Breakthrough for children with serious epileptic seizures

Emergency medicine doctors now have a better way to treat severe epileptic seizures in children, thanks to a New Zealand-Australian study.

Prolonged epileptic seizures are the most common neurological emergency in children seen by hospitals. The seizures are potentially fatal: up to five percent of affected children die, and a third suffer long-term complications from brain damage. Crucially, the longer the seizure, the greater the chance of long-term complications.

The study — which will change management of this condition internationally — was published in the medical journal The Lancetthis week (Thursday 18 April). It was led by Professor Stuart Dalziel from the Faculty of Medical and Health Sciences at the University of Auckland and Starship Children’s Hospital, and the senior author was Professor Franz Babl at Melbourne’s Murdoch Children’s Research Institute.

In severe seizures, the first line of treatment (benzodiazepines) only stops the seizures in 40 to 60 percent of patients. Before this study, the second line treatment was the anti-convulsant drug phenytoin, but until now this practice had never been scrutinised in a robust major randomised controlled trial. Also, phenytoin was known to have a number of serious complications.

In this world-leading study, funded by the Health Research Council of New Zealand, researchers compared phenytoin with newer anti-convulsant levetiracetam for the second line treatment of seizures. Levetiracetam is used routinely as a daily medication to prevent seizures, but has not been properly tested against phenytoin for treatment of severe prolonged seizures.

The research, conducted by the PREDICT research network in 13 emergency departments at hospitals in Aotearoa New Zealand and Australia, involved 233 child patients aged between three months and 16 years.

The researchers found that when given individually, the drugs are as good as each other: both had a moderate success rate (50-60 percent) at stopping a prolonged seizure.

But strikingly, treatment with one drug and then the other increased the success rate of stopping a seizure to approximately 75 percent.

Previously, children who continued seizing after phenytoin then needed to be intubated, sedated and placed on a ventilator in intensive care. By giving these two medications one after the other, researchers have potentially halved the number of children ventilated and sent to intensive care.

“This study has now given us robust evidence to manage children with prolonged seizures without reverting to intubation and intensive care,” says Dr Dalziel, who is Professor of Emergency Medicine and Paediatrics in the Departments of Surgery and Paediatrics, and a paediatric emergency medicine specialist at Auckland’s Starship Children’s Hospital.

“By controlling seizures in the emergency department we will increase the chance of these children recovering more quickly and returning back to their normal lives,” he says. “This research has already changed practice and led to new guidelines in New Zealand and Australia.”

“This study is going to profoundly improve treatment for children who are critically ill with epilepsy around the world,” says Professor Franz Babl, who is also Professor of Paediatric Emergency Medicine at the University of Melbourne.

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Story Source:

Materials provided by University of Melbourne. Note: Content may be edited for style and length.

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Journal Reference:

1. Stuart R Dalziel, Meredith L Borland, Jeremy Furyk, Megan Bonisch, Jocelyn Neutze, Susan Donath, Kate L Francis, Cynthia Sharpe, A Simon Harvey, Andrew Davidson, Simon Craig, Natalie Phillips, Shane George, Arjun Rao, Nicholas Cheng, Michael Zhang, Amit Kochar, Christine Brabyn, Ed Oakley, Franz E Babl. Levetiracetam versus phenytoin for second-line treatment of convulsive status epilepticus in children (ConSEPT): an open-label, multicentre, randomised controlled trial. The Lancet, 2019; DOI: 10.1016/S0140-6736(19)30722-6

https://www.sciencedaily.com/releases/2019/04/190418095203.htm

Boehringer’s blockbuster Spiriva under pressure, profits down

Boehringer Ingelheim has announced an increase in sales for full year 2018, but a slight decline in profits, as price competition began to affect its biggest selling drug Spiriva.

The German pharma’s net sales increased 4% after adjustment for currency fluctuations to 17.5 billion euros, but operating income fell by 0.4% to 3.2 billion euros.

Boehringer is also investing heavily in its R&D, boosting its expenditure in this area by 2.8% to 3.2 billion euros.

Overall the company’s human pharmaceuticals business grew by 5.1%, with increasing sales from newer drugs offsetting the impact of expiring patents on older drugs.

Boehringer’s lung drug Spiriva, approved for chronic obstructive pulmonary disease (COPD) and asthma, generated net sales of 2.4 billion euros, down 11.4% compared with last year, which the company said was down to increasing price pressure.

Its finance director Michael Schmelmer said the company hopes to offset the falling sales by getting new respiratory drugs approved, and the company hopes that Spiolto, more recently approved in the US in 2015, will bring in more revenues in future years.

In a question and answer session at the company’s annual results conference in Germany today, managing director Hubertus von Baumbach noted that Spiriva’s patent had expired in the US.

But he said that there had been “no significant impact” so far, adding: “We have taken steps that make us think that we could counteract any negative impact.”

Its Jardiance diabetes drug, developed in partnership with Eli Lilly, is beginning to gain serious traction after it became the first blood sugar controlling drug to show a benefit in reducing risk of heart problems in high-risk patients.

Its sales increased by 53% for 2018, and net sales totalled 1.8 billion euros, while Boehringer’s other big diabetes drug Trajenta saw sales increase by 9% to 1.4 billion euros.

The company’s third biggest selling drug, the anticoagulant Pradaxa, increased sales by 7% compared with the previous year, to 1.5 billion euros.

Boehringer also has a new blockbuster – the respiratory drug Ofev, which is approved for idiopathic pulmonary fibrosis and increased its 2018 sales by 29% with net sales totalling 1.1 billion euros.

The company expects more from Ofev as it has filed the drug with the FDA and the European Medicines Agency for treatment of interstitial pulmonary diseases in patients with systemic scleroderma – a rare disease for which there are no approved therapy options.

https://pharmaphorum.com/news/boehringer-ingelheim-2018-sales-profits/

Health insurers stocks now look like a buy, Barron’s says

Investing in health insurers today amounts to a bet against the Medicare for All proposal championed by Senator Bernie Sanders and other Democrats running for president, Andrew Bary writes in this week’s edition of Barron’s. While the stocks have been battered, given the long odds of an industry-killing plan becoming law, shares of the leading insurers – UnitedHealth (UNH), Anthem (ANTM), Cigna (CI), Humana (HUM) and CVS (CVS) – look appealing, Bary contends. The stocks trade for an average of just 12 times projected 2019 earnings and UnitedHealth, Anthem, and Humana already are generating double-digit growth in earnings per share, he adds.

https://thefly.com/landingPageNews.php?id=2894886

Publicity spurs billing revamp at Zuckerberg hospital

Zuckerberg San Francisco General Hospital is updating its billing practices after making headlines over its policies.

A Vox report in January revealed the hospital is out of network with all private health plans, which can leave patients with massive bills.

After the story ran, the hospital’s billing practices garnered national media attention, particularly the practice of balance billing.

Balance billing occurs when a patient receives services from an out-of-network provider and is billed for the difference between what the patient’s insurer decides to pay and what the provider believes the care is worth.

Zuckerberg hospital — which is San Francisco’s largest public hospital and houses a level 1 trauma center — temporarily halted balance billing beginning Feb. 1 as it worked on a long-term plan to address billing issues.

Now, the hospital’s operator, the San Francisco Department of Public Health, has announced new billing policies at the facility.

The changes are aimed at shielding patients from large bills by removing them from payment disputes between the hospital and the insurance company, said Rachael Kagan, director of communications with the department.

“We don’t have a large number of privately insured patients at Zuckerberg San Francisco General Hospital, but some of those who have been in that situation in the past have had a terrible experience and we want to rectify that,” said Ms. Kagan.

“We don’t want that to happen in the future. We know that it’s very stressful to get a large bill and we consider our responsibility to the patients to care for them in all ways. They will have gotten excellent medical care from us, and we want to protect their financial well-being also,” she added.

The changes

Under the new policies, balance billing will not resume at the hospital. The new balance billing policy will apply to accounts that were open on Feb. 1 or later. Accounts that were closed as of Feb. 1 will remain settled.

However, the hospital will still seek reimbursement from the insurance company.

“We still believe insurance companies should pay their fair share for the care that we provide to their customers. So, we will continue to seek reimbursement from them, but we will no longer put patients in the middle of that. We will no longer seek the balance from the individual patient,” said Ms. Kagan.

The hospital estimated that up to 1,700 of its 104,000 patients a year may have received a balance bill.

Another change addresses the issue of privately insured patients receiving out-of-network care at the hospital. The hospital will no longer bill them more than they would pay at an in-network hospital for the same care, Ms. Kagan said.

“That will make a big and immediate difference for patients and will take away the issue of in network or out of network from the patient’s point of view. But again, we still will seek reimbursement from the insurance companies,” she added.

Other billing changes have a broader scope than just privately insured patients.

Zuckerberg hospital will also set a maximum out-of-pocket cost for patients at all income levels, with any insurance status, and this maximum will be income-based. No one will be charged more than 5 percent of their income.

For instance, those earning up to 138 percent of the federal poverty level would have no out-of-pocket cost, while people earning 1,000 percent of the federal poverty level or higher would see an out-of-pocket maximum of $4,800.

“That should provide some assurance that folks won’t be experiencing sticker shock or have an extremely high hospital bill no matter what their insurance status is or what their circumstances are. We want to take that anxiety away,” Ms. Kagan said.

Additionally, the hospital will make its patient financial assistance programs easier to qualify for so more people will get financial assistance. This involves increasing the threshold to qualify for the hospital’s charity care program. The threshold to qualify will increase from 350 percent of the federal poverty level to 500 percent of the federal poverty level.

The hospital is also adjusting the “sliding scale” financial assistance program for San Francisco residents. Previously, Zuckerberg hospital assessed eligibility for the program based on income and assets but will now only take income into account.

Next steps

The changes will be fully implemented over the coming months.

Ms. Kagan said some changes will take less time to roll out than others. The ban on balance billing is implemented immediately. But it will take longer to implement the change regarding out-of-network vs. in-network costs because the hospital will need to get information from the individual’s insurance plan, including what the charge would be for the same service at an in-network hospital.

“It’s just a matter of changing policies and then starting to implement the new management of these accounts,” said Ms. Kagan.

Overall, she said she’s pleased the hospital is taking these steps to better align its billing with its values and mission.

https://www.beckershospitalreview.com/finance/publicity-spurs-billing-revamp-at-zuckerberg-hospital.html

Court throws out 7 of SmileDirectClub’s counts against Alabama dental board

On April 17, a federal court for the Northern District of Alabama dismissed seven of the 11 counts SmileDirectClub has brought against the Board of Dental Examiners of Alabama.

The complaints were filed after SmileDirectClub and D. Blaine Leeds, DDS, received a cease-and-desist letter from the dental board, accusing the company of illegally practicing dentistry in Alabama. At the time, SmileDirectClub had opened its first location in the state.

SmileDirectClub claims the dental board exceeded its authority and practiced protectionism. Dr. Leeds and SmileDirectClub alleged the board discriminated against them after ruling Dr. Leeds and the company could not practice in the state.

The company has a teledentistry platform that allows out-of-state dentist Dr. Leeds to provide aligner therapy treatments.

Alabama’s dental board and the American Association of Orthodontists argued the introduction of SmileDirectClub caused issues of health, safety and the well being of patients seeking orthodontic care.

Four counts were denied in the dental board’s motion to dismiss.

To read the full report, click here.

https://www.beckersdental.com/dentists/34511-court-throws-out-7-of-smiledirectclub-s-counts-against-alabama-dental-board.html

34% of patients delay, skip out on payments for dental expenses

Nearly half of Americans delay dental and medical treatment due to the costs, according to a survey by DentalPlans.com and cited by Study Finds.

DentalPlans.com surveyed 2,000 Americans over 18 months, which showed before insurance or deductions the average cost of emergency medical care in the U.S. tops $12,126. Of which, Americans typically pay 49 percent of the bill out of pocket.

Further, the survey revealed it takes patients 2.4 years to pay off their medical or dental expenses. Some patients (34 percent) delay payments or try to escape bills altogether. Twenty-five percent of patients turn to crowdsourcing and fundraising websites to raise money to pay their bills.

Below are 10 medical worries for Medicare patients:

1. Dentures/veneers: 27 percent
1. Trauma: 27 percent
3. Broken bones: 23 percent
4. Hip/knee replacement: 22 percent
5. Lost tooth: 20 percent
6. Root canal: 19 percent
7. Cavity: 13 percent
8. Chipped tooth: 12 percent
9. Stiches: 11 percent
9. Concussion: 11 percent

Below are the factors in delaying treatment:

1. Cost: 45 percent
2. Time: 19 percent
3. Fear of bad news: 11 percent
3. Don’t like it: 11 percent
4. Travel: 8 percent

https://www.beckersdental.com/dentists/34509-34-of-patients-delay-skip-out-on-payments-for-dental-expenses.html

SmileDirectClub prepares for IPO, on track to record $1B in 2019 revenue

SmileDirectClub, a provider of at-home teeth straightening solutions, picked bankers for its upcoming initial public offering, according to Business Insider.
JPMorgan will serve as the startup company’s lead manager. SmileDirectClub is expected to file the IPO by the end of June.

SmileDirectClub has raised nearly $400 million in private funding. Last fall the company recorded an infusion at a $3.2 billion post-money valuation.

By the end of the year, SmileDirectClub predicts its revenue will top $1 billion.

https://www.beckersdental.com/dentists/34492-smiledirectclub-prepares-for-ipo-on-track-to-record-1b-in-2019-revenue.html