Weekend Update

The FEHBlog is in Connecticut for a series of meetings in the Nutmeg State over the next two days. Congress is back in DC. The House of Representatives delayed a vote on a FY 2015 continuing resolution due to the President’s request for funding to train Syrian rebels. Hopefully both bodies of Congress will pass a continuing resolution this week. The Hill’s update is here.

The Mercer consulting firm last week issued an employer survey (1700 employers) estimating that employer health plan costs will increase 3.9% in 2015 if employers aggressively seek to hold down costs with, e.g., high deductible plans. With no proactive changes, costs are expected to increase 2% more to 5.9%. That shows a lot of confidence in health plan cost control measures, including wellness programs.

The Wall Street Journal reported on a lively debate among medical experts over whether or not cancer is overdiagnosed.  In a sidebar, the Journal explained that this debate is leading oncologists to engage in shared decision making with patients, e.g., explain benefits and risks of screenings and other procedures and allow the patient to make the preventive care decision.

“We in our health-care conversations have not adequately explained both sides,” says Otis Brawley, chief medical officer of the American Cancer Society. For example, he says, mammograms do save lives, but not as many as most people think. For women in their 60s, regular screenings reduce the risk of dying of breast cancer by about 30%. “But 70% of women who were going to die of breast cancer will still die of it,” Dr. Brawley says.

Patients often overestimate the lifetime risk of dying of cancer, he says. For prostate cancer and for breast cancer, it’s about 2.7%. Put another way, for every 10,000 women in their 60s screened annually for 10 years, between five and 49 breast-cancer deaths will be averted; about 90 women will die of breast cancer anyway and 64 to 194 will be treated unnecessarily, according to a recent analysis in JAMA. An additional 940 will have biopsies that find no cancer.

For some patients, lowering even a small risk of dying of cancer is worth undergoing frequent screening and aggressively treating even low-risk cancers. Many cancer survivors say they are glad their cancer was found early, and don’t second-guess if it needed to be caught at all. Some say they’d rather know they have even a low-risk cancer than stop looking and be left to wonder.

Financial considerations would not play a role in this shared decision making as the ACA generally requires non-grandfathered health plans to cover these preventive services without enrollee cost sharing in network. This recent change could be militating in favor of this movement.

Finally, last week, the Food and Drug Administration approved for marketing a new drug to treat obesity. According to this NPR report,

[The new drug] Contrave [developed by Orexigen Therapeutics], for better or worse, is a combination of two [currently generic] drugs that have been around for a long time. One is bupropion, an antidepressant sold as Wellbutrin, that’s also been used to help people stop smoking. The other is naltrexone, a medicine that’s prescribed to help people stay off drugs and alcohol.  Contrave is intended for people who are obese or who are overweight and have other weight-related health problems, such as high blood pressure and type 2 diabetes.

The drug will be available this fall. The article also discusses the drug’s potential side effects.

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