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Guidance for an Effective Approach to Integrated Evidence Planning in a Dynamic World.
Clin Pharmacol Ther
January 2025
Boston Consulting Group, Zurich, Switzerland.
The value of a medicine is defined by its impact on patients, caregivers, health system, and society. A pharmaceutical company will generate evidence to demonstrate this value in various studies, including randomized clinical trials, non-interventional and observational studies, real-world data analyses, modeling, and simulation. The quality and strength of the evidence supporting a medicine's effectiveness, safety and product quality will drive decisions by healthcare system stakeholders for marketing authorization (regulatory authorities).
View Article and Find Full Text PDFDoes Merit-based Incentive Payment System Performance Differ Based on Orthopaedic Surgeon Gender?
Clin Orthop Relat Res
December 2024
Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA.
Background: Value-based care payment and delivery models such as the recently implemented Merit-based Incentive Payment System (MIPS) aim to both provide better care for patients and reduce costs of care. Gender disparities across orthopaedic surgery, encompassing reimbursement, industry payments, referrals, and patient perception, have been thoroughly studied over the years, with numerous disparities identified. However, differences in MIPS performance based on orthopaedic surgeon gender have not been comprehensively evaluated.
View Article and Find Full Text PDFBiomarkers.
Alzheimers Dement
December 2024
Knight Alzheimer Disease Research Center, Saint Louis, MO, USA.
Background: With the traditional FDA approval of lecanemab for treatment of early symptomatic Alzheimer disease (AD), there has been a surge in demand for clinical AD biomarker testing. While amyloid PET, cerebrospinal fluid (CSF) biomarkers, and AD blood tests are all clinically available, each have different benefits and limitations affecting their real-world use.
Methods: Pragmatic issues affecting usage of different AD biomarker testing modalities have been experienced in a large specialty memory clinic in St.
Trends in Cervical Laminoplasty Incidence in the United States: A Comparison of Commercial Insurance, Medicare, and Device Manufacturer Databases.
Clin Spine Surg
November 2024
Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA.
Study Design: Retrospective database study.
Objective: To leverage a commercial insurance claims database to explore trends in laminoplasty utilization and reimbursement in the United States. Secondarily, volume estimates were compared with data from the industry and from the Centers for Medicare and Medicaid (CMS).
Are Fewer Diagnoses Better? Assessing A Proposal To Improve The Medicare Advantage Payment System.
Health Aff (Millwood)
January 2025
Daniel Waldo, Actuarial Research Corporation.
Medicare Advantage (MA) plans report diagnoses more completely than they are reported in traditional Medicare. As a result, payment to MA plans is greater than it would be if coding patterns were identical in the two sectors. The Medicare Payment Advisory Commission estimates that the overpayment to MA attributable to differential coding was $50 billion in 2024.
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