to increasing the use of generics, and strategies that can be used to promote greater use of generics.
The evidence shows that generics are significantly underused despite the fact that their use could motivate better long-term adherence, as prescriptions for expensive branded drugs are twice as likely to go unfilled. Some of the underuse of generic medications is likely the result of patient and physician perceptions about the safety and a perceived lack of efficacy of the lower cost options, but the evidence shows that generic drugs are as effective as their branded counterparts regarding clinical outcomes. Differences in the physical appearance of generics and their brand name counterparts might also cause confusion among patient. The authors suggest programs to educate physicians and patients about the benefits of generics.
Note: For an embargoed PDF, please contact Cara Graeff. To speak with someone from ACP, please contact Steve Majewski at SMajewski@mail.acponline.org or 215-351-2514.
2. Intensive breastfeeding cuts diabetes risk in half for high-risk women
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Breastfeeding exclusively or almost exclusively and for at least two months is independently associated with decreased incidents of diabetes among women with gestational diabetes. The study is published in Annals of Internal Medicine.
Women with gestational diabetes mellitus (GDM) are seven times more likely to develop type 2 diabetes. Prevention strategies after birth focus on modification of lifestyle behaviors, such as diet and exercise. Lactation is another modifiable postpartum behavior that improves glucose and lipid metabolism and increases insulin sensitivity. However, evidence that lactation prevents type 2 diabetes remains inconclusive.
Researchers classified more than 1,000 women who were enrolled in the Study of Women, Infant Feeding and Type 2 Diabetes After GDM Pregnancy, or SWIFT Study, between 2008 and 2011 based on lactation intensity and duration. All of the women were given oral glucose tolerance tests at baseline (6 to 9 weeks after delivery) and annually for 2 years. Almost 12 percent of participants developed type 2 diabetes within two years after delivery. Those who exclusively formula-fed their babies at 6 to 9 weeks of age were more than twice as likely to develop diabetes as women who exclusively breastfed their infants. There was a graded 35-57 percent reduction in the 2-year diabetes incidence associated with greater lactation intensity (from exclusively formula-feeding to exclusively breastfeeding) and with increasing lactation duration (from less than 2 months to more than 10 months of breastfeeding).
Based on these findings, the researchers suggest efforts to promote and support exclusive and extended breastfeeding among women at high risk for type 2 diabetes.
Note: For an embargoed PDF, please contact Cara Graeff. To speak with the lead author, Dr. Erica Gunderson, please contact Ann Wallace at Ann.M.Wallace@kp.org.
3. Screening for Hep C in U.S. prisons is cost-effective, would benefit the general community
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A computer model suggests that screening for hepatitis C virus (HCV) in U.S. prisons and treating infected persons is highly cost-effective and would reduce ongoing HCV transmission, the incidence of advanced liver diseases, and liver-related deaths both inside prison and in the general community. A prison-based screening and treatment program could reduce overall health costs as much as $760 million over a 30-year period and most of those savings would take place in the general community. The study is published in Annals of Internal Medicine.
In the United States, the prevalence of HCV in the noninstitutionalized population is approximately 1.0 percent. The corresponding prevalence in U.S. prisons is 17.3 percent. Liver disease is a frequent cause of death among inmates and in the general society and HCV is the leading cause of liver cancer and the most common indication for liver transplantation. Recent studies have shown that treating HCV in prisons with newer, more effective (and more expensive) agents is feasible and cost-effective. However, cases of HCV must be identified if they are to be treated.
Researchers developed a computer model to project long-term benefits and costs of different HCV screening and treatment scenarios in U.S. prisons. They found that implementing a universal opt-out screening program of inmates would reduce the burden of HCV society-wide because a larger proportion of prisoners released to the community would have been cured of the disease.
Based on these findings, the researchers suggest that greater government resources be allocated to prison health care as an investment in society.
Note: For an embargoed PDF, please contact Cara Graeff. To speak with the lead author, Dr. Jagpreet Chhatwal, please contact Terri Ogan at firstname.lastname@example.org or 617-726-0954.
Also in this issue:
Four-Week Direct-Acting Antiviral Regimens in Noncirrhotic Patients With Hepatitis C Virus Genotype 1 Infection
Anita Kohli, MD*; Sarah Kattakuzhy, MD*; Sreetha Sidharthan, BS; Amy Nelson, RN; Mary McLaughlin, RN; Cassie Seamon, RN; Eleanor Wilson, MD; Eric G. Meissner, MD, PhD; Zayani Sims, BS; Rachel Silk, RN, MPH; Chloe Gross, RN; Elizabeth Akoth, RN, MS; Lydia Tang, MD; Angie Price, NP; Tim A. Jolley, RN; Benjamin Emmanuel, MPH; Michael Proschan, PhD; Gebeyehu Teferi, MD; Jose Chavez, MD; Stephen Abbott, MD; Anuoluwapo Osinusi, MD, MPH; Hongmei Mo, MD; Michael A. Polis, MD; Henry Masur, MD; and Shyam Kottilil, MD, PhD
Original Research http://www.annals.org/article.aspx?doi=10.7326/M15-0642
HIV Salvage Therapy Does Not Require Nucleoside Reverse Transcriptase Inhibitors
Karen T. Tashima, MD; Laura M. Smeaton, MS; Carl J. Fichtenbaum, MD; Adriana Andrade, MD, MPH; Joseph J. Eron, MD; Rajesh T. Gandhi, MD; Victoria A. Johnson, MD; Karin L. Klingman, MD; Justin Ritz, MS; Sally Hodder, MD; Jorge L. Santana, MD; Timothy Wilkin, MD; and Richard H. Haubrich, MD, on behalf of the A5241 Study Team
Original Research http://www.annals.org/article.aspx?doi=10.7326/M15-0949
Hepatitis B Virus Reactivation and Prophylaxis During Solid Tumor Chemotherapy
Sonali Paul, MD, MS; Akriti Saxena, MD; Norma Terrin, PhD; Kathleen Viveiros, MD; Ethan M. Balk, MD, MPH; and John B. Wong, MD
Using Behavioral Economics to Design Physician Incentives That Deliver High-Value Care
Ezekiel J. Emanuel, MD; Peter A. Ubel, MD; Judd B. Kessler, PhD; Gregg Meyer, MD, MSc; Ralph W. Muller, MA; Amol S. Navathe, MD, PhD; Pankaj Patel, MD, MSc; Robert Pearl, MD; Meredith B. Rosenthal, PhD; Lee Sacks, MD; Aditi P. Sen, PhD; Paul Sherman, MD; and Kevin G. Volpp, MD, PhD
Medicine and Public Issues http://www.annals.org/article.aspx?doi=10.7326/M15-1330
Annals of Internal Medicine