According to a recent report, the costs associated with cancer care in the United States are predicted to reach at least $157.77 billion by 2020 and may be much higher based on elderly population growth, higher rates of survival, and escalating chemotherapy and cancer treatment costs. The projection represents a 27% increase compared with cancer care costs in 2010, but it assumes stable incidence and survival rates and costs between 2010 and 2020 and only reflects population growth projections.

Acute kidney injury (AKI) is a common occurrence among hospitalized patients, with incidence increasing from 10 to 25 per 1000 discharges over the past 15 years. AKI is defined as an abrupt decline in renal function, indicated either by increased serum creatinine (CR) level (>0.3 mg/dL or 50% above baseline) or decreased urine production (<0.5 mL/kg/h over 6 hours). AKI is significantly associated with increased mortality.

Patients with untreated aortic stenosis have a high mortality rate (50% in the first 2 years after emergence of symptoms). Survival rates are improved in patients who undergo surgical replacement of the aortic valve. However, 30% of patients with severe symptomatic aortic stenosis are at high surgical risk due to advanced age, left ventricular dysfunction, or multiple coexisting conditions. For those patients, a less invasive procedure may offer a viable alternative.

The recommended treatment goal for patients with diabetes is hemoglobin (Hb) A1C <7%. For patients with type 1 diabetes, the standard treatment is insulin, whereas patients diagnosed with type 2 diabetes follow a stepwise treatment regimen to reach that goal. Current guidelines call for initial treatment with lifestyle modification plus metformin. Other oral medications are added as necessary to achieve HbA1C <7%.

The most recent economic recession (2007-2009) saw an increase of 5 million Americans in the population of those without employment-based health insurance. The decrease in the number of adults with employer-sponsored insurance was offset in part by expansions of existing Medicaid programs; for children, the declines were wholly offset by expansions in Medicaid and the Children’s Health Insurance Program (CHIP). In fact, while the number of adults who were uninsured increased over the period, the number of children who were uninsured declined.

Stroke, with direct and indirect costs totaling $68.9 billion, is a major primary health priority in the United States. Every 40 seconds, someone in the United States experiences a stroke, and every 3 to 4 minutes, someone dies of a stroke.

Administering intravenous (IV) recombinant tissue plasminogen activator (tPA) within 3 hours of onset of symptoms is associated with a 30% greater likelihood of decreased disability compared with placebo. In selected patients, IV recombinant tPA may be safely used up to 4.5 hours after symptom onset.

In the 1990s, the reimbursement for gonadotropin-releasing hormone (GnRH) agonists was 95% of the average wholesale price; a Government Accountability Office report found that physicians were able to acquire GnRH agonists at <82% of the average wholesale price. Based on the profitability of use of the GnRH agonists for androgen deprivation therapy (ADT), the overall use of ADT doubled; by 1999, nearly 50% of all patients with prostate cancer were being treated with ADT within 1 year of diagnosis. In 2003, payments from Medicare Part B for GnRH agonists totaled approximately $1 billion.

A new randomized trial studying the effects of stents in large coronary arteries found that there were no significant differences in rates of death or myocardial infarction for patients who received sirolimus-eluting, everolimus-eluting, or bare-metal stents. The findings from the study were recently published online in the New England Journal of Medicine [2010;10.1056/NEJMoa/1009406].

According to researchers, the use of opioids has increased 50% to 100% in recent years, despite conflicting recommendations from agencies such as the World Health Organization (WHO) and the US Food and Drug Administration (FDA). The WHO has suggested that too little attention was being given to treating pain, citing restrictions of prescribing opioids for nonmalignant pain, while the FDA has issued warnings about the dangers of opioids and has required manufacturers to document safety of the drugs through new Risk Evaluation and Mitigation Strategies.

Collaboration between surgeons and internists (generally hospitalists) in the form of comanagement of nonsurgical aspects of inpatient perioperative hospital care has become increasingly common, according to researchers. There have been few studies on the effect of comanagement on costs and outcomes; those that have been done have focused on patients undergoing orthopedic surgical procedures. Results have suggested a modest reduction in postsurgical complications of joint replacement surgery, but few other beneficial effects on outcomes.

More than half of pediatric hospital admissions are associated with chronic conditions,
and the increasing prevalence of complex chronic pediatric disorders has, according to researchers, increased the need for tools and systems to facilitate management of information and support clinical decision-making.

Sixty-five million people in the United States have hypertension, putting them at increased risk for stroke, myocardial infarction, and heart failure. Among patients with hypertension, blood pressure (BP) control is below national targets. Researchers have hypothesized that the lack of effective BP control is due to barriers such as access to care and clinical inertia, rather than to a lack of effective antihypertensive medications.

Anaheim—A pooled analysis of 2 phase 3, double-blind, multinational, randomized controlled studies involving patients with community-acquired pneumonia (CAP) found that those taking ceftaroline fosamil spent less time in hospitals compared with those taking ceftriaxone. However, the results, presented during a poster session at the ASHP meeting, were not statistically significant.

Anaheim—A study found that heparin protocols involving higher target partial thromboplastin time (PTT) ranges, shorter recheck intervals, and higher PTT hold criteria may be effective in improving the safety and efficacy of ultrafiltration and decreasing hospital costs. The results were presented at the ASHP meeting during a poster presentation titled Adjustment of a Standardized Pharmacy Heparin Dosing Protocol for Use in Acute Heart Failure Patients Receiving Ultrafiltration.

Anaheim—Although there are a few targeted therapies available to treat patients with triple-negative breast cancer (TNBC), they are not effective. However, researchers are working on new therapies that can be used alone or in combination with chemotherapy. Several experts provided an overview of TNBC and discussed past, current, and future trends associated with the disease during a symposium at the ASHP meeting titled Understanding Triple-Negative Breast Cancer and Emerging Targeted Therapies.

Atlanta—Ongoing treatment with rilonacept reduced gout flares during urate-lowering therapy, according to a phase 3 study reported at the ACR meeting.

Lead author Robert Terkeltaub, MD, Veterans Affairs Medical Center in San Diego, California, said that these results are similar to results of a phase 2 study of rilonacept. “The results of the study suggest that rilonacept is a new way of preventing gout flares in people starting urate-lowering therapy,” he said.

Atlanta—A combination tablet of ibuprofen plus high-dose famotidine (a gastroprotectant) dubbed HZT-501 reduces gastrointestinal (GI) ulcers overall in chronic nonsteroidal antiinflammatory drug (NSAID) users as well as in a subset of NSAID users also taking low-dose aspirin, compared with ibuprofen alone, according to pooled results of 2, 24-week, doubleblind, controlled trials reported at the ACR meeting.

Atlanta—A pooled analysis of a phase 3, multicenter, randomized, placebo-controlled study found that patients taking low- and high-dose colchicine were not significantly more likely to have adverse events (AEs) compared with a placebo group. The results were presented at the ACR meeting in a poster session titled Chronologic Age, Renal Function, and Comorbid Conditions (Physiologic Age) of Patients with Gout Did Not Increase Likelihood of Adverse Events (AEs): AGREE Study Post Hoc Analyses.