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AimsTo determine how a diabetes diagnosis affects contraception use.MethodsThis retrospective cohort study used private insurance data from non-pregnant women aged 15-49 years, 2000-2014. We identified women with a new diabetes diagnosis and a control group without diabetes, matched on important potential confounders. We compared rates of prescription or procedural contraception use in the two groups before and after an index date (diabetes diagnosis and outpatient visit, respectively), yielding difference-in-differences estimates of the effect of a diabetes diagnosis on contraception use.ResultsWe identified 75,355 women with a new diabetes diagnosis and 7.5 million women without a diabetes diagnosis. Overall rates of contraception use did not increase in the year after diagnosis (absolute difference-in-difference: 0.4% [99.9% CI, -2.1% to 2.9%]; p

BackgroundMail order pharmacy (MOP) use has been linked to improved medication adherence and health outcomes among patients with diabetes. However, no large-scale intervention studies have assessed the effect of encouraging MOP use on medication adherence.ObjectiveTo assess an intervention to encourage MOP services to increase its use and medication adherence.DesignRandomized encouragement trial.Patients63,012 diabetes patients from three health care systems: Kaiser Permanente Northern California (KPNC), Kaiser Permanente Hawaii (KPHI), and Harvard Pilgrim Health Care (HPHC) who were poorly adherent to at least one class of cardiometabolic medications and had not used MOP in the prior 12 months.InterventionPatients were randomized to receive either usual care (control arm) or outreach encouraging MOP use consisting of a mailed letter, secure email message, and automated telephone call outlining the potential benefits of MOP use (intervention arm). HPHC intervention patients received the letter only.MeasurementsWe compared the percentages of patients that began using MOP and that became adherent to cardiometabolic medication classes during a 12-month follow-up period. We also conducted a race/ethnicity-stratified analysis.ResultsDuring follow-up, 10.6% of intervention patients began using MOP vs. 9.3% of controls (p

Purpose of reviewTo advance our understanding of the impacts of policies and programs aimed at improving detection, engagement, prevention, and clinical diabetes management in the USA, we synthesized findings from a network of studies that used natural experiments to evaluate diabetes health policies and programs.FindingsStudies from the Natural EXperiments for Translation in Diabetes (NEXT-D) network used rigorous longitudinal quasi-experimental study designs (e.g., interrupted time series) and analytical methods (e.g., difference-in-differences) to augment causal inference. Investigators partnered with health system stakeholders to evaluate whether glucose testing rates changed from before-to-after clinic interventions (e.g., integrating electronic screening decision prompts in New York City) or employer programs (e.g., targeted messaging and waiving copayments for at-risk employees). Other studies examined participation and behavior change in low- (e.g., wellness coaching) or high-intensity lifestyle modification programs (e.g., diabetes prevention program-like interventions) offered by payers or employers. Lastly, studies assessed how employer health insurance benefits impacted healthcare utilization, adherence, and outcomes among people with diabetes. NEXT-D demonstrated that low-intensity interventions to facilitate glucose testing and enhance engagement in lifestyle modification were associated with small improvements in weight but large improvements in screening and testing when supported by electronic health record-based decision-support. Regarding high-intensity diabetes prevention program-like lifestyle programs offered by payers or employers, enrollment was modest and led to weight loss and marginally lower short-term health expenditures. Health plans that incentivize patient behaviors were associated with increases in medication adherence. Meanwhile, shifting patients to high-deductible health plans was associated with no change in medication use and preventive screenings, but patients with diabetes delayed accessing healthcare for acute complications (e.g., cellulitis). Findings were more pronounced among lower-income patients, who experienced increased rates and acuity of emergency department visits for diabetes complications and other high-severity conditions. Findings from NEXT-D studies provide informative data that can guide programs and policies to facilitate detection, prevention, and treatment of diabetes in practice.

PURPOSE OF REVIEW:Diabetes incidence is rising among vulnerable population subgroups including minorities and individuals with limited education. Many diabetes-related programs and public policies are unevaluated while others are analyzed with research designs highly susceptible to bias which can result in flawed conclusions. The Natural Experiments for Translation in Diabetes 2.0 (NEXT-D2) Network includes eight research centers and three funding agencies using rigorous methods to evaluate natural experiments in health policy and program delivery. RECENT FINDINGS:NEXT-D2 research studies use quasi-experimental methods to assess three major areas as they relate to diabetes: health insurance expansion; healthcare financing and payment models; and innovations in care coordination. The studies will report on preventive processes, achievement of diabetes care goals, and incidence of complications. Some studies assess healthcare utilization while others focus on patient-reported outcomes. NEXT-D2 examines the effect of public and private policies on diabetes care and prevention at a critical time, given ongoing and rapid shifts in the US health policy landscape.

Several states have implemented limits or caps on out-of-pocket (OOP) costs for insulin, but the effectiveness of these caps is uncertain. This observational study examines the potential effect of the caps on the OOP cost and use of insulin among a sample of commercially insured persons with diabetes. Visual Abstract. Association of State Insulin Out-of-Pocket Caps With Insulin Cost-Sharing and Use Among Commercially Insured Patients With Diabetes: Several states have implemented limits or caps on out-of-pocket (OOP) costs for insulin, but the effectiveness of these caps is uncertain. This observational study examines the potential effect of the caps on the OOP cost and use of insulin among a sample of commercially insured persons with diabetes. Background: Twenty-five states have implemented insulin out-of-pocket (OOP) cost caps, but their effectiveness is uncertain. Objective: To examine the effect of state insulin OOP caps on insulin use and OOP costs among commercially insured persons with diabetes. Design: Pre–post study with control group. Setting: Eight states implementing insulin OOP caps of $25 to $30, $50, or $100 in January 2021, and 17 control states. Participants: Commercially insured persons with diabetes and insulin users younger than 65 years. Subgroups of particular interest included members from states with insulin OOP caps of $25 to $30, enrollees with health savings accounts (HSAs) that require high insulin OOP payments, and lower-income members. Measurements: Mean monthly 30-day insulin fills and OOP costs. Results: State insulin caps were not associated with changes in insulin use in the overall population (relative change in fills per month, 1.8% [95% CI, −3.2% to 6.9%]). Insulin users in intervention states saw a 17.4% (CI, −23.9% to −10.9%) relative reduction in insulin OOP costs, largely driven by reductions among HSA enrollees; there was no difference in OOP costs among nonaccount plan members. More generous ($25 to $30) state insulin OOP caps were associated with insulin OOP cost reductions of 40.0% (CI, −62.5% to −17.6%), again primarily driven by a larger reduction in the subgroup with HSA plans. Limitations: Single national insurer; 9-month follow-up. Conclusion: Insulin OOP caps were associated with reduced insulin OOP costs but no overall increases in insulin use. A proposed national insulin cap of $35 for commercially insured persons might lead to meaningful insulin OOP savings but have a limited effect on insulin use. Primary Funding Source: Centers for Disease Control and Prevention and National Institute of Diabetes and Digestive and Kidney Diseases. [ABSTRACT FROM AUTHOR]

Objective To assess sales of anti-cancer medicines in the 2017 World Health Organization's WHO Model list of essential medicines in China, Indonesia, Kazakhstan, Malaysia, Philippines and Thailand from 2007 (2008 for Kazakhstan and Malaysia) to 2017. Methods We extracted sales volume data for 39 anti-cancer medicines from the IQVIA database. We divided the total quantity sold by the reference defined daily dose to estimate the total number of defined daily doses sold, per country per year, for three types of anti-cancer therapies (traditional chemotherapy, targeted therapy and endocrine therapy). We adjusted these data by the number of new cancer cases in each country for each year. Findings We observed an increase in sales across all types of anti-cancer therapies in all countries. The largest number of defined daily doses of traditional chemotherapy per new cancer case was sold in Thailand; however, the largest relative increase per new cancer case occurred in Indonesia (9.48-fold). The largest absolute and relative increases in sales of defined daily doses of targeted therapies per new cancer case occurred in Kazakhstan. Malaysia sold the largest number of adjusted defined daily doses of endocrine therapies in 2017, while China and Indonesia more than doubled their adjusted sales volumes between 2007 and 2017. Conclusion The use of sales data can fill an important knowledge gap in the use of anti-cancer medicines, particularly during periods of insurance coverage expansion. Combined with other data, sales volume data can help to monitor efforts to improve equitable access to essential medicines. Objectif Evaluer la vente de medicaments contre le cancer figurant dans l'edition 2017 de la Liste modele des medicaments essentiels publiee par Organisation mondiale de la Sante en Chine, en Indonesie, au Kazakhstan, en Malaisie, aux Philippines et en ThaTlande entre 2007 (2008 pour le Kazakhstan et la Malaisie) et 2017. Methodes Nous avons extrait de la base de donnees IQVIA les informations relatives au volume de vente pour 39 medicaments contre le cancer. Nous avons divise le nombre total de medicaments vendus par la dose quotidienne determinee de reference, afin d'estimer le nombre total de doses quotidiennes determinees vendues par pays et par an, pour trois types de traitements contre le cancer (chimiotherapie conventionnelle, therapie ciblee et endocrinotherapie). Nous avons ajuste ces donnees en tenant compte du nombre de nouveaux cas de cancer diagnostiques chaque annee dans chaque pays. Resultats Nous avons observe une hausse des ventes pour tous les types de traitements contre le cancer dans tous les pays. C'est la Thailande qui vend le plus grand nombre de doses quotidiennes determinees en chimiotherapie conventionnelle pour chaque nouveau cas de cancer; neanmoins, c'est en Indonesie que nous avons constate la plus grande augmentation relative pour chaque nouveau cas de cancer (nombre multiplie par 9,48). En termes d'augmentation absolue et relative des ventes de doses quotidiennes determinees pour latherapie ciblee, c'est au Kazakhstan qu'elle etait la plus elevee. La Malaisie est le pays ayant vendu le plus grand nombre de doses quotidiennes determinees pour l'endocrinotherapie, tandis que la Chine et l'Indonesie ont plus que double leur volume de vente ajuste entre 2007 et 2017. Conclusion L'exploitation des donnees de vente peut combler un manque de connaissances dans l'utilisation de medicaments contre le cancer, surtout pendant les periodes d'elargissement de la couverture maladie. En les associant a d'autres informations, les donnees sur le volume de vente permettent de suivre les efforts fournis pour garantir un acces de plus en plus equitable aux medicaments essentiels. Objetivo Evaluar las ventas de los medicamentos contra el cancer que aparecen en la Lista modelo OMS de medicamentos esenciales de 2017 de la Organizacion Mundial de la Salud en China, Filipinas, Indonesia, Kazajstan, Malasia y Tailandia desde 2007 (2008 en el caso de Kazajstan y Malasia) hasta 2017. Metodos Los datos sobre el volumen de ventas de 39 medicamentos contra el cancer se obtuvieron de la base de datos IQVIA. Se dividio la cantidad total que se vendio por la dosis diaria definida de referencia para estimar el numero total de dosis diarias definidas que se vendieron, por pais y por ano, para tres tipos de tratamientos anticancerosos (quimioterapia tradicional, terapia dirigida y tratamiento endocrino). Se adaptaron estos datos por el numero de nuevos casos de cancer en cada pais para cada ano. Resultados Se observo un incremento en las ventas de todos los tipos de tratamientos anticancerosos en todos los paises. El mayor numero de dosis diarias definidas de quimioterapia tradicional por cada nuevo caso de cancer se vendio en Tailandia; sin embargo, el mayor incremento relativo por cada nuevo caso de cancer se registro en Indonesia (9,48 veces). Los mayores incrementos absolutos y relativos de las ventas de dosis diarias definidas de las terapias dirigidas por cada nuevo caso de cancer se registraron en Kazajstan. Malasia vendio el mayor numero de dosis diarias definidas adaptadas de los tratamientos endocrinos en 2017, mientras que China e Indonesia duplicaron con creces sus volumenes de ventas ajustadas entre 2007 y 2017. Conclusion El empleo de los datos de ventas puede llenar un importante vacio de conocimientos sobre el uso de los medicamentos contra el cancer, en particular durante los periodos de la ampliacion de la cobertura de los seguros. Los datos sobre el volumen de ventas, junto con otros datos, pueden ayudar a supervisar los esfuerzos por mejorar el acceso equitativo a los medicamentos esenciales. [phrase omitted], Introduction The sustainable development goals (SDG) identify access to quality medicines as a key component of universal health coverage (UHC). (1) The SDGs also reflect a global recognition of the [...]

ObjectivesReducing unnecessary antibiotic use, particularly among children, continues to be a public health priority. Previous intervention studies have been limited by size or design and have shown mixed results. The objective of this study was to determine the impact of a multifaceted, community-wide intervention on overall antibiotic use for young children and on use of broad-spectrum agents. In addition, we sought to compare the intervention's impact on commercially and Medicaid-insured children.MethodsWe conducted a controlled, community-level, cluster-randomized trial in 16 nonoverlapping Massachusetts communities, studied from 1998 to 2003. During 3 years, we implemented a physician behavior-change strategy that included guideline dissemination, small-group education, frequent updates and educational materials, and prescribing feedback. Parents received educational materials by mail and in primary care practices, pharmacies, and child care settings. Using health-plan data, we measured changes in antibiotics dispensed per person-year of observation among children who were aged 3 to