A) Increased use of DNA testing for colorectal cancer screening
The Epic Research Network reported last month that DNA testing for colorectal cancer jumped from 3% of screening tests in 2018 to 31% of screening tests in 2023. DNA screening tests (Cologuard) are recommended by the US Preventive Services Task Force. But they have a higher rate of false positives than FIT tests and are dramatically more expensive.
Here is a link to a note on colorectal cancer screening from March which includes statistics about lives saved with various screening approaches.
B) Tirzepatide effective in treating fatty liver
Source: Loomba, et al NEJM June 8, 2024 LINK
The New England Journal reported this week that tirzepatide (Mounjaro or Zepbound) was effective at resolving metabolic associated steatohepatitis, MASH, previously known as non-alcoholic fatty liver disease. The study included 157 people who had liver biopsies to demonstrate resolution and absence of scarring. Patients tolerated tirzepatide well; none stopped it due to side effects.
From a previous note on this topic written with Chantell Sell Reagan, Pharm D:
The prevalence of MASH is between 1.5-6% of the adult population, and this disease can cause inflammation and scarring (fibrosis) of the liver. In some cases, MASH can cause cirrhosis and liver failure, and it is the second most common reason for liver transplants (after alcoholic liver disease).
Tirzepatide is expensive, but cheaper than the only drug approved for this condition, resmetirom (Rezdiffra), which has a list price of $47,400 annually.
C) Hospital outpatient fees raise medical costs
Source: Behind the Bill: The hidden injustice of hospital facility fees, United States of Health, May, 2024 LINK
The initial source of this data is a Leukemia and Lymphoma Society publication from November, 2023.
The United States of Care issued a report on hospital facility fees as part of its advocacy for site neutral payments. They note that provider consolidation has exposed more plan members to hospital facility fees. When a provider purchases a physician practice, patients can be charged a facility fee even if they are still receiving care in an unchanged physician office. The report also notes that facility fees might worsen health inequities as some studies show higher hospital fees for patients of color. Here is a link to a good summary in The Guardian.
Here’s a post from December on the differential costs of colonoscopy by site.
D) First human death reported from bird flu
Mexico reported the first human death from avian influenza (H5N2) last month. The 59 year old man had multiple comorbidities. The source of his infection was not clear, although there had been a backyard poultry outbreak in an adjacent state. Investigators have tested contacts and so far have not found any secondary cases. Other strains of avian influenza (H5N1) have been found in cattle in multiple states in the US and has been responsible for deaths of mammals (including cats, ferrets and alpacas), although there have only been mild cases in 2 farm workers reported so far in the US.
Here’s a link to a post on this written by Patricia Toro, MD MPH in early May. Employer implications that she noted then:
Symptoms of bird flu, in humans or animals, can be very mild. Encourage employees to be tested if they are sick, particularly if they have animals in their household.
Employers should have an emergency workforce plan in place for any unexpected respiratory viral outbreak that can be used in case the bird flu mutates to allow for easy human to human transmission, which is not the case today.
E) Supreme Court unanimously rejects challenge to abortion pill
The Supreme Court voted unanimously on Thursday to uphold the Food and Drug Administration's (FDA) approval of mifepristone, a pill used in more than half of abortions in the United States. Mifepristone was first approved in 2000, and indications to use it were expanded in 2016. The drug is now approved for abortions up to 10 weeks of gestation.
During the pandemic, the requirement that this medication be given directly to patients by physicians was eliminated, so some telemedicine companies provide medication abortions without in-person appointments or examinations.
Surgical or medication abortions are prohibited in 14 states since the Dobbs decision. This Supreme Court decision does not change this prohibition. This decision maintains the current status quo, so there is no employer action on health plan design or administration required based on this decision.