@article {13066, title = {Estimated Annual Spending on Lecanemab and Its Ancillary Costs in the US Medicare Program.}, journal = {JAMA Internal Medicine}, volume = {183}, year = {2023}, pages = {885-889}, abstract = {Lecanemab, an antidementia medication with modest clinical benefit, received accelerated US Food and Drug Administration (FDA) approval. Traditional FDA approval of lecanemab could occur in 2023, prompting Medicare to reconsider coverage restrictions and potentially enabling widespread use. Lecanemab{\textquoteright}s $26 500 proposed annual acquisition cost and ancillary spending (eg, imaging) could increase Medicare spending, possibly leading to beneficiary premium increases. To estimate annual Medicare spending on lecanemab, we performed a cost analysis using nationally representative survey data from the 2018 Health and Retirement Study (HRS).}, keywords = {Health Care Costs, lecanemab, Medicare spending}, issn = {2168-6114}, doi = {10.1001/jamainternmed.2023.1749}, author = {Arbanas, Julia Cave and Damberg, Cheryl L and Leng, Mei and Harawa, Nina and Sarkisian, Catherine A and Landon, Bruce E and Mafi, John N} } @article {12115, title = {Estimated Annual Spending on Aducanumab in the US Medicare Program}, journal = {JAMA Health Forum}, volume = {3}, year = {2022}, pages = {e214495 - e214495}, abstract = {The US Food and Drug Administration{\textquoteright}s June 2021 decision to approve aducanumab for treatment for Alzheimer dementia raised concerns that a drug with uncertain benefit and high cost could, in aggregate, threaten Medicare{\textquoteright}s solvency. In response to these concerns, Biogen recently announced a 50\% annual drug price reduction from $56 000 to $28 200 per patient. Preliminary US spending estimates either used extrapolated Alzheimer dementia prevalence data from 2012 or did not explicitly quantify ancillary costs, such as additional diagnostic imaging to monitor the amyloid-associated imaging abnormalities (ARIAs) that occur in 41\% of treated patients, and did not incorporate the recently announced price reduction.1-3 We estimated upper bound and lower bound annualized Medicare costs for administering aducanumab to beneficiaries with the approved indications of mild cognitive impairment (MCI) or mild dementia, focusing on the degree to which associated ancillary health services affect spending.1}, keywords = {aducanumab, annual spending, Medicare}, isbn = {2689-0186}, doi = {https://doi.org/10.1001/jamahealthforum.2021.4495}, author = {Mafi, John N. and Leng, Mei and Arbanas, Julia Cave and Tseng, Chi-Hong and Damberg, Cheryl L. and Catherine A Sarkisian and Landon, Bruce E.} } @article {12504, title = {Estimated wasteful spending on aducanumab dispensing in the U.S. Medicare population: A cross-sectional analysis.}, journal = {Journal of the American Geriatrics Society}, volume = {70}, year = {2022}, pages = {2714-2718}, abstract = {Aducanumab, a weight-dosed Alzheimer{\textquoteright}s drug with uncertain benefits and high cost, could strain Medicare{\textquoteright}s budget if approved for widespread use.1 In April 2022, Medicare issued a final determination restricting aducanumab{\textquoteright}s use to clinical trials. However, Medicare{\textquoteright}s coverage decision may still be overturned by legal challenges, potentially leading to much higher uptake.2 Moreover, several other Alzheimer{\textquoteright}s infusion drugs similar to aducanumab are currently in the development pipeline.3 Because aducanumab is available in two fixed-dose vial sizes, its use may result in large amounts of discarded drug and wasteful spending.4, 5 To quantify the amount of discarded drug and potential savings that could be generated from more efficient aducanumab vial sizes, we analyzed patient weight distributions from a nationally representative sample of Medicare beneficiaries with mild cognitive impairment (MCI) or mild dementia. }, keywords = {Alzheimer disease, drugs, Medicare, Spending}, issn = {1532-5415}, doi = {10.1111/jgs.17891}, author = {Oronce, Carlos Irwin A and Arbanas, Julia Cave and Leng, Mei and Landon, Bruce E and Damberg, Cheryl L and Sarkisian, Catherine and Mafi, John N} } @article {7916, title = {Health status and behavioral risk factors in older adult Mexicans and Mexican immigrants to the United States.}, journal = {J Aging Health}, volume = {25}, year = {2013}, month = {2013 Feb}, pages = {136-58}, publisher = {25}, abstract = {

OBJECTIVE: Investigate the "salmon-bias" hypothesis, which posits that Mexicans in the U.S. return to Mexico due to poor health, as an explanation for the Hispanic health paradox in which Hispanics in the United States are healthier than might be expected from their socioeconomic status.

METHOD: Sample includes Mexicans age 50 years or above living in the United States and Mexico from the 2003 Mexican Health and Aging Study and the 2004 Health and Retirement Study. Logistic regressions examine whether nonmigrants or return migrants have different odds than immigrants of reporting a health outcome.

RESULTS: The salmon-bias hypothesis holds for select health outcomes. However, nonmigrants and return migrants have better health outcomes than immigrants on a variety of indicators.

DISCUSSION: Overall, the results of this study do not support the salmon-bias hypothesis; other explanations for the paradox could be explored.

}, keywords = {Aged, Emigrants and Immigrants, Emigration and Immigration, Female, Health Status, Health Surveys, Humans, Male, Mexican Americans, Mexico, Middle Aged, Risk Factors, Risk-Taking, Social Class, United States}, issn = {1552-6887}, doi = {10.1177/0898264312468155}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3663916/}, author = {Emma Aguila and Jos{\'e} J Escarce and Leng, Mei and Morales, Leo} }