Less-is-More Approach Now Under Heavy Fire

An analysis in the New England Journal of Medicine (http://bit.ly/c2keSV (link is external)) February 18 about how the Dartmouth Atlas of Health Care rates hospitals has caught many eyes. Peter S. Bach, MD, a physician at Memorial Sloan-Kettering Cancer Center, posits that the Atlas uses flawed methodologies in suggesting that less is more. Dartmouth Atlas officials defend their methods in an addendum.

“Say Hospital A and Hospital B each has a group of patients with a fatal disease,” Bach writes. “Hospital A gives each patient a $1 pill and cures half of them; Hospital B provides no treatment. An Atlas analysis would conclude that Hospital B was more efficient, since it spent less per decedent. But all the patients die at Hospital B, whereas only half of the patients die at Hospital A, where the cost per life saved is a bargain at $2.”

In our cover story about disease management one of that industry’s boosters makes a similar point. Ariel Linden, DrPH, MS, a widely published researcher of DM outcomes, says that he is unable to find the extravagant savings that some DM vendors tout.

Linden favors a DM approach where the patient is managed in a primary care setting in an intensive — and expensive — manner. “Whoever said it was going to be cheap? I can’t understand this reasoning. Chronically ill patients are difficult, they’re sick, and they’ve spent most of their lives with unhealthy behaviors.”

Researchers are asking the same thing about hospital care. A University of Pittsburgh study finds that patients live longer at hospitals that offer the most intensive care (http://bit.ly/9LS9Ua (link is external)).

Is that the choice? Save lives or save money? Managed care will surely be drawn into this debate about where to draw the line.

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Features

LETTER TO THE EDITOR

Medications for Parkinson’s Disease (link is external)

PERSPECTIVE

The Changing Roles of P&T Committees (link is external)

Epilepsy Management: Newer Agents, Unmet Needs, and Future Treatment Strategies (link is external)

PIPELINE PLUS

Modest Growth Seen in Epilepsy Market (link is external)

MEETING HIGHLIGHTS

European Society of Cardiology and Transcatheter Cardiovascular Therapeutics (link is external)

BOOK REVIEW

“Generic: The Unbranding of Modern Medicine,” by Jeremy A. Greene, MD, PhD (link is external)

DEPARTMENTSMEDICATION ERRORS

Misadministration of IV Insulin Associated With Dose Measurement And Hyperkalemia Treatment (link is external)

PRESCRIPTION: WASHINGTON

FDA’s Proposed 503B Draft Compounding Guidance Raises Concerns of All Kinds (link is external)

New Drugs/Drug News (link is external)

Pharmaceutical Approval Update (link is external)

DRUG FORECAST

Riociguat (Adempas): a Novel Agent For the Treatment of Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension (link is external)


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