A head-to-head comparison of drug-coated stents suggests the old standby that used the drug sirolimus prevents more major cardiac events than a newer version, which is coated with zotarolimus. Coating stents with time-released drugs can help prevent infection or clogging, but it’s not clear whether there’s a clinical effect seen with the different coatings.

“This study adds to the evidence base,” says Alice K. Jacobs, MD, national spokeswoman and past president of the American Heart Association and director of the cardiac catheterization laboratories and of interventional cardiology at Boston Medical Center.

But she says it’s only one study. “Medical directors will need to critically review the data from multiple trials before deciding which stents to use in a given subset of patients.”

Researchers at Ulsan College of Medicine in South Korea compared zotarolimus-eluting stents (ZES) with the widely used sirolimus- and paclitaxel-eluting stents (SES, PES) in routine clinical practice and randomly assigned 2,645 patients who were set to undergo angioplasty to receive one of the three types of stents.

The primary endpoint in the trial was a composite of major adverse cardiac events (MACE) and included death, myocardial infarction, and ischemia-driven revascularization after 12 months of therapy.

Noninferiority comparisons (between ZES vs. SES) and superiority comparisons (between ZES vs. PES) were performed. Their findings, published in the Journal of the American College of Cardiology, suggest the patients in the ZES group had noninferior rates of MACE than the SES group (10.2 percent vs. 8.3 percent) and significantly fewer MACE than the PES group (10.2 percent vs. 14.1 percent). The incidence of death or myocardial infarction was similar among the groups, but the incidence of stent thrombosis was significantly lower in the SES group.

Less stent thrombosis is likely to mean fewer revascularizations. “A decrease in repeat procedures will likely be associated with a decrease in costs,” says Jacobs.

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.