Public Release: 

News from Annals of Internal Medicine March 31, 2015

American College of Physicians

1. USPSTF reviews evidence to update recommendations on iron supplementation and deficiency screening in pregnant women

The U.S. Preventive Services Task Force (USPSTF) reviewed published evidence to update its recommendations on iron supplementation and screening for iron deficiency anemia in pregnant women. The evidence review is being published in Annals of Internal Medicine simultaneously with an evidence review in Pediatrics on screening for iron deficiency anemia in young children.

Iron needs increase during pregnancy due to the demands of the growing fetus and placenta; increased erythrocyte mass; and, in the third trimester, expanded maternal blood volume. Iron deficiency in pregnancy is a concern because some studies suggest an association between iron status and negative outcomes for women and their infants, such as low birthweight, premature birth, and perinatal death. Researchers for the USPSTF reviewed evidence to assess the benefits and harms of routine iron supplementation in pregnant women on maternal and infant health outcomes. They also sought to determine the benefits and harms of screening asymptomatic pregnant women for iron deficiency anemia. The evidence suggests that routine iron supplementation during pregnancy may reduce the incidence of iron deficiency and iron deficiency anemia in expectant mothers. The researchers found no trials on the effect of prenatal screening for iron deficiency anemia on clinical outcomes.

A draft recommendation statement on routine iron supplementation and screening for iron deficiency anemia in pregnancy and a draft recommendation statement on screening for iron deficiency anemia in young children will be posted at http://www.uspreventiveservicestaskforce.org on Monday, March 30 at 12:01 a.m.

Note: The URL will be live when the embargo lifts. For an embargoed PDF, please contact Megan Hanks. To receive the draft recommendation statements under embargo or interview someone from the USPSTF, please contact Ana Fullmer at newsroom@uspstf.net or 202-350-6668.

2. New hep C treatments cost-effective for some patients, yet may exceed insurers' willingness to pay

New therapies for hepatitis C virus (HCV) are cost-effective for some patients, but current costs may be higher than U.S. insurers are willing to pay, according to a study published in Annals of Internal Medicine. Recently approved sofosbuvir administered in combination with ribavirin can be used to treat patients with chronic HCV genotype 2 or 3 without interferon, yielding cure rates greater than with the previous standard of care without the fear of toxicity. However, sofosbuvir costs approximately $28,000 for 4 weeks of treatment, which may be too expensive for patients on publicly funded health insurance programs which do not guarantee access to such costly drugs. Using a simulation study, researchers sought to estimate the cost-effectiveness of sofosbuvir-based treatments for HCV genotype 2 or 3 infection in the United States. They found that at current cost, sofosbuvir-based HCV therapy improves outcomes and provides good economic value in patients with cirrhosis and genotype 2 or 3 infection and in those who were previously treated with interferon. However, in treatment-naive noncirrhotic patients, the incremental cost-effectiveness ratio would be well over $100,000 per quality-adjusted life-year, a cost that may exceed U.S. insurer's commonly cited willingness-to-pay threshold. The authors of an accompanying editorial http://www.annals.org/article.aspx?doi=10.7326/M15-0674 from the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health suggest that cost may be the only thing standing in the way of eradicating HCV.

Note: The URL will be live when the embargo lifts. For an embargoed PDF, please contact Megan Hanks. To interview the lead author, please contact Elissa Snook at Elissa.Snook@bmc.org or 617-638-6823.

3. AGA guidelines boldly suggest high value care for incidental CT findings

The American Gastroenterological Association (AGA) has released new guidelines on the management of asymptomatic neoplastic pancreatic cysts found incidentally during computed tomography (CT) or magnetic resonance imaging (MRI). The author of a commentary being published in Annals of Internal Medicine explains how the AGA's bold new recommendations will affect the way physicians consider diagnostic testing. The new guidelines back away from previous recommendations that were more aggressive. Rather than promote invasive work-up, surveillance, or surgery for typical patients, the AGA guidelines restrict aggressive follow up to patients with more high-risk features. The author suggests that learning to use restraint with medical tests could help to minimize harms and costs while preserving benefit.

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The summary above was included in yesterday's tip sheet from Annals of Internal Medicine and embargoed for Monday, March 30 at 12:01 a.m. The embargo for this commentary has been lifted, as the related guideline, American Gastroenterological Association Institute Guideline on the Diagnosis and Management of Asymptomatic Neoplastic Pancreatic Cysts, has been posted online at http://www.gastrojournal.org/article/S0016-5085%2815%2900100-6/abstract.

Information from the commentary published in Annals of Internal Medicine can be used immediately in coverage of this topic. To speak with the lead author, Dr. Russ Harris, please contact Sonya Sutton at ssutton@unc.edu.

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