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Over the past decade, programs have emerged that provide heroin users with naloxone to treat overdose, but the cost-effectiveness of this approach is unknown. This model estimates that this manner of naloxone distribution would reduce the mortality of overdose, would be cost-effective over a wide range of assumptions, and could even be cost-saving in some situations.

Topics: heroin, naloxone, heroin overdose, cost effectiveness
Sally L. Hodder, MD; Jessica Justman, MD; James P. Hughes, PhD; Jing Wang, MS; Danielle F. Haley, MPH; Adaora A. Adimora, MD; Carlos Del Rio, MD; Carol E. Golin, MD; Irene Kuo, PhD; Anne Rompalo, MD; Lydia Soto-Torres, MD; Sharon B. Mannheimer, MD; LeTanya Johnson-Lewis, BS; Susan H. Eshleman, MD, PhD; Wafaa M. El-Sadr, MD; for the HIV Prevention Trials Network 064, the Women's HIV SeroIncidence Study Team

Data are lacking on HIV acquisition among young women in areas with high HIV prevalence. This study enrolled 2099 women aged 18 to 44 years with HIV risk factors but no self-reported HIV infection who resided in areas with high HIV prevalence and high poverty rates. Researchers found that these women had an annual HIV incidence of 0.32%. This rate is similar to that found in some sub-Saharan countries. Improved programs for HIV prevention, testing, and treatment are needed for young women in areas with high HIV prevalence.

Topics: hiv, hiv infection
Noah McKittrick, MD; Ian Frank, MD; Jeffrey M. Jacobson, MD; C. Jo White, MD; Deborah Kim, RPh; Rosemarie Kappes, RN, MPH; Carol DiGiorgio, RN; Thomas Kenney, BS; Jean Boyer, PhD; Pablo Tebas, MD, for the Center for AIDS Research

Compared with the general population, HIV-infected patients may have greater morbidity and mortality from influenza and a decreased response to seasonal influenza vaccine. In this trial, HIV-infected patients who received a quadruple dose of seasonal influenza vaccine had a higher antibody response and a greater seroconversion rate than did those who received a standard dose. Adverse event rates were similar in the 2 groups. Administering a quadruple dose of seasonal influenza may improve seasonal influenza vaccination of HIV-infected patients.

Topics: hiv, influenza virus vaccine, vaccines, swine influenza, influenza
Peter S. Hussey, PhD; Samuel Wertheimer, MPH; and Ateev Mehrotra, MD, MPH

The association between costs and quality has been an important consideration in policy debates but is poorly understood. This review of 61 studies addressing relationships between health care quality and cost found incon-sistent evidence on both the direction and magnitude of the relationship of quality and costs. Future studies should focus on defining the types of health care spending that are most effective in improving quality and the types of spending that represent waste.

Topics: quality of care, quality indicators, spending, cost measures, health care costs
Prateek J. Khatri, MD; John G. Webb, MD; Josep Rodés-Cabau, MD; Stephen E. Fremes, MD; Marc Ruel, MD; Kelly Lau, BSc; Helen Guo, MSc; Harindra C. Wijeysundera, MD, PhD; and Dennis T. Ko, MD, MSc

Concerns about adverse effects of transcatheter aortic valve implantation (TAVI) may deter patients from undergoing this therapy. This review of 49 studies summarizes what we know about the risks associated with TAVI and evaluates whether adverse events vary depending on the type of valve used and the implantation route. Heart block requiring permanent pacemaker insertion, vascular complications, and acute renal failure requiring renal replacement therapy were the most common side effects associated with TAVI. The findings should help clinicians and patients make better-informed decisions regarding TAVI.

Topics: aortic valve stenosis, transcatheter aortic-valve implantation, transcatheter heart valve prosthesis

This U.S. Preventive Services Task Force (USPSTF) recommendation updates its 2005 statement on hormone therapy for preventing chronic conditions in postmenopausal women. The USPSTF recommends against the use of combined estrogen and progestin for prevention of chronic conditions in postmenopausal women with a uterus and against the use of estrogen for prevention of chronic conditions in postmenopausal women who have had a hysterectomy.

Topics: hormone replacement therapy, menopause, estrogen, chronic disease, endocrine therapy, progestins, postmenopause
David W. Baker, MD, MPH; Amir Qaseem, MD, PhD, MHA; P. Preston Reynolds, MD, PhD; Lea Anne Gardner, PhD, RN; Eric C. Schneider, MD, MSc, on behalf of the American College of Physicians Performance Measurement Committee*

Focusing on health care interventions that provide high value and eliminating those that do not is a strategy to manage escalating health care costs while improving quality of care. This American College of Physicians position paper advocates performance measures that target the overuse of low-value services. The authors discuss the strengths and limitations of these measures, provide specific examples of measures that assess low-value services, and discuss how these measures can be used in clinical practice and policy settings.

Topics: quality of care, costs and cost analysis, health care costs, measurement scales, ...
Henry G. Kaplan, MD; and Judith A. Malmgren, PhD

Ongoing controversy surrounds the appropriate age to begin and the frequency of mammography screening for breast cancer. The authors of this commentary argue that we need to develop more accurate, less invasive tests that not only find cancer early but also determine how aggressive the cancer is and how it should be treated. Until then, they believe the focus should be on finding cancer early with less worry about “overdiagnosis.”

Topics: mammography, breast cancer, breast neoplasm screening, overdiagnosis, oncologist
Wilson M. Compton, MD, MPE; Nora D. Volkow, MD; Douglas C. Throckmorton, MD; and Peter Lurie, MD, MPH

In this issue, Coffin and Sullivan's analysis suggests that distribution of naloxone to heroin users is likely to be a cost-effective strategy for treating overdose. The editorialists discuss the analysis and encourage future study of this strategy to manage prescription opioid overdose.

Topics: heroin, naloxone, opioid intoxication, heroin overdose
Alyna T. Chien, MD, MS; and Meredith B. Rosenthal, PhD

In this issue, Hussey and colleagues reviewed the limited evidence on the relationship between health care costs and quality and Weeks and colleagues discuss moving from fee-for-service to bundled payments. The editorialists discuss the articles and outline what we need to learn to develop payment models that produce value in health care.

Topics: quality of care, budgets, incentives, spending, healthcare payer, case rate payment system, ...
Eliseo Guallar, MD, DrPH; JoAnn E. Manson, MD, DrPH; Christine Laine, MD, MPH, Editor in Chief; and Cynthia Mulrow, MD, MSc, Senior Deputy Editor

In this issue, the USPSTF recommends against using hormone therapy for the prevention of chronic conditions in postmenopausal women. The editorialists discuss why evidence that became available after the USPSTF finalized its recommendations does not justify the Task Force to rethink its stance against using hormone therapy to prevent chronic conditions in menopausal women.

Topics: hormone replacement therapy, menopause, chronic disease, endocrine therapy
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Yusuke Tsugawa, MD, MPH; Kenneth J. Mukamal, MD, MPH; and Christina C. Wee, MD, MPH
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Federico Navarro-Sarabia, MD; and Gabriel Herrero-Beaumont, MD
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Peter Jüni, MD; Anne W.S. Rutjes, PhD; Bruno R. da Costa, PhD; and Stephan Reichenbach, MD, MSc
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Yong Wang, MD, PhD; Hanbin Wang, MD, PhD; Shaofu Qiu, PhD; Xishan Xiong, MD; Xiaoling Liu, MD; and Hongbin Song, MD, PhD
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Theo Meyer, MD, DPhil; Jeffrey Shih, MD; and Gerard Aurigemma, MD
Includes: CME
Topics: heart failure, heart failure with preserved ejection fraction, heart failure, diastolic, heart ...
Topics: heroin, naloxone, heroin overdose
Topics: progestins, hormone replacement therapy, menopause, estrogen, chronic disease, endocrine therapy
William B. Weeks, MD, MBA; Stephen S. Rauh, MBA, CFA; Eric B. Wadsworth, PhD, CPA; and James N. Weinstein, DO, MS

Consensus is building that episode-based bundled payments can produce substantial Medicare savings, and the Center for Medicare & Medicaid Innovation's Bundled Payment Initiative endorses this concept. The authors of this article discuss the initiative's potential sources of savings and unintended consequences. The authors conclude that the true cost savings to Medicare will be realized only when the federal government provides ample incentives to eliminate capacity and move toward capitation.

Topics: case rate payment system, medicare
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