JAMA Health Forum最新文献

{"title":"Liaison Committee on Medical Education's Diversity Standards and Medical School Attrition.","authors":"Mytien Nguyen, Tonya L Fancher, Hyacinth R C Mason, Bassel M Shanab, Shruthi Venkataraman, Sarwat I Chaudhry, Mayur M Desai, William McDade, Dowin Boatright","doi":"10.1001/jamahealthforum.2025.0697","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.0697","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e250697"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prescription Dispensing for Insulin Glargine After Interchangeable Biosimilar Designation.","authors":"Stephen J Murphy, Nicholas C Holtkamp","doi":"10.1001/jamahealthforum.2025.0033","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.0033","url":null,"abstract":"<p><strong>Importance: </strong>The first US Food and Drug Administration-approved interchangeable biosimilar designation-that for insulin glargine-occurred in 2021, enabling pharmacy substitution for the branded originator. However, the impacts of this interchangeable designation on prescription dispensing are unknown.</p><p><strong>Objective: </strong>To assess impacts of the transition of Semglee to interchangeable designation on prescription dispensing.</p><p><strong>Design and setting: </strong>This economic evaluation analyzed changes in insulin glargine dispensing before and after the introduction of the interchangeable designation using data collected from IQVIA's National Prescription Audit, a nationally representative comprehensive database of pharmacy dispensing for the US, and PayerTrak. Data cover the time period from September 2019 through June 2024 and were analyzed from June 2023 to December 2024.</p><p><strong>Exposure: </strong>Any medical diagnosis that would make insulin glargine a relevant treatment.</p><p><strong>Main outcomes and measures: </strong>The primary outcomes were monthly US aggregate pharmacy dispensing of Semglee and insulin glargine-yfgn, measured both in prescription counts (in thousands of prescriptions) and as a proportion of the US aggregate insulin glargine market. Results were disaggregated into Semglee and insulin glargine-yfgn to show that changes in dispensing were associated with the interchangeable designation even after accounting for Semglee's formulary changes. This evaluation additionally examined dispensing channel and payer type.</p><p><strong>Results: </strong>After the introduction of interchangeable Semglee and insulin glargine-yfgn in November 2021, there was a discontinuous increase in aggregate Semglee/insulin glargine-yfgn dispensing of 47.41 (95% CI, 19.45-75.38; P = .001), suggesting that the interchangeable designation was associated with substantially increased utilization. In addition, Semglee and insulin glargine-yfgn's share of the total insulin glargine market matched its dispensing trends, demonstrating that the jump in dispensing was not associated with changes in the market as a whole. When disaggregating by channel, there were also statistically significant increases in all 3 channels: retail (20.27; 95% CI, 2.58-37.95; P = .03), mail (6.63; 95% CI, 3.58-9.67; P < .001), and long-term care (20.52; 95% CI, 11.06-29.98; P < .001). This jump, however, coincided with advantageous formulary changes for Semglee but not insulin glargine-yfgn, the increased utilization of which was still associated with the interchangeable designation. In the Medicare Part D, Medicaid, and cash channels, insulin glargine-yfgn adoption grew faster than Semglee, reaching higher levels of dispensing in every single period measured after launch.</p><p><strong>Conclusions and relevance: </strong>In this economic evaluation, the first US Food and Drug Administration approval of interchangeable status was a","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e250033"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12048848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inflation Reduction Act Provisions and Medicare Part D Out-of-Pocket Costs for Specialty Drugs.","authors":"Jalpa A Doshi, Pengxiang Li, Matthew J Klebanoff, John K Lin","doi":"10.1001/jamahealthforum.2025.1387","DOIUrl":"10.1001/jamahealthforum.2025.1387","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e251387"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12084838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Health Improvements and Economic Performance Among Individuals With Diabetes.","authors":"Jack M Chapel, Dana P Goldman, Matthew E Kahn, Bryan Tysinger","doi":"10.1001/jamahealthforum.2025.0756","DOIUrl":"10.1001/jamahealthforum.2025.0756","url":null,"abstract":"<p><strong>Importance: </strong>Advances in diabetes detection and treatment have mitigated the risks of serious complications and death, but little is known about whether economic outcomes for people with diabetes have similarly improved.</p><p><strong>Objective: </strong>To assess whether associations between diagnosed diabetes and labor market outcomes have changed over time.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study analyzed data from the National Health Interview Survey from 1998 to 2018. The sample was nationally representative of the US population aged 40 to 64 years. Average marginal effects, the regression-adjusted difference in probability of outcomes between people with and without diabetes, pooled by 3-year periods (1998-2000 to 2016-2018), were estimated with controls for demographics, education, and comorbid health risks. Behavioral Risk Factor Surveillance (BRFSS) data from 1993 to 2023 were included in robustness analyses. Data were analyzed from September 2023 to November 2024.</p><p><strong>Exposure: </strong>Diagnosed diabetes, defined based on respondents' self-report that they have ever been diagnosed by a medical professional.</p><p><strong>Main outcomes and measures: </strong>The main outcomes were labor force participation and any Supplemental Security Income or Social Security Disability Insurance income receipt. Secondary outcomes included reporting health limitations for any activities, health limitations for work, any nights in hospital, and receiving health care 10 or more times in the past year.</p><p><strong>Results: </strong>The study included 249 712 individuals, 25 177 with diabetes. The weighted population was 50% female, 12% Hispanic, 11% non-Hispanic Black, 72% non-Hispanic White, and 5% multiracial or other race (Alaska Native or American Indian, Asian, or nonspecified). In the weighted population from 1998 to 2000, 46% of people with diabetes were 55 years and older, while 27% of people without diabetes were 55 years and older. In the weighted population from 2016 to 2018, 56% of people with diabetes were 55 years and older, while 38% of people without diabetes were 55 years and older. The average marginal effect of diabetes on probability of labor force participation was -10.9 percentage points (95% CI, -13.0 to -8.9) from 1998 to 2000 and -11.0 percentage points (95% CI, -13.0 to -9.1) from 2016 to 2018; for people who received Supplemental Security Income or Social Security Disability Insurance income, it was 4.4 percentage points (95% CI, 3.3-5.5) and 4.9 percentage points (95% CI, 3.7-6.0) from 1998 to 2000 and 2016 to 2018, respectively. During the same period, average marginal effects for all examined health outcomes significantly improved. Similar patterns were observed using BRFSS data, but with a slight improvement in labor force participation between 2017 to 2019 and 2021 to 2023.</p><p><strong>Conclusions and relevance: </strong>This cross-sectional stud","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e250756"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12084845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coverage Retention and Plan Switching Following Switches From a Zero- to a Positive-Premium Plan.","authors":"Coleman Drake, Dylan Nagy, Sarah Avina, Daniel Ludwinski, David M Anderson","doi":"10.1001/jamahealthforum.2025.1424","DOIUrl":"10.1001/jamahealthforum.2025.1424","url":null,"abstract":"<p><strong>Importance: </strong>Millions of lower-income Health Insurance Marketplace enrollees were defaulted from zero-premium to positive-premium health plans in 2022, 2023, and 2024. This turnover in zero-premium plans may cause coverage losses by creating administrative burdens that complicate enrollees' ability to maintain coverage.</p><p><strong>Objective: </strong>To determine how turnover affected Marketplace reenrollment.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study used log-linear fixed-effects models including counties in 29 states that used the HealthCare.gov platform from 2022 through 2024.</p><p><strong>Exposure: </strong>HealthCare.gov enrollees living in a county that experienced turnover that year.</p><p><strong>Main outcomes and measures: </strong>County-year-level counts of overall reenrollment, automatic and active enrollment, and active reenrollment split by whether enrollees stayed with or switched from their previous plan. We controlled for premium affordability, insurer competition, other county characteristics, and state-by-year policy changes.</p><p><strong>Results: </strong>The sample consisted of 2159 counties representing roughly 10 million HealthCare.gov enrollees annually in 29 states that used the HealthCare.gov platform from 2022 through 2024. The share of enrollees living in counties exposed to turnover increased from 10.3% to 93.9% from 2021 to 2022 as the American Rescue Plan Act subsidies were implemented. These increases have persisted into 2024. Turnover across insurers was associated with a 7.0% (95% CI, -12.7 to -1.3) decrease in automatic reenrollment. Any turnover was not associated with changes in active enrollment, though it was associated with a 13.4% decrease (95% CI, -17.7 to -9.1) in enrollees choosing to stay with their previous, default plan and a roughly equivalent 15.0% increase (95% CI, 11.5-18.5) in enrollees choosing to switch plans.</p><p><strong>Conclusions: </strong>Turnover affects coverage losses by decreasing automatic, passive reenrollment among lower-income enrollees that may not realize they need to start paying premiums to retain coverage that previously did not have a premium. Turnover also nudges returning enrollees to select new plans rather than selecting their previous plans. This likely increases insurer price competition but also may create hassles for enrollees. These findings suggest that coverage losses from turnover in 2026 among lower-income Marketplace enrollees may be particularly large if enhanced subsidies from the Inflation Reduction Act expire.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e251424"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness of Universal Routine Depression Screening for Adolescents in Primary Care.","authors":"Tran T Doan, David W Hutton, Davene R Wright, Lisa A Prosser","doi":"10.1001/jamahealthforum.2025.0711","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.0711","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Approximately one-fifth of adolescents in the US experience a major depressive episode each year. Universal depression screening for adolescents is recommended as part of routine pediatric primary care, but its cost-effectiveness is unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the cost-effectiveness of universal routine depression screening in adolescent primary care compared with usual care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This economic evaluation used a decision-analytic model with an embedded state-transition submodel and annual transitions. A hypothetical population of 1000 adolescents and young adults from ages 12 to 22 years, including 12 demographic groups of disaggregated combinations of sex (female and male) and race or ethnicity (American Indian or Alaska Native; Asian, Native Hawaiian, or Pacific Islander; Black or African American; Hispanic, Latino, or Spanish; White; and multiracial or other race or ethnicity) was simulated in pediatric primary care settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Universal depression screening of varying frequencies, including annual, biennial, and single-time screening at age 12 years, compared with usual care, defined as 20% annual screening rate.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Costs, health effects as measured by quality-adjusted life-years (QALYs) and depression-free days, and incremental cost-effectiveness ratios (ICERs) from the health care sector and limited societal perspectives.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A universal annual screening policy had an ICER of $66 822 per QALY or $84 per depression-free day gained compared with single-time screening from the limited societal perspective, including caregiver time costs. Universal single-time screening had an ICER of $44 483 per QALY and $62 per depression-free day gained compared with usual care. Targeted universal depression screening was more cost-effective for female individuals and those who identified as Hispanic, Latina, or Spanish, multiracial, or other race or ethnicity. Results were sensitive to treatment recovery rates, depression health state utility scores, treatment costs involving psychotherapy, suicide-related hospitalization costs, and initial depression prevalence at age 12 years. In approximately 99.8% of probabilistic simulations, universal annual screening had an ICER less than $150 000 per QALY threshold.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;The study results suggest that universal annual depression screening for adolescents in primary care is cost-effective compared with a $100 000 per QALY willingness-to-pay threshold. Universal annual screening may be more cost-effective if health systems invest in efforts to enhance family access to telemedicine behavioral health, decrease treatment costs, or improve treatment effectiveness. Future analyses could examine whether additional potentially associated demographic factors, such a","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e250711"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12048853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Opioid Use Estimates Through Multiple Data Sources.","authors":"Jonathan P Caulkins, Greg Midgette, Peter Reuter","doi":"10.1001/jamahealthforum.2025.0806","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.0806","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e250806"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Excess US Deaths Before, During, and After the COVID-19 Pandemic.","authors":"Jacob Bor, Rafeya V Raquib, Elizabeth Wrigley-Field, Steffie Woolhandler, David U Himmelstein, Andrew C Stokes","doi":"10.1001/jamahealthforum.2025.1118","DOIUrl":"10.1001/jamahealthforum.2025.1118","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e251118"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postpartum Care Differences in LGBTQ+ and Non-LGBTQ+ Individuals.","authors":"Kevin H Nguyen, Jamie R Daw, Heidi L Allen","doi":"10.1001/jamahealthforum.2025.0672","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.0672","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e250672"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12048847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward Integrating Care for Dually Eligible Beneficiaries.","authors":"Rachel M Werner, Julia Hinckley, Eric T Roberts","doi":"10.1001/jamahealthforum.2025.1112","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.1112","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e251112"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}