Canadian researchers say there could be as many as 267,329 new cases of prostate cancer diagnosed each year by 2021. That would be 10 times as many as in 2009 (25,355 cases).

Researchers in the department of radiation oncology at the Sunnybrook Health Sciences Center at the University of Toronto calculated prostate cancer cases using best-, most likely-, and worst-case scenarios.

“The trends we’re anticipating in Canada are going to be very similar to the United States,” says Andrew Loblaw, MD, lead author. He’s a staff radiation oncologist and clinician scientist at the center.

“For clinical executives, this would mean about 650,000 men diagnosed in the United States. So there’s going to be the need for increased capacity to diagnose these men. You’re going to need better quality in active surveillance. You’re going to have to increase your treatment capacity — both surgery and radiation. And lastly, it’s about cost. Both countries are struggling to effectively manage those health care dollars,” he says.

The four factors likely to affect the incidence of prostate cancer are an increase in the aging population, increased prevalence of PSA screening, lowered PSA cutoff to recommend biopsy, and improved sensitivity to prostate biopsy. Of the four factors, the aging population and the possible lowering of the PSA threshold before biopsy are expected to be the major influencers in new cases.

The U.S. Centers for Disease Control and Prevention makes no such predictions. Jun Li, MD, PhD, MPH, an epidemiologist at the CDC, says the latest data available for prostate cancer incidence are from 2006. The agency reports that the incidence of prostate cancer has decreased significantly, by 2.4 percent per year from 2000 to 2006.

With better screening, physicians are better equipped at finding prostate cancer earlier, and plotting an effective treatment plan. Loblaw points out that the “men who died this year from prostate cancer were diagnosed 17 years ago. And those men who are diagnosed today are going to have markedly different treatments, so these men will have different mortality rates 17 years from now.”

Three prostate cancer scenarios played out — Canada / Common cancers in men

Source: Quon H, Loblaw A, Nam R. Dramatic increase in prostate cancer cases by 2021. BJUI. Apr 20. doi: 10.1111/j.1464-410X.2011.10197.x. [Epub ahead of print]

Source: Centers for Disease Control and Prevention. United States Cancer Statistics. 2007

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.