AHDB 欢迎有关临床、政策和业务相关主题的文章，这些主题与医疗保健中的力量整合有关，这些力量会影响医疗保健服务的成本和质量，提高医疗保健质量，并最终导致获得医疗服务，重点关注卫生组织结构和过程、健康信息、健康政策、健康和行为经济学，以及与基于价值的护理质量相关的健康技术、产品和患者行为。

The American Health and Drug Benefits journal welcomes articles on clinical, policy, and business topics related to the integration of forces in healthcare. These topics impact the cost and quality of healthcare services, aiming to enhance the quality of care and ultimately improve patient access to services. The journal focuses on the structure and processes of health organizations, health information, health policy, health and behavioral economics, as well as health technologies, products, and patient behaviors related to value-based care quality.

《American Health and Drug Benefits》欢迎关于与医疗保健中力量整合相关的临床、政策和业务主题的文章。这些主题影响医疗服务的成本和质量，旨在提高医疗保健质量，并最终改善患者获得医疗服务的体验。期刊重点关注卫生组织的结构与过程、健康信息、健康政策、健康与行为经济学，以及与基于价值的护理质量相关的健康技术、产品和患者行为。

American Health and Drug Benefits

Researchers have made great strides in unlocking the biology of cancer, especially on the molecular and immunologic levels, and this is rapidly being translated into new therapies. With more than 900 oncology compounds currently in development,1 advancements in molecular sequencing, and new diagnostic modalities, cancer care has become a major focus for investment and research, and with it come challenges and opportunities.

New therapies and novel diagnostics for cancer are coming to the market at a greater rate than for other clinical categories, and this trend is reflected in increased rates of survival and lower cancer-related US mortality since the 1990s.2 Cancer care is changing, as evident in new payer–provider collaboration efforts and new approaches to cancer drug management that are described by James T. Kenney, Jr, RPh, MBA, and by Michael Kolodziej, MD, FACP, in their editorials in this theme issue of American Health & Drug Benefits.

However, such rapid development and growth come with a high price tag, raising the question of how to pay for these expensive therapies. Indeed, cost in oncology has become a top concern not only for patients, but also for oncologists and, increasingly, for payers. Recent estimates put the cost of cancer care at $100 billion annually, and this is projected to rise to $200 billion by 2020.3 The growing cost of treating cancer has contributed to a heightened focus on evidence-based treatment and pathways to ensure appropriate use of therapies, minimize waste, and control costs. Thus enters “value” into the conversation at all oncology settings.

A unique attempt at defining value in oncology is presented in this issue in the report from the Steering Committee of the Third Annual Conference of the Association for Value-Based Cancer Care, which was held on May 2–5, 2013, and addressed “value” from the point of view of different stakeholders in oncology. The need for change in oncology reimbursement is a repeated theme in this discussion and has recently been echoed in the medical literature.4

Erin Zagadailov, PharmD, MS, and colleagues make an important contribution to the literature by highlighting the growing importance of patient-reported outcomes (PROs) in oncology drug management. The authors review cancer drugs that were approved with PRO information as a significant measure that may need to be taken into account by payer decisions. This important article brings to the fore the challenges and the opportunities of incorporating oncology-related PRO data into payer decision-making.

Rhonda Greenapple, MSPH, focuses on the introduction of new care delivery models in oncology and emerging payment models, based on results of a new payer survey. Anticipating a rapid expansion of innovative approaches to cancer management over the next 2 years, health plans are supporting new delivery models, such as pathways and palliative care, as well as new payment models, focusing on pay for performance as a cost-effective way to enhance outcomes.

Finally, Michael M. Wong, MD, PhD, and colleagues evaluate the increase in the economic burden of metastatic renal cell carcinoma (mRCC), looking for the most cost-effective way to control the cost of this tumor type and to guide treatment and policy decisions. Their analysis shows that targeted therapies are cost-effective in the setting of refractory mRCC, and that oral therapies have an economic advantage over intravenous agents. However, comparative effectiveness research is lacking and is sorely needed in this area.

Oncology continues to be an area with unique opportunities for reducing waste, cost-savings, and improving quality of care and outcomes. This theme issue provides a sample of key topics facing patients with cancer, oncologists, payers, and other stakeholders in the care continuum. The challenges are many, and yet they also present many opportunities for innovation and change.

Dalia Buffery

American health & drug benefits

Progress in Cancer Care: Challenges and Opportunities.

癌症护理进展：挑战与机遇。

The outlook for cardiometabolic health remains suboptimal in 2013, despite considerable awareness of the health consequences and the associated costs of cardiometabolic risk factors, including cardiovascular disease, diabetes, dyslipidemia, hypertension, and obesity. There is not much that has not been said about these top killers of Americans. Yet despite all the research and the published literature, new treatments, and well-documented high morbidity and mortality associated with heart disease, type 2 diabetes, and obesity, the incidence of each of these conditions continues to climb.

As an example, in 2011, 16.3 million Americans had chronic heart disease, 76.4 million had hypertension, 5.7 million had heart failure, and 7 million had a stroke—all directly increasing the mortality risk from heart disease.1 In 2007, approximately 25.8 million Americans had diabetes, and many millions more had prediabetes.2 Unless new approaches to diabetes therapy become available in the coming years, it is projected that approximately 21% of the American population will have type 2 diabetes by 2050.3

Heart disease remains the leading killer of Americans,4 and even with the many antihyperglycemic drug classes, less than 50% of patients with diabetes reach the American Diabetes Association's glycemic goal of hemoglobin A1c <7%.5 Why has the transition from epidemiologic research and well-conducted clinical trials into standards of care apparently been so ineffective? Are the therapeutic options inadequately perceived in terms of efficacy, safety, cost or convenience, even in the presence of data that would suggest otherwise? As with so many other facets of medicine, potential contributors are diverse, and remediation requires a concerted effort on the part of many stakeholders to isolate, and then address each of the mediating variables.

For example, considering the serious health implications of obesity, it is surprising that it took until 2013 for the American Medical Association to classify it as a disease,6 possibly because obesity was mainly assumed to be the result of lifestyle or behavior. It may take yet another generation of personalized medicine research to fully identify biologically based risk factors for development of obesity and cardiometabolic complications, beyond those which already can be deduced in diabetes, and as has already begun in heart disease. As in so many other conditions, it may be the interaction of genetic, sociodemographic, and other characteristics that yielded the highest specificity and sensitivity in this regard.

A number of recent developments are noteworthy in their ability to disentangle these issues. Hulsmans and Holvoet recently noted that not all obese patients are at the same risk of developing cardiometabolic complications.7 Therefore, they say, “there is an urgent need for novel biomarkers for early identification of obese patients at high risk. Possible candidate biomarkers are microRNAs, which are highly conserved non-coding RNA molecules of approximately 22 nucleotides that exert post-transcriptional effects on gene expression.”7 This is a promising start that will enable more effective targeting of subgroups of obese patients with efficient risk-mitigation strategies.

Obviously, the costs associated with the management of illnesses linked to the presence of cardiometabolic risk factors continue to rise in tandem. In 2007, the estimated total US cost for diabetes was $174 billion.2 In 2010, the direct cost for cardiovascular disease was $272.5 billion, which is expected to reach $818.1 billion by 2030.8 Similarly, the total cost related to obesity is projected to reach $861 billion to $957 billion by 2030.9 These numbers alone are sufficient to drive home the link between clinical and economic priorities.

The articles in this theme issue of American Health & Drug Benefits provide significant contributions to the literature and highlight for all healthcare stakeholders the importance of focusing on cardiometabolic risk factors.

Spinler and colleagues have conducted the first non–claims-based analysis of data from the national cardiovascular registry PINNACLE, to identify Medicare beneficiaries with multiple chronic cardiovascular conditions who are eligible for medication therapy management (MTM), a modality that has been shown to improve outcomes and reduce costs in patients with chronic diseases. The authors point out that many eligible patients are not participating in MTM programs, in large part because of a lack of knowledge of these programs’ benefits. These data therefore not only support tailored therapy for Medicare beneficiaries at risk, but also imply the need for an effective communication program within the subpopulation, a theme that is apparent in other articles in this issue. Spinler and colleagues charge providers to explain to patients the benefits of MTM programs and encourage their participation. They call on providers to educate patients on why enrolling in such programs can help to improve their health outcomes and reduce overall costs. Tzeel aptly notes in his perspective, “as the authors so eloquently state, ‘we believe that promoting the utilization of such programs to eligible patients should be the responsibility of all healthcare providers within the framework of care advocated by the ACC within the framework of the patient-centered medical home for CV care.’”

Also in this issue, Banerji and Dunn elucidate the increasing prevalence of diabetes and the staggering economic implications, focusing their analysis of the literature on a lack of medication adherence among patients with type 2 diabetes as one of the principal culprits for the dire state of this disease. Banerji and Dunn call for innovation in drug therapies that will focus on patient convenience and ease of use to enhance adherence, suggesting that these are crucial to improving outcomes and reducing the morbidity and mortality rates far beyond the trends seen with currently available medications. Their article serves to emphasize that issues of cost and convenience are as important as efficacy and safety in promoting adherence. They provide some hope in their review of new treatment approaches in the current pipeline that may offer new solutions to lagging adherence as well. As Bourret observes, “Banerji and Dunn aptly make the case for a call to action for aggressive change and innovation in the management of patients with type 2 diabetes and the development of new pharmaceuticals that reduce cardiovascular risk, result in less weight gain, and improve adherence and health outcomes.” The status quo, they suggest, is no longer acceptable.

And in a one-of-its-kind presentation, Hawkins-Taylor and Carlson resurrect the events surrounding the case of BiDil, noting the need to consider sociocultural parameters, including race and ethnicity, in drug development. The US Food and Drug Administration (FDA) approval of this first and only drug specifically indicated for a racial group resulted in a controversy that, the authors show, has implications for the future development of targeted therapies, especially in the age of personalized medicine. In 2005, when BiDil was approved for the treatment of heart failure in African Americans, the potential impediments associated with introducing combination therapy as a unique treatment in a self-identified patient subgroup was not fully appreciated by different stakeholders, although it was mentioned in the FDA's approval.

As Murphy notes, “In a literature replete with references to personalized medicine tailored to variations in genetics and disease-related phenotypes, the case study presented by Hawkins-Taylor and Carlson … emphasizes the importance of incorporating sociodemographic variables into this definition.” With all the focus on race, the authors emphasize, lost was the main clinical message— the need to manage heart failure with a combination of vasodilator therapies in African Americans. The role of genetics and biology, extracting information from data which would resonate with a demographic minority and their providers, did not factor in within the debate about the utility of this particular therapy, but in the age of personalized medicine, resurrecting this case from its recent past has important implications for drug developers, policymakers, providers, and payers. The lesson, Murphy says, is that “failure to achieve meaningful adoption after approval, despite a methodologically rigorous pedigree, emphasizes the importance of ensuring clinical and commercial stakeholder convergence during, not after, the drug development process.”

Finally, Mahgerefteh and colleagues review the evidence for the 2 new therapies approved by the FDA in mid-2012 for the treatment of obesity, highlighting the current public crisis of obesity and the need for improved therapies. The authors focus on the potential benefits seen in clinical trials with these 2 drugs, with independent and new mechanisms of action, which, in addition to weight reduction, have also been shown to improve blood pressure, blood glucose levels, and lipid levels. As Felicetta says in his perspective, “Time, and real-world data, will tell whether these … medications are indeed able to live up to the promises they offer.”

With the aging of the US population and increasing life expectancy, the toll of heart disease, diabetes, and obesity will reach unsustainable levels that may exceed current projections. This theme issue is a call to action to patients, providers, payers, researchers, drug manufacturers, and policymakers. The challenges are many, and the needs for innovation and change are urgent.

Cardiometabolic Risk Factors: Novel Approaches Can Improve Patient Outcomes.

心血管代谢风险因素：新型方法可改善患者预后。

Joseph R. Antos

Fall Follies: The ACA Lurches into Operation.

《秋日乱象：平价医疗法案蹒跚启动》

Raymond Singer

Stakeholder Perspective: The Clinical Toll of Nonvalvular Atrial Fibrillation Poses Significant Economic Burden

利益相关者视角：非瓣膜性心房颤动的临床负担带来显著经济压力

Stakeholder Perspective: Cardiovascular Safety of Azithromycin Therapy: Revisiting the Evidence

利益相关者视角：阿奇霉素治疗的心血管安全性：重新审视证据

The article discusses innovations to ensure medication adherence amid COVID-19 in the U.S. Topics include American, health plans and pharmacy benefit managers (PBMs) are facing unprecedented challenges in ensuring their members adhere to their treatment regimens;and COVID-19 pandemic has created a number of barriers to treatment adherence.

Javier Gonzalez

A Call for Innovation: We Need to Go Off Road to Ensure Medication Adherence Amid COVID-19

呼吁创新：我们需要另辟蹊径以确保在新冠疫情期间的药物依从性

David B Nash

Am Health Drug Benefits

Thinking about 2030

思考2030年

Richard G. Stefanacci

Anindita Banerjee

Leading Population Health Efforts: The Power of Vowels.

引领人口健康工作：元音的力量。

What Is Your IQ(VIA)

你的智商(VIA)是什么

Karen Geary

Finding the Right Drug at the Right Dose the First Time: Has the Era of Personalized Formularies Finally Arrived?

首次用药即找到合适的药物和剂量：个性化处方时代是否终于到来？

Abbreviation	Am. Health. Drug. Benefits.
Journal Impact	1.23
Quartiles(Global)	HEALTH POLICY & SERVICES(Q4)

ISSN	1942-2962, 1942-2970
h-index	37

Publication Information	Publisher: Engage Healthcare Communications, Inc.，Publishing cycle: ，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 2009，Proportion of original research papers: 60.00%，Self Citation Rate:0.00%， Gold OA Rate: 0.00%

American Health and Drug Benefits

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