Welcome to the July Fourth Weekend Edition of This Week in Managed Care. I’m Laura Joszt.
Here are the Top Five Stories in Managed Care for the first half of 2019.
5. Medicare Annual Wellness Visit
Number 5 comes from the March issue of The American Journal of Managed Care® (AJMC®), which featured the study, “Medicare Annual Wellness Visit Association With Healthcare Quality and Costs.”
This study examined claims data to see whether annual Medicare wellness visits encouraged preventive care and led to lower healthcare spending. The answer was “yes” to both. The authors found wellness visits were not associated with trips to the emergency department or hospitalization, and were linked to a 5.7% drop in overall healthcare spending over the next 11 months.
They concluded: “In a setting that prioritizes care coordination and utilization management, [annual wellness visits] have the potential to improve healthcare quality and reduce cost.”
4. ACC Prevention Guidelines
Our number 4 story came from conference coverage at the American College of Cardiology Scientific Session. The meeting featured cardiovascular prevention guidelines that call for less aspirin and the recommendation of two drug classes for prevention of cardiovascular events in patients with type 2 diabetes: SGLT2 inhibitors and GLP-1 receptor agonists.
However, the guidelines emphasize that lifestyle changes are the foundation of cardiovascular prevention.
Roger Blumenthal, MD, cochair of the Guideline Committee for the American College of Cardiology and the American Heart Association, said: “The most important way to prevent cardiovascular disease, whether it’s a build-up of plaque in the arteries, heart attack, stroke, heart failure or issues with how the heart contracts and pumps blood to the rest of the body, is by adopting heart healthy habits and to do so over one’s lifetime. More than 80% of all cardiovascular events are preventable through lifestyle changes.”
3. Slowing, Stopping, Reversing Parkinson Disease
Our third top story of the first half of 2019 offers good news in Parkinson disease.
Results from a February study in the Journal of Parkinson’s Disease describe an experimental treatment that may have the potential to slow, stop, or reverse the condition. The 3-part study involves a delivery system to increase levels of glial cell line-derived neurotrophic factor, which can revive dying dopamine cells.
Said scientist Steven Gill, MB, MS, FRCS, who designed an infusion device used in the process, “I believe that this approach could be the first neuro-restorative treatment for people living with Parkinson's, which is, of course, an extremely exciting prospect.”
2. Oral Semaglutide for T2D
Our two top stories for the first half of 2019 involve drugs for type 2 diabetes.
Our second most popular article was Novo Nordisk’s March application to FDA for approval for oral semaglutide, which would be the first noninjectable glucagon-like peptide-1 (GLP-1) receptor agonist. Officials at the manufacturer believe making this drug available in a pill form will lead to more patients using the GLP-1 class.
Novo Nordisk has also asked FDA for cardiovascular indications for both the oral and injectable forms of semaglutide.
Said Todd Hobbs, MD, chief medical officer for Novo Nordisk, "We know that many adults with type 2 diabetes are still struggling to control their blood sugar and are at increased cardiovascular risk. We hope that, if approved, these products can help those patients."
Following the March application, AJMC® covered the June presentation of PIONEER 6, the cardiovascular outcomes study for oral semaglutide, at the American Diabetes Association (ADA) 79th Scientific Sessions. Results showed the drug reduced cardiovascular events in high-risk patients, but fell short of the bar for superiority.
It is expected that Novo Nordisk will pool results from PIONEER and an earlier study for injectable semaglutide in seeking cardiovascular indications. Look for the first FDA action in September.
1. Reducing Renal Failure in T2D
And, our top story for the first half of 2019 is… Coverage of the CREDENCE trial, which showed that canagliflozin cut the risk of renal failure and death by 30% in patients with type 2 diabetes and chronic kidney disease.
According to lead author Vlado Perkovic, MBBS, PhD, FASN, FRACP, “Canagliflozin is the first medical breakthrough in nearly 20 years proven to slow the progression of chronic kidney disease in patients with diabetes at high risk of developing kidney failure.”
CREDENCE was the first dedicated renal outcomes trial for an sodium-glucose cotransporter-2 (SGTL2) inhibitor, and the results released in April were also featured in June at the ADA Sessions. The ability of SGLT2 inhibitors to prevent renal decline was a theme of the ADA meeting, where renal data were presented for several type 2 diabetes drugs.