Study finds similar quality and cost of care for patients treated by an allopathic (M.D.) or osteopathic (D.O.) physician

1. Study finds similar quality and cost of care for patients treated by an allopathic (M.D.) or osteopathic (D.O.) physician
Abstract: https://www.acpjournals.org/doi/10.7326/M22-3723
Editorial: https://www.acpjournals.org/doi/10.7326/M23-1165
URL goes live when the embargo lifts
An observational study of more than 329,000 Medicare admissions found that older persons receiving hospital care from an allopathic (M.D.) or an osteopathic (D.O.) physician experience similar quality and cost of care. The findings are published in Annals of Internal Medicine.

Medical education in the United States falls under two types of programs—allopathic medical schools that award a Doctor of Medicine, or M.D. degree, and osteopathic schools that award a Doctor of Osteopathic Medicine, or D.O. degree. Approximately 90 and 10 percent of practicing physicians in the United States have M.D. and D.O. degrees, respectively. Education requirements between programs are very similar, but osteopathic programs focus on holistic care and physical manipulation of the body. Osteopathic physicians are also more likely to more likely to practice in rural and underserved areas and pursue careers in primary care compared with allopathic physicians, contributing to narrowing the gaps in disparities in access to health care in the United States.

Researchers from the David Geffen School of Medicine at UCLA and the University of Tokyo studied 329,510 Medicare admissions between 2016 and 2019 to determine whether quality and costs of care differ between hospitalized patients treated by allopathic or osteopathic physicians. Of these admissions, 253,670 (77.0%) and 75,840 (23.0%) received care from allopathic and osteopathic physicians, respectively. The data showed no clinically important differences in mortality, readmission, length of stay, and healthcare spending between the two groups. The findings were consistent across a range of medical conditions and across severity of patient’s illness, suggesting that any differences between allopathic and osteopathic medical schools, either in training or the types of students who enroll, are not associated with differences in costs or quality of care in the inpatient setting. According to the authors, these findings should be reassuring for policymakers, medical educators, and patients.

An accompanying editorial from authors at University of California San Francisco and Eastern Virginia Medical School highlights the similarities between allopathic and osteopathic practices because of workplace and educational standardization. However, the authors also highlight that despite these similarities, the medical field has been reluctant to accept osteopathic medical students into their preferred specialties, causing increasingly pronounced disparities in competitive programs.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Atsushi Miyawaki, M.D., PhD, please email amiyawaki@m.u-tokyo.ac.jp.
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2. Treatment cost analysis highlights systemic health inequities faced by persons with sickle cell disease
While not cost-effective by conventional measures, gene therapy may be an equitable therapeutic strategy
Abstract: https://www.acpjournals.org/doi/10.7326/M22-3272
Editorial: https://www.acpjournals.org/doi/10.7326/M23-1145
URL goes live when the embargo lifts
A new distributional cost-effectiveness analysis of gene therapy versus standard-of-care for sickle cell disease (SCD) found that while gene therapy is cost-ineffective by conventional measures, it can be an equitable therapeutic strategy for persons living with SCD in the United States when equity, cost, and value of treatment are considered together. These findings highlight systemic health inequities faced by persons with sickle cell disease (SCD). The authors say this is the first quantitative consideration of health equity for patients with SCD regarding the decision between gene therapy and standard care and the first study of its kind in any rare disease. The analysis is published in Annals of Internal Medicine.

Persons with SCD face substantial mortality risks and decreased quality of life for every year they live with the disease. SCD occurs more often in people whose ancestors came from sub-Saharan Africa and other parts of the world where malaria is or was common. In the United States, this means that patients are predominantly drawn from socially disadvantaged ethnic minority populations. Gene therapy treatment would allow for lifelong disease remission without the concomitant risks associated with allo-transplantation, but it is prohibitively expensive.

Researchers from Yale University School of Medicine studied claims data and other published sources to compare gene therapy versus standard-of-care in patients with SCD by using conventional cost-effectiveness and distributional cost-effectiveness measures. While conventional cost-effectiveness analysis does not capture the effects of treatments on disparities, distributional cost-effectiveness uses equity weights to incorporate these considerations. The authors found that the total quality-adjusted life years, or QALYs, for persons receiving gene therapy treatment for SCD would cost $2.8 million versus $1.2 million for persons receiving standard care. According to the authors, the inequality aversion parameter would need to be 0.90 for the full SCD population for gene therapy to be preferred per distributional cost-effectiveness standards. This is right in line with benchmark values previously reported in the United States for inequality aversion (range: 0.5-3.0), with higher values representing a higher emphasis on reducing a particular health disparity.

An accompanying editorial from the Centre for Health Economics, University of York; York, United Kingdom highlights that the results of this analysis do not provide a simple answer to how much U.S. healthcare payers should be willing to pay for increasing health equity, but it does provide quantitative information that can help facilitate transparent and consistent decision making. The author argues that to help reduce health disparities, health care payers need to invest more in equity-enhancing technologies for conditions that disproportionately affect socially disadvantaged populations and are often underdiagnosed and poorly managed in such populations.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author George Goshua, MD, MSc, please contact Julie Parry at julie.parry@yale.edu.
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3. Low dose colchicine associated with lower incidence of total knee and hip replacements
Abstract: https://www.acpjournals.org/doi/10.7326/M23-0289
URL goes live when the embargo lifts
An exploratory analysis of the LoDoCo2 (Low-Dose Colchicine 2) randomized, controlled, double-blind trial found that daily therapy with a low dose of colchicine was associated with lower incidences of both total knee replacement and total hip replacement surgeries. The analysis is published in Annals of Internal Medicine.

Osteoarthritis is an increasingly common joint disease that can be associated with low-grade inflammation in response to weight-bearing traumatic injury. Previous studies have demonstrated an association between the use of anti-inflammatory therapies and the slowing of osteoarthritis disease progression. Colchicine is effective in many inflammatory and fibrotic conditions, but it is not currently recommended for treatment of osteoarthritis. Its long-term effects have also not been assessed.

Researchers from Sint Maartenskliniek and Radboud University Medical Center, Nijmegen, the Netherlands conducted an exploratory analysis of the LoDoCo2 trial to examine whether colchicine, 0.5 mg daily, reduced incident total knee replacements and total hip replacements. In the study, 5,522 participants aged 35 to 82 at 43 centers in Australia and the Netherlands, received 0.5 mg of colchicine daily or matching placebo during a median follow-up of 28.6 months. The authors found that 2.5 percent of persons receiving colchicine had total knee replacement or total hip replacement compared with 3.5 percent of persons who received placebo. The effects were consistent for men, but there was insufficient statistical power to determine whether these benefits may have extended to women as well. According to the authors, the exploratory observations support the hypothesis that inflammation plays a role in the progression of osteoarthritis. They also note that colchicine has been widely used in many patients with other diseases and is generally considered to have a favorable safety profile, which makes it a good candidate for treatment of osteoarthritis over longer periods.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Michelle W.J. Heijman, MSc, please email M.Heijman@maartenskliniek.nl.
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