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INTRODUCTION

6/18/2019 - Medical Grand Rounds: The Price is NOT Right: The Physician Role in Rising Insulin Costs & When Observational Studies Give You Heartburn: Appraising the Evidence Behind PPIs and Related Adverse Effects

QUIZ

EVALUATION

CERTIFICATE

INTRODUCTION

Credit Hours: CME 1.00

Target Audience:

Faculty, residents, fellows, and community physicians in General Internal Medicine and subspecialties.

Educational Objectives:

Upon completion of this activity, participants should be able to:

  • Delineate the Hill criteria as a tool to establish causation.
  • Appraise the literature regarding adverse effects of PPIs.
  • Discuss a rational approach to PPI prescribing and deprescribing
  • Explain the complex re-imbursement process and the flow of pricing between pharmacy benefit managers, drug companies, wholesalers, and pharmacies which contribute to increased drug prices.
  • Explain the safety and efficacy of utilizing human insulins when addressing cost barriers and show how to safely make that transition.

Presentation Topics
Title:  The Price is NOT Right: The Physician Role in Rising Insulin Costs
Presenter:  Neeti Patel, MD

Title:  When Observational Studies Give You Heartburn: Appraising the Evidence Behind PPIs and Related Adverse Effects
Presenter:  Phillip Hamilton, MD

Suggested Additional Reading:

  1. Herket et al. Cost-Related Insulin Underuse Among Patients With Diabetes. JAMA Intern Med. 2019;179(1):112-114.
  2. Hua et al. Expenditures and Prices of Antihyperglycemic Medications in the United States: 2002–2013. JAMA. 2016 Apr 5; 315(13): 1400–1402.
  3. McEwen et al. Why Are Diabetes Medications So Expensive and What Can Be Done to Control Their Cost? Current Diabetes Reports. September 2017, 17:71
  4. Greene JA, Riggs KR. Why is there no generic insulin? Historical origins of a modern problem. N Engl J Med. 2015;372:1171–5.
  5. White JR Jr. A brief history of the development of diabetes medications. Diabetes Spectr. 2014;27:82–6.
  6. Kesselheim AS, Avorn J, Sarpatwari A. The high cost of prescription drugs in the United States: origins and prospects for reform. JAMA. 2016;316:858–71.
  7. Carter AW, Heinemann L. If PBMs guard access to drugs, then quis custodiet ipsos custodies? (who will guard the guardians?). J Diabetes Sci Technol. 2016;10:1406–10.
  8. Grunberger G. Insulin Analogs—Are They Worth It? Yes! Diabetes Care. 2014 Jun;37(6):1767-70.  Davidson M. Insulin Analogs—Is There a Compelling Case to Use Them? No! Diabetes Care 2014;37:1771–1774.
  9. Tylee T. Hirsch IB. Costs Associated With Using Different Insulin Preparations. JAMA. 2015;314(7):665-666.
  10. Horvath K, Jeitler K, Berghold A, et al. Long-acting insulin analogues vs NPH insulin (human isophane insulin) for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2007;(2):CD005613.
  11. Mannucci E, Monami M, Marchionni N. Short-acting insulin analogues vs regular human insulin in type 2 diabetes: a meta-analysis. Diabetes Obes Metab. 2009;11(1):53-59.
  12. Jehle PM, Micheler C, Jehle DR, Breitig D, Boehm BO. Inadequate suspension of neutral protamine Hagedorn (NPH) insulin in pens. Lancet. 1999;354(9190):1604-1607
  13. Malkani, S. Are newer insulins always the better option? Curr Opin Endocrinol Diabetes Obes.2019
  14. Lazarus, B. et al. Proton Pump Inhibitor Use and the Risk of Chronic Kidney Disease. JAMA Internal Medicine. 2016.
  15. Xie, Y. et al. Risk of Death Among Users of Proton Pump Inhibitors: a longitudinal observational cohort study of United States Veterans. BMJ. 2016.
  16. Malfertheiner, P. et al. Proton-pump Inhibitors: Understanding the Complications and Risks. Gastroenterology and Hepatology. 2017.
  17. Reeve, E. et al. Feasibility of a Patient-Centered Deprescribing Process to Reduce Inappropriate Use of Proton Pump Inhibitors. Annals of Pharmacotherapy. 2015.
  18. Vaezi, M. et al. Complications of Proton Pump Inhibitor Therapy. Gastroenterology. 2017.

Authors:
Neeti Patel, MD — PGY 3 Internal Medicine Resident
No relationships with industry relevant to the content of this educational activity have been disclosed.
Phillip Hamilton, MD — PGY 3 Internal Medicine Resident
No relationships with industry relevant to the content of this educational activity have been disclosed.
Authors disclosure of relevant financial relationships with any entity producing, marketing, re-selling, or distributing health care goods or services, used on, or consumed by, patients is listed above. No other planners, members of the planning committee, content reviewers and/or anyone else in a position to control the content of this education activity have relevant financial relationships to disclose.

The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Pittsburgh School of Medicine designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credits. Each physician should only claim credit commensurate with the extent of their participation in the activity.

The University of Pittsburgh is an affirmative action, equal opportunity institution.