Study shows costeffectiveness of financial incentive program to control cholesterol

first_img Source:https://www.hsph.harvard.edu/news/press-releases/increasing-cholesterol-medication-adherence-with-financial-incentives-may-be-cost-effective/ Reviewed by Kate Anderton, B.Sc. (Editor)Sep 14 2018A program that offered financial incentives to both patients and their physicians to control low-density lipoproteins (LDL) cholesterol could be a cost-effective intervention for patients at high risk of cardiovascular disease (CVD), according to new research led by Harvard T.H. Chan School of Public Health.The study showed that the shared incentive program provided reasonable value even when accounting for additional costs, such as electronic pill bottles to monitor drug adherence, more frequent cholesterol measurements, administrative expenses, and the actual cash incentive, which maxed out at $1,024 per year, split between the doctor and patient.”Financial incentive interventions are only effective sometimes. When these programs show health benefits, the next question should be whether the health gains are worth the added costs, which is what we modeled in this study,” said lead author Ankur Pandya, assistant professor of health decision science.The study will be published on September 14, 2018 in JAMA Network Open.CVD is the leading cause of death and health care costs in the U.S. The use of cholesterol-lowering drugs known as statins, which are cheap in their generic form, are proven to help prevent CVD. Yet long-term adherence to these medications is below 50%. One proposed strategy to improve adherence rates and lower LDL cholesterol–often referred to as “bad” cholesterol– is offering financial incentives, but it’s unclear if such programs are worth the costs.To determine the cost-effectiveness of financial incentives, the Harvard Chan researchers, along with colleagues from Brigham and Women’s Hospital and the Perelman School of Medicine at the University of Pennsylvania, developed a model-based analysis that simulated CVD progression.They applied this analysis to data from a 2015 clinical trial involving statins in which patients were randomized to one of four groups: no financial incentives; financial incentives for only the patient; financial incentives for only the doctor; or a financial incentive shared between the patient and doctor. That study showed the shared incentive group was superior at reducing LDL cholesterol, but it did not examine whether the health gains represented good value given the added costs. The 2015 study was also limited in that it only followed up with patients three months after the study ended.Related StoriesRed meat and white meat have equal effects on blood cholesterol levelsDietary cholesterol or egg consumption not linked with elevated risk of strokeStudy: Only half of U.S. children and adolescents have ideal cholesterol levelsThe CVD model, developed by corresponding and senior author Thomas Gaziano, was used by Chan School researchers to simulate lifetime CVD progression among a cohort of 1 million patients that mirrored the 2015 study population. Results showed that the shared incentives program had an incremental cost-effectiveness ratio (ICER) of $60,000 per quality-adjusted life year (QALY), a metric that reflects how much money is required to produce one year of high-quality life with a particular intervention. Under current standards, ICERs between $50,000 and $150,000 per QALY represent “intermediate value.” The researchers said the findings demonstrated that the shared financial incentives program provided reasonable value for the health gains it produced compared with programs that offered financial incentives to only the patient or only the doctor or offered no financial incentive at all.Importantly, the researchers found that the cost-effectiveness of the shared incentives intervention hinged on how long the LDL benefits persisted. They concluded that a large-scale study of the shared incentives strategy with at least five years of follow-up is warranted by the Centers for Medicare and Medicaid Services or private health care payers to test this strategy in a real-world setting.”Combining financial incentives for providers and patients with advanced technologies to monitor compliance, including electronic pill bottles, has the potential to improve patient care while remaining cost-effective, and this strategy should be further evaluated,” said Gaziano, assistant professor in the department of health policy and management at Harvard Chan School and director of the global cardiovascular health policy and prevention unit at Brigham and Women’s Hospital.last_img read more

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French presidents climate talent search nabs 18 foreign scientists

first_img By Elisabeth PainDec. 11, 2017 , 2:00 PM Click to view the privacy policy. Required fields are indicated by an asterisk (*) *Update, 12 December, 3:33 p.m.: This story has been updated to include comments from scientists who won the grants, and from French scientists who are not involved in the initiative. 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MERGUI/Flickr Sign up for our daily newsletter Get more great content like this delivered right to you! Country Emmanuel Macron center_img French President Emmanuel Macron’s effort to lure disgruntled foreign climate scientists to France—especially from the United States—has produced its first harvest. France today announced that Macron’s Make Our Planet Great Again initiative has recruited its first class of 18 scientists. Of the new recruits, 13, including a few French nationals, now work in the United States, whereas others are based in Canada, India, and elsewhere in Europe.One recruit is Louis Derry, a U.S. citizen who studies Earth’s critical zone—its life-supporting skin—at Cornell University. When he first heard about Macron’s move to attract about 50 high-level foreign climate scientists for France, he thought it had to be another swipe at U.S. President Donald Trump by the satirical newspaper Le Canard enchaîné. But it was real. In June, just a few hours after Trump announced the withdrawal of the United States from the Paris climate accord, Macron cheekily invited disgruntled U.S. scientists to relocate to France. A week later, the French government unveiled a website that soon spelled out the details: It was offering 3- to 5-year grants, worth up to €1.5 million each.Derry, who says he liked both the scientific opportunity and the collateral benefits, was one of more than 1800 scientists to express initial interest in applying. “I think it’s hard to find too many downsides to living in Paris for a little while,” he says. Venkatramani Balaji, Moving from Princeton University to the Laboratory of Climate and Environmental Sciences in Saclay. Frédéric Bouchard, Moving from the University of Montreal in Canada to the Geosciences Paris-Sud Laboratory in Saclay. Julien Boucharel, Moving from the University of Hawaii in Honolulu to the Space Geophysics and Oceanography Studies Laboratory in Toulouse. Virginie Guemas, Moving from Barcelona Supercomputing Center in Spain to the National Centre for Meteorological Research in Toulouse. Nuria Teixido, Moving from Stanford University in Palo Alto, California, to the Villefranche Oceanographic Laboratory. Louis Derry, Moving from Cornell University to the Paris Institute of Physics of the Globe. Barbara Ervens, Moving from the National Oceanic and Atmospheric Administration in Boulder, Colorado, to the Institute of Chemistry of Clermont Ferrand. Joost de Gouw, Moving from the University of Colorado in Boulder to the Institute of research on catalysis and the environment of Lyon. Delphine Renard, Moving from the University of California, Santa Barbara, to the Centre of Functional and Evolutionary Biology in Montpellier. Alessandra Giannini, Moving from Columbia University to the Laboratory of Dynamic Meteorology in Paris. Thomas Lauvaux, Moving from Pennsylvania State University in State College to the Laboratory of Climate and Environmental Sciences in Saclay. Vincent Vadez, Moving from the Consultative Group on International Agricultural Research in New Delhi to the Plant Biodiversity and Adaptation Research Group in Montpellier. Christopher Cantrell, Moving from the University Colorado in Boulder to the Interuniversity Laboratory of Atmospheric Systems in Créteil. Camille Parmesan, Moving from the University of Plymouth in the United Kingdom to the Station for Theoretical and Experimental Ecology in Moulis. Benjamin Sanderson, Moving from the National Center for Atmospheric Research in Boulder, Colorado, to the Climate, Environment, Couplings and Uncertainties Laboratory in Toulouse. Philip Schulz, Moving from the National Renewable Energy Laboratory in Golden, Colorado, to the Research and Development Institute for Photovoltaic Energy in Paris. Lorie Hamelin, Moving from the Institute of Soil Science and Plant Cultivation in Pulawy, Poland, to the Biological Systems and Processes Engineering Laboratory in Toulouse. Giuliano Giambastiani, Moving from the Italian National Resource Council in Rome to the Institute of Chemistry and Processes for Energy, Environment and Health in Strasbourg. Ultimately, 450 researchers were deemed eligible to apply for the grants, and 255 submitted applications. Ninety were then invited to submit proposals in collaboration with a French institution. The French National Research Agency ultimately received 57 proposals, which were reviewed by a nine-member international panel chaired by Corinne Le Quéré, director of the Tyndall Centre for Climate Change Research in Norwich, U.K. The proposals were “high quality and in cutting-edge fields,” Le Quéré says.Macron and French research minister Frédérique Vidal announced the 18 initial grants at a Paris event held on the eve of the One Climate Summit, which aims to harness global financial backing for climate action on the 2-year anniversary of the Paris climate accord.The initiative has divided French scientists. Many praise Macron’s vision; although 18 new scientists won’t create “a revolution,” says paleoclimatologist Frédéric Parrenin at the Institute for Geosciences of the Environment in Grenoble, France, “this program is highly symbolic: France now takes a leading role in the world to push forward climate policies.” But it’s not clear whether the cost, at least €28.5 million, will come out of existing budgets, and the newcomers will have “a very peculiar status,” working outside the classical research system at a much higher salary than their colleagues, says Didier Swingedouw, a climate dynamics physicist at the Oceanic and Continental Environments and Paleoenvironments Laboratory in Pessac, France. “I could easily imagine that this will create some sources of tension.”In a public statement, SNCS-FSU, a trade union for researchers based near Paris, criticized the initiative as “a pure communication stunt that doesn’t bring any additional support for French research.” SNCS-FSU also called the benefits given to scientists from abroad “an insult to French scientists … whose commitment is not correctly rewarded in their own country.” Part of the French scientific community has long called for more funding for institutions and more permanent positions for young researchers, who often see themselves forced out of academia after 6 years of postdoc because of French employment laws.Meet the winnersDerry, who has lived in France before, will make the planet great again part-time: The program allows him to work at the Paris Institute of Physics of the Globe while keeping his tenured position at Cornell. “I anticipate spending about half my year on each side of the Atlantic,” he says. “I hope to serve as a bit of a bridge between the U.S. and French critical zone programs and communities.”Another winner, Camille Parmesan, who is originally from Texas and now a professor at the University of Plymouth in the United Kingdom, says that, at first, “none of us [knew] what to make of” Macron’s initiative. But she decided it was “absolutely fabulous, and a very appropriate response to Trump pulling out of the Paris accords.” Parmesan, who studies how global warming might affect species and ecosystems, was also feeling stymied by what she sees as declining funding opportunities in the United States and United Kingdom. Now, she will join a center for theoretical and experimental ecology in Moulis, France, where, starting next fall, her work will include studying how animal movements caused by climate change might bring diseases into Europe.The €1.5 million grant is “the opportunity I’ve been waiting for,” says Parmesan, noting that France also offers “some really unique facilities and infrastructure” that could aid her work.Italian climate scientist Alessandra Giannini, has been based at the International Research Institute for Climate and Society, affiliated with Columbia University’s Earth Institute in Palisades, New York, since 2003. She’s looking forward to the “opportunity to really focus on the research,” rather than scrambling for funds, she says. Giannini will be joining two meteorology and oceanographic laboratories in Paris, where she will investigate the physical processes underlying uncertainty in climate change projections in the tropics. But she doesn’t see her move “as a drastic change, because nowadays our scientific community is global, [and] we work on similar topics.”  Spanish marine biologist Núria Teixidó, who holds a position at Stazione Zoologica Anton Dohrn in Naples, Italy, and is currently a visiting scientist at Stanford University’s Hopkins Marine Station in Pacific Grove, California, says her new grant will give her the means to hire help and develop scientific independence. By joining the Ocean Observatory of Villefranche-sur-Mer in France, Teixidó says she will also be able to expand her research on the effect of ocean acidification on marine ecosystems to include possible mitigation measures.For some winners, accepting Macron’s invitation comes with risks. Some will leave tenured positions, and for many, the details of their 5-year positions still need to be worked out.There also are some risks for France, Le Quéré says. “If France invests in new instruments and new areas of research and then the people leave … you lose all this investment.” But “if [the winners] remain in France,” she says, funders may face the question of how to maintain support for a growing field.Together with Germany, which joined the initiative in September with a commitment of €15 million, France will conduct a second round of proposal evaluations next spring. “It’s very clear that France is going to address climate change,” Le Quéré says. “Not just in terms of research, but in terms of action.”Here is the list of the 18 winners:  French president’s climate talent search nabs 18 foreign scientists Emaillast_img read more

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