NEJM Highlights February 2015: the most boring month in my NEJM reading memory

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Our selection from a month with relatively few exciting articles – perhaps this long Boston winter has us all down.


Precious metals and health plan buying:
The implementation of the ACA has placed new decision making on individuals purchasing health insurance on the exchanges. In this report, the authors argue based on experiments that for many individuals, reversing the gold-silver-bronze nomenclature (gold becomes bronze and vice versa) reverses the preference independently of the underlying characteristics of the plans. For the public health advocate this highlights the need for educating shoppers, and also the need for a presentation of plans that allows meaningful choice based on true differentiating features. For the plan managers it highlights the importance of brand and other intangibles (i.e. where they fall in the list displayed on the exchange).
Pertuzumab (Perjeta) for breast cancer:
Nearly 3 years ago Pertuzumab (Perjeta – Roche), a monoclonal antibody targeting the HER class of receptors was approved for HER-2 positive metastatic breast cancer based on interim trial data. In this final report of the CLEOPATRA trial a remarkable prolongation of survival of more than 15 months is shown over the previous standard of care — very few cancer treatments ever show unambiguously that magnitude of benefit. Interestingly, together with the cost of the drug ($5,900/month) and the duration of treatment (assumed to be the median progression free survival time of 20 months), this allows an estimate of the typical cost per year of life gained: approximately $71,000 / year.
Diarrheal disease kills 29,000 Americans a year:

Clostridrium difficile (aka C. diff) is an intestinal pathogen that is hard to treat (recurrence is frequent) and strongly associated with contact with health facilities and treatment with antibiotics. It is a classic scenario – an elderly person comes into hospital for a pneumonia, is treated with broad spectrum antibiotics which disrupt the gut flora allowing C. diff to take hold. This is followed by multiple rounds of treatment and relapse, with rapid functional decline… leading to death. In this extensive surveillance study the authors rigorously quantify the enormous burden of disease from C. diff in terms of mortality and morbidity in the United States, double that of previous estimates, with nearly half a million cases and 30,000 deaths yearly. It is fortunate that the new approach of fecal transplants is highly promising and offers new solutions.

Burden of Clostridium difficile Infection in the United States; Duodenal Infusion of Donor Feces for Recurrent Clostridium difficile

The New England Journal of Medicine is a premier medical journal covering many issues of interest to the health sector. In this monthly series we offer a brief overview of highlights that might be of interest to our clients and others.