This Week in Managed Care: August 23, 2019

The battle is on among sodium glucose cotransporter 2 (SGLT2) inhibitors in heart failure, US prevention experts say more women should get BRCA testing, and the American Heart Association offers an advisory on high triglycerides.

Welcome to This Week in Managed Care, I’m Laura Joszt.

Heart Failure Outcomes of SGLT2 Inhibitors

SGLT2 inhibitors have changed diabetes care, and now the early results from outcomes trials show the same could be true in heart failure.

AstraZeneca announced this week that dapagliflozin, sold as Farxiga, met its primary end point in preventing cardiovascular death and worsening of heart failure for patients with reduced ejection fraction.

Said AstraZeneca’s Mene Pangalos, PhD, “With the DAPA-HF trial, Farxiga becomes the first in its class to demonstrate efficacy and safety data for the treatment of patients with heart failure, with and without type 2 diabetes, on top of standard of care.”

Earlier this summer, the makers of empagliflozin, the SGLT2 inhibitor sold as Jardiance, announced that FDA had awarded fast-track designation for their heart failure indication based on data from the EMPEROR trials, which are not due until June 2020.

Those trials are also studying the drug’s effectiveness in patients with and without type 2 diabetes.

BRCA1/2 Screening Recommendation From USPSTF

Scientists from the US Preventive Services Task Force (USPSTF) say more women should have genetic testing for BRCA1/2 mutation-related cancers. But they warn that testing is not for everyone.

The task force recommends:

• Primary care doctors should assess women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer.
• Primary care doctors can use a family assessment tool for women with ancestry associated with BRCA1/2 gene mutations in breast cancer.
• Women with positive results on the assessment tool should receive genetic counseling and, if indicated, genetic testing.

On the flip side, the task force said women with no prior cancer, family history of cancer, or ancestry with high risk should not be tested.

Payers often make coverage decisions based on USPSTF recommendations. For more on genetic testing in hereditary cancer, see the current issue of Evidence-Based Oncology™.

Prescription Fish Oil

The American Heart Association this week issued a science advisory on the use of prescription omega-3 fatty acids to treat high triglycerides. The advisory discusses 2 types of medications on the market, one that combines EPA and DHA, and one that is EPA only.

The advisory states:

• 4 grams per day of prescription omega-3 fatty acids can lower high triglyceride levels, which the AHA defined as 200 mg/dL or higher.
• Before prescribing medication, doctors should rule out hypothyroidism or poorly managed type 2 diabetes and address lifestyle changes.
• Since there are no head-to-head comparisons of EPA and EPA plus DHA, the panel does not recommend one over the other.
• People should not try to treat the condition themselves with nonprescription fish oil supplements that are not FDA approved.

The advisory notes that the EPA-only medication Vascepa has been shown to reduce cardiovascular events 25% in patients with elevated triglycerides.

The FDA has scheduled an advisory committee hearing for November to consider a cardiovascular indication for the medication, which was first approved in 2012 to treat triglycerides.

Neighborhood Characteristics Can Predict Premature Mortality

Your neighborhood can predict whether you will die early, a new study has found. Research in the journal Health & Place analyzed the 140 neighborhoods in Toronto, Canada, to find links among the environmental, health, socioeconomic, and demographic factors that led to early mortality.

The best neighborhood predictors were:

• Poor cancer screenings
• A lack of tree cover
• Higher use of student nutrition programs
• A high walkability index

Said lead author Stephanie Melles, PhD, MSc, “It’s an ongoing concern that neighborhoods with fewer trees, lower uptake rates in cancer screening programs, higher levels of pollution, and lower total income levels best predict mortality rates. It’s also the case that visible minorities and indigenous peoples are most at risk of living in neighborhoods with higher premature mortality rates. Though we expected these results, they emphasize a persistent issue of social injustice.”

Read more.

Managed Care Cast

Finally, this week our Managed Care Cast features a discussion with leaders from the National Alliance of Healthcare Purchaser Coalitions. As employers are facing escalating costs, they are banding together to gain leverage and better control healthcare costs.

Listen to our podcast from the National Alliance’s recent meeting in Pittsburgh.

And for more, visit our employer compendium.

For all of us at the Managed Markets News Network, I’m Laura Joszt. Thanks for joining us.