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August 19, 2010 Volume VII, No. 7

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

According to an American Cancer Society report, in 2008, cancer has the most devastating economic impact of any disease, accounting for nearly a trillion dollars in economic losses from premature death and disability. This week's issue provides more details on this report, including the economic impact of different types of cancers and other diseases. On a related note, learn why some physicians aren't using chemoprevention for prostate cancer.

Your colleague in the business of healthcare,
Jessica Papay
Editor, Disease Management Update

This week's DM news:

Table of Contents

  1. The Cost of Cancer
  2. ADHD Misdiagnosis
  3. Reducing Acute, Chronic Care Costs
  4. Outcomes-Driven Incentives
  5. Targeted Conditions for Medication Adherence
  6. Medical Homes in 2010
  7. Prostate Cancer Chemoprevention
  8. Health Coaching 2010

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Please send comments, questions and replies to jpapay@hin.com.

Melanie Matthews, mmatthews@hin.com

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Cancer Has Greatest Economic Impact from Premature Death, Disability of All Causes of Death Worldwide

For the first time, research shows that cancer has the most devastating economic impact of any cause of death in the world — costing the global economy nearly a trillion dollars a year. The American Cancer Society and LIVESTRONG® have released a first-of-its-kind study on the economic cost of all causes of death globally, including cancer and other noncommunicable and communicable diseases. According to WHO projections, this year, cancer will become the world's leading cause of death, followed by heart disease and stroke. This report shows that cancer has the greatest economic impact from premature death and disability of all causes of death worldwide.

For this study, researchers used data from the WHO that combine the death and disability dimensions of illness into a single summary, called a DALY (disability adjusted life year), for 17 types of cancer as well as the 15 leading causes of death. These data show that there were 83 million years of "healthy life" lost due to death and disability from cancer. To reduce this death toll by one DALY, WHO recommends to invest as much as three times per capita gross domestic product to make an intervention cost-effective. The data from this study provides compelling new evidence that balancing the world's global health agenda to address cancer will not only save millions of lives, but also billions of dollars. In 2008, cancer accounted for nearly a trillion dollars in economic losses from premature death and disability. The economic toll from cancer is nearly 20 percent higher than heart disease, the second leading cause of economic loss ($895 billion and $753 billion respectively). This analysis does not include direct medical costs, which would further increase, and possibly double, the total economic cost caused by cancer. The lost years of life and productivity caused by cancer represent the single largest drain on national economies, compared to other causes of death, including HIV/AIDS and other infectious diseases.

Death and disability from lung cancer, colon/rectal cancer and breast cancer account for the largest economic costs on a global scale, and the greatest burden in high-income countries. In the low-income countries, cancers of the mouth and oropharynx, cervix and breast have the greatest impact. Available interventions to prevent, detect, and/or treat these common cancers could not only save lives but also improve economic development prospects in many nations. Cancers of the lung, bronchus and trachea by far account for the largest drain — nearly $180 billion yearly — on the global economy. If current trends continue, tobacco will kill 8 million per year by 2030, with more than 80 percent of the deaths taking place in low- to middle-income countries. About one third of those deaths will be from cancer. Unfortunately, tobacco kills thousands of nonsmokers every year as well — among them an estimated 200,000 who are exposed to it in the workplace.

This landmark economic study comes at a time when cancer and other non-communicable diseases are gaining more attention from the global health community and in the wake of a U.N. General Assembly call for a high-level meeting on the issue in September 2011. Noncommunicable diseases account for 60 percent of the world’s deaths, yet according to the Center for Global Development, they receive less than 1 percent of the public and private funding for health. As the death and disability toll from lung cancer remains high across income levels of nearly all nations, efforts like the Framework Convention on Tobacco Control (FCTC) could have a significant impact in reducing economic losses. The FCTC, the world’s first global health treaty and signed by 168 countries, aims to reduce deaths from tobacco usage by regulating the sale and marketing of tobacco products and protecting people from tobacco smoke.

These and other findings in the report are more important than ever in light of the fact that, in 2010, cancer is projected to become the leading cause of death worldwide followed by heart disease and stroke. Sixty percent of the estimated 7.6 million cancer deaths in 2008 and more than half of the estimated 12.4 million cases of cancer diagnosed each year take place in developing countries, yet little research has been focused on the economic impact of the disease in countries where preventable forms of cancer are taking a disproportionate toll.

To learn more about this research, please visit:

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Nearly 1 Million Children Potentially Misdiagnosed with ADHD

Nearly 1 million children in the U.S. are potentially misdiagnosed with attention deficit hyperactivity disorder (ADHD) simply because they are the youngest — and most immature — in their kindergarten class, according to new research by a Michigan State University economist. These children are significantly more likely than their older classmates to be prescribed behavior-modifying stimulants such as Ritalin. Such inappropriate treatment is particularly worrisome because of the unknown impacts of long-term stimulant use on children’s health. It also wastes an estimated $320-$500 million a year on unnecessary medication — some $80-$90 million of it paid by Medicaid. ADHD is the most commonly diagnosed behavioral disorder for kids in the U.S., with at least 4.5 million diagnoses among children under age 18, according to the CDC. However, there are no neurological markers for ADHD (such as a blood test), and experts disagree on its prevalence, fueling intense public debate about whether ADHD is under-diagnosed or over-diagnosed.

According to researchers, the "smoking gun" of the study is that ADHD diagnoses depend on a child’s age relative to classmates and the teacher’s perceptions of whether the child has symptoms. "If a child is behaving poorly, if he’s inattentive, if he can’t sit still, it may simply be because he’s 5 and the other kids are 6. There’s a big difference between a 5-year-old and a 6-year-old, and teachers and medical practitioners need to take that into account when evaluating whether children have ADHD."

Using a sample of nearly 12,000 children, researchers examined the difference in ADHD diagnosis and medication rates between the youngest and oldest children in a grade. The data is from the Early Childhood Longitudinal Study Kindergarten Cohort, which is funded by the National Center for Education Statistics. According to the study, the youngest kindergartners were 60 percent more likely to be diagnosed with ADHD than the oldest children in the same grade. Similarly, when that group of classmates reached the fifth and eighth grades, the youngest were more than twice as likely to be prescribed stimulants. Overall, the study found that about 20 percent — or 900,000 — of the 4.5 million children currently identified as having ADHD have likely been misdiagnosed.

The results — both from individual states and when compared across states — were definitive. For instance, in Michigan — where the kindergarten cutoff date is December 1 — students born December 1 had much higher rates of ADHD than children born December 2. (The students born December 1 were the youngest in their grade; the students born December 2 enrolled a year later and were the oldest in their grade.) Thus, even though the students were a single day apart in age, they were assessed differently simply because they were compared against classmates of a different age set, said researchers. In another example, August-born kindergartners in Illinois were much more likely to be diagnosed with ADHD than Michigan kindergartners born in August of the same year as their Illinois counterparts. That’s because Illinois’ kindergarten cutoff date is September 1, meaning those August-born children were the youngest in their grade, whereas the Michigan students were not.

According to the study, a diagnosis of ADHD requires evidence of multiple symptoms of inattention or hyperactivity, with these symptoms persisting for six or more months — and in at least two settings — before the age of seven; settings include home and school. Although teachers cannot diagnose ADHD, their opinions are instrumental in decisions to send a child to be evaluated by a mental health professional. "Many ADHD diagnoses may be driven by teachers' perceptions of poor behavior among the youngest children in a kindergarten classroom," said the researchers. "But these 'symptoms' may merely reflect emotional or intellectual immaturity among the youngest students."

To learn more about this research, please visit:

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Reducing Acute, Chronic Care Costs Through an Effective Health Risk Stratification Model

Predictive modeling and health risk stratification can help providers identify members for case management and DM interventions, says Dr. William Vennart, vice president of medical management and national medical director with CareAdvantage Inc. These methods ensure that patients receive treatment for their chronic conditions early on and, in turn, reduce unnecessary utilization and lower acute and chronic care costs.

To listen to this complimentary HIN podcast, please visit:

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Structuring an Outcomes-Driven Incentives Program

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Dr. Elizabeth Rula, principal investigator of Health Outcomes Research at Healthways Inc.

Question: What is important to consider when planning an incentives program aimed at driving outcomes?

Response: It is important to consider structuring the program such that it will reward ongoing participation or achievement of a goal. When you only provide an incentive for enrollment in a program, individuals will enroll in the program, get their incentive and then drop out before really participating or benefiting from that program. However, if you incent them to stay with it and really engage in a program, then they will achieve the benefits and that should show up in your ROI.

For more information on building an incentives program, please visit:

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Targeted Conditions for Medication Adherence

Medication adherence programs can improve patient care and lower healthcare costs by more effectively managing chronic medication utilization. We wanted to see which targeted conditions care organizations thought posed the greatest opportunity to improve medication adherence.

Click here to view the chart.

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Medical Homes in 2010 — Awareness, Adoption, Tools and Outcomes

Patient-centered medical home (PCMH) pilots are in high gear around the country and high on the healthcare reform agenda. This white paper from the Healthcare Intelligence Network (HIN) measures adoption of the PCMH as compared to our first medical home survey in 2006, the targeted populations that would benefit from this model of care, the components of a medical home and the effects of this model in the healthcare industry.

To download this complimentary white paper, please visit:

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Physicians Reluctant to Use Chemoprevention for Prostate Cancer

Despite the dramatic results of the Prostate Cancer Prevention Trial (PCPT), which showed a significant reduction in prostate cancer among those taking finasteride, physicians have not increased its use, according to a study published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research. The first results of the PCPT were published in 2003 in The New England Journal of Medicine and were widely reported. The randomized controlled trial consisted of 18,000 men and showed a 25 percent reduced risk of prostate cancer. Unfortunately, it also showed a 27 percent increased risk in high-grade tumors, which was noted in an accompanying editorial. One researcher who led the study said that the editorial may have colored the perception of finasteride.

In 2008, another report was published in Cancer Prevention Research where researchers reanalyzed the data along with the available tumor biopsies. Results showed that finasteride did not actually increase risk; it made the available testing more sensitive. This result confirmed the benefits of finasteride for prostate cancer prevention. However, results of this new study showed that physicians have not changed their practice patterns.

Researchers surveyed 325 urologists and 1,200 primary care physicians (PCP) to determine their prescribing patterns. Although the number of men starting finasteride grew over a five-year period, the publication of the PCPT trial did not influence their decision. Fifty-seven percent of urologists and 40 percent of PCPs said they prescribed finasteride more often; only 2 percent said they had been influenced by the findings in PCPT. In fact, 64 percent of urologists and 80 percent of PCPs never prescribe finasteride for chemoprevention. When asked for reasons for their decision, 55 percent said they were concerned about the risk of high-grade tumors and 52 percent said they did not know it could be used for chemoprevention. According to the researchers, "The use of finasteride for prostate cancer prevention does not appear to be widely endorsed. The concept of chemoprevention is a difficult one for patients and physicians." Researchers agree that chemoprevention is an important new frontier that needs continued emphasis.

To learn more about this research, please visit:

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Health Coaching in 2010

Health coaching's domain has moved beyond traditional disease management to encompass care transitions coaching, medication adherence, and more. Join the more than 90 organizations that have taken HIN's third annual Health Coaching survey to find out how healthcare organizations are implementing health coaching as well as the financial and clinical outcomes that result. Complete the survey by August 31 and receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.

To participate in this survey and receive its results, please visit:

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