How the health sector ended 2023: Prices, employment and more

 Spending on home healthcare surged in November, experiencing a 12.9% year-over-year increase, closely trailed by prescription drug spending, which soared 12.2%, according to a Jan. 31 report from nonprofit Altarum.

Altarum released its latest "Health Sector Economic Indicators" report that sheds light on critical aspects of the nation's health sector. The report offers an analysis of data on health sector spending, prices, employment and utilization. Here are the key highlights:

Health spending and GDP:

• Health spending has maintained a trajectory below 17.5% of GDP for nearly two years.
  
  
• In November 2023, national health spending experienced a 5.9% year-over-year growth, representing 17.4% of GDP.
  
  
• Nominal GDP in November 2023 increased by 5% compared to November 2022, growing 0.9 percentage points slower than health spending.
  
  
• Personal healthcare spending saw 7.3% year-over-year growth in November, primarily driven by an increase in utilization rather than price hikes.
  
  
• Notably, spending on home healthcare surged the fastest at 12.9%, followed closely by prescription drug spending at 12.2%. In contrast, dental services and hospital care witnessed more modest growth at 5.8% and 5.9%, respectively.

Healthcare employment:

• December marked a slowdown in healthcare employment growth, with only 37,700 jobs added, compared to the robust 78,300 jobs added in November.
  
  
• Despite the December dip, the healthcare sector experienced historic growth in 2023, adding a total of 654,000 jobs, contributing nearly a quarter of all jobs across the economy.
  
  
• Ambulatory care settings and hospitals led December's healthcare job growth, adding 19,200 and 15,300 jobs, respectively.
  
  
• The nursing and residential care facilities sector added 3,200 jobs in December, with nursing homes contributing 4,700 jobs while other nursing and residential care settings lost 1,500 jobs.
  
  
• Overall, the economy added 216,000 jobs in December, maintaining an unemployment rate of 3.7%.
  
  
• Healthcare wage growth in November 2023 was 2.9% year over year, slightly trailing behind the total private sector's 4% growth. Wage growth was highest in nursing and residential care (4%), followed by hospitals (3.3%) and ambulatory care settings (2.4%).

Healthcare price growth:

• The Health Care Price Index recorded a 2.9% year-over-year increase in December, slightly lower than the revised growth rate of 3% the previous month.
  
  
• Economy-wide inflation stabilized, with the consumer price index and producer price index growing at 3.4% and 1%, respectively.
  
  
• Among major healthcare categories, dental care (5%), home healthcare (4.2%) and nursing homecare (4%) experienced the fastest price growth, while physician and clinical services (0.3%) exhibited the slowest growth.
  
  
• Healthcare utilization growth slightly decreased to 4.4% year over year in November, attributed to a minor decline in overall spending growth in the latter half of 2023.
  
  
• Home healthcare (8.6%), prescription drugs (8.5%) and physician services (7.8%) demonstrated the fastest utilization growth, while dental services (1.4%) and hospital care (2.9%) experienced the slowest growth.

https://www.beckershospitalreview.com/healthcare-information-technology/how-the-health-sector-ended-2023-prices-employment-and-more.html

COVID-19 variants ranked by fatality risk

 The beta variant was the most deadly of all the COVID-19 strains that the World Health Organization deemed variants of concern, according to a meta-analysis published Jan. 31. 

The research, published in the International Journal of Infectious Diseases, analyzed 112 studies from multiple countries to determine the case fatality rates among five variants of concern. The studies were published between January 2020 and March 2023. 

In order of severity, the meta-analysis found beta's death rate was 4.19%, gamma's was 3.6%, alpha's was 2.62%, delta's was 2.01% and omicron's was 0.7%. Researchers determined the death rates based on which variant was dominant during specific time periods.

More than two years have passed since the WHO has designated a SARS-CoV-2 strain as a variant of concern. Since then, "a substantial body of epidemiological research has accrued, forming a robust foundation for a comprehensive analysis of epidemic trends and [case fatality rate] levels during VOC epidemic periods," the researchers said. 

Overall, the fatality rate during the period was 2.62%, with rates in North America slightly higher than the average at 2.67%. Limitations to the meta-analysis include the intensity of testing, which can differ between regions depending on vaccine availability and resource strains, such as exhausted healthcare workers, the authors said in conclusion. 

More recently, virologists are testing the severity of JN.1, an omicron strain that accounts for more than 9 in 10 U.S. COVID-19 cases. The CDC has dismissed findings from Ohio State University researchers, saying there's "no evidence" the JN.1 variant is more severe than previous strains.

https://www.beckershospitalreview.com/public-health/covid-19-variants-ranked-by-fatality-risk.html

Optum didn't build hospitals — it hired their employees

 In 2018, former UnitedHealth Group CEO David Wichmann made a clear statement to investors: Optum's growth strategy did not include ownership of inpatient care facilities. In other words, the company would not build or own hospitals.

Instead, one piece of the plan to eventually make Optum's care delivery arm, Optum Care, a $100 million business by 2028 was partnering with health systems to manage administrative services such as revenue cycle management and information technology.

"Those will occur in markets where there are maybe less assets for us to accumulate and build from," Mr. Wichmann said at the time. 

Fast forward to 2024, Optum has inked at least nine health system partnerships, most recently with Minneapolis-based Allina Health. Part of that deal includes Optum hiring 2,000 Allina employees, all of whom will continue to support the system's patients and providers.

"Healthcare is changing rapidly and the technological needs to support care delivery are increasingly complex," David Ingham, DO, Allina's vice president and CIO, said Feb. 1. "This new relationship with Optum brings the best of both organizations to the table in support of providers, patients and communities."

Other systems that have outsourced administrative functions and employees to Optum include  Brewer, Maine-based Northern Light Health (1,400 employees hired by Optum); Waukesha, Wis.-based ProHealth Care (800 employees hired); Owensboro (Ky.) Health (575 employees hired); Walnut Creek, Calif.-based John Muir Health (540 employees hired); Cooperstown, N.Y.-based Bassett Healthcare Network (500 employees hired); Boulder (Colo.) Community Health (275 employees hired); and Greenbrae, Calif.-based MarinHealth (an unknown number of employees hired).

"Nobody was going to save the day for us in healthcare," Tim Dentry, Northern Light's president and CEO, told the Portland Press Herald in 2023. "This decision by Northern Light is going to take a huge amount of pressure off of individual entities like [Eastern Maine Medical Center, a hospital parented by the health system]."

Notably, Optum's largest public partnership to date was with SSM Health, which involved the hiring of 2,100 of the St. Louis-based system's employees. The partnership formally began in early 2022 and has since been terminated, an SSM Health spokesperson confirmed with Becker's on Jan. 3. Neither the health system nor Optum elaborated on why the two organizations split or the employment status of the SSM workers.

When Mr. Wichmann discussed Optum Care's $100 million goal for 2028, Optum as a whole recorded $101.3 billion in revenue for 2018. Optum Health, the division that encompasses Optum Care, reported revenues of $24.1 billion. Five years later, Optum's revenues for 2023 exceeded $226 billion, and Optum Health surpassed $95 billion. 

Optum also revealed in November it now employs or is affiliated with nearly 90,000 physicians and another 40,000 advanced practice clinicians serving tens of millions of people every year. Optum Care employed or worked with 38,000 physicians in 2018.

On top of the 2018 strategy to not build hospitals, Mr. Wichmann said Optum was also not interested in purchasing post-acute care facilities. Today, Optum owns naviHealth, a post-acute management organization, and it purchased home health provider LHC Group in 2023 for $5.4 billion. It also intends to purchase home and hospice care provider Amedisys for $3.3 billion.

https://www.beckershospitalreview.com/finance/optum-didnt-build-hospitals-it-hired-their-employees.html

'1st county in US names loneliness a public health emergency'

 California's San Mateo County has declared loneliness a public health emergency, making it the first county in the nation to do so. 

A resolution on the declaration was passed by the county's Board of Supervisors on Jan. 30. The vice president of the Board of Supervisors, David Canepa, told NBC News the measure is meant to promote social connection across San Mateo, where nearly 20% of the population is 65 or older. In 2022, the county conducted a survey that found 45% of its residents were experiencing loneliness and isolation. 

The resolution itself does not allocate funds for programs to reduce loneliness, though Mr. Canepa said a county fund subsidized by sales fax may help support efforts to foster social connection, such as investing in infrastructure to make neighborhoods more walkable. 

"What we're trying to do is to really get people out of the corners and say, 'Hey, look, there are a lot of people who are feeling like you. You are not alone. And moving forward, here are some of the things we can do to support you,'" Mr. Canepa told NBC News. 

The declaration was inspired by a growing body of research that has tied loneliness to health consequences such as increased risks for dementia, heart conditions, depression and anxiety. 

Over the past year, global leaders heightened their focus on loneliness. In November, the World Health Organization deemed it a "pressing health issue" and organized a committee to study the role of social connection in people's health and craft solutions to bolster social ties at a global level. U.S. Surgeon General Vivek Murthy, MD, who is co-chairing the WHO's committee to address loneliness, released an advisory last spring calling attention to the public health crisis posed by loneliness and isolation in the U.S. 

Dr. Murthy praised San Mateo County's effort in a Feb. 2 post on X, formerly Twitter.

https://www.beckershospitalreview.com/public-health/1st-county-in-us-names-loneliness-a-public-health-emergency.html

Beyond sensational headlines of transmitted Alzheimer's, stronger case for prion theory

 The headlines are, at a minimum, a bit sensational: “Alzheimer’s can be transmitted between people.” “What you need to know about Alzheimer’s spreading between humans.” “First evidence of human-to-human transmission of Alzheimer’s disease.” 

The nuance, thankfully, is far less frightening, at least from a public health standpoint. A case series published Jan. 29 in Nature Medicine by scientists at University College London reported that five patients who were given growth hormones derived from human cadavers as part of a now-obsolete childhood medical treatment later developed early-onset Alzheimer’s disease. 

“This is not a public health crisis by any means. It’s not like we’ve discovered any kind of transmission outside of this rare treatment,” Keith Vossel, M.D., director of the Alzheimer’s Research Center at the University of California, Los Angeles, assured Fierce Biotech Research. But it is the first documented instance of Alzheimer’s disease being contracted iatrogenically, or via a medical procedure, he said.

The tragic cases also strengthen some researchers’ hypothesis that the amyloid beta plaques thought to drive the condition behave like prions, self-perpetuating misfolded proteins that cause severe brain disease.

“I wouldn’t go so far as to say that it validates a theory, but I think it just adds one more strong piece of evidence for the prion-like hypothesis of Alzheimer’s seeding and trans-synpatic spreading,” said Vossel, who was not involved with the new research.

So how did the patients in the case series wind up with Alzheimer’s? Call it a major medical mishap: They were part of a cohort of more than 1,800 people who, between the years of 1959 and 1985, were treated for various diseases with injections of human cadaveric pituitary-derived growth hormone, or c-hGH. Unbeknownst to the clinicians performing the treatment, the c-hGH contained amyloid beta plaques, presumably from the brains of the deceased donors. The treatment also contained other prions that led to at least 200 other patients developing Creutzfeldt-Jakob disease, a rapidly progressive neurodegenerative prion disease, as the researchers reported in an earlier paper.

In the three to four decades following, five of the eight patients described in the case series developed Alzheimer’s, most of them during their late 30s and 40s. Two of the others had some degree of cognitive impairment while the last one was asymptomatic. Analyses conducted after they died revealed that all eight patients had some signs of Alzheimer’s pathology, such as the presence of amyloid beta plaques or brain volume changes, including the patient who didn’t show symptoms before death. Notably, they had varying degrees of the cerebral vessel disease that’s typically associated with Alzheimer’s, suggesting their form of the condition might be unique. 

To rule out genetic causes, the University College London team ran genomic analysis to look for gene mutations linked to neurodegenerative disease on five of the patients. (Samples weren’t available for the other three.) Aside from a single risk allele in a gene associated with Alzheimer’s in one case—which is far from a guarantee of developing the disease—the researchers didn’t find any variants that could explain what happened. 

After examining all the other factors over the course of the patients’ lives that could have led them to develop Alzheimer’s so young, the researchers asserted that the contaminated c-hGH was to blame. Their conclusion was bolstered by findings from a mouse study they published back in 2019 in which mice that were injected with some of the same c-hGH from the period developed amyloid beta plaques in their brains. 

If iatrogenic transmission did indeed occur in these patients via prions, this could have implications for the scientific understanding of Alzheimer’s and for designing drugs to treat it, the University College London scientists wrote in their paper. Prions come in different strains that can differ in how quickly they replicate within tissues, move between tissue types and are cleared by the body, as this review in Nature explains. If amyloid beta plaques are prions, and a therapy targets only the most common strain, treatment could ultimately backfire.

“Structurally diverse [prion forms], present as minor components, may be selected for propagation by a drug that binds to the dominant species, potentially leading to the development of resistance,” the researchers wrote. Other scientists have found evidence of amyloid beta strains in microscopy studies, they noted. On top of that, the patients in the case series presented differently than those who develop Alzheimer’s due to genetics, with earlier disease onset and more rapid progression but without a clear pattern of blood vessel disease. 

“We hypothesize that iatrogenic [amyloid-beta disease] caused by c-hGH can result in a clinical phenotype (possibly mediated by amyloid-beta strain type), in which clinical [blood vessel disease] is less prominent,” the researchers wrote. “Additionally, it is entirely possible that some iatrogenic cases of Alzheimer’s disease may differ markedly from sporadic and inherited forms … the full spectrum of dementias caused by amyloid-beta transmission remains to be elucidated.” 

Yet despite the evidence so far, Vossel believes the findings are still vulnerable to what he described as a “referral bias.” While the patients were young and lacked genes that would predispose them to Alzheimer’s, it’s still possible that they would have ultimately developed the disease anyway, Vossel said.

“I think a lot of people assume that if someone has early Alzheimer's disease that it should be genetic in cause, but the truth is that most Alzheimer’s disease is sporadic in nature,” he said. “I think it’s a little premature to put too much weight on this one article. We can gather more information.”

https://www.fiercebiotech.com/research/alzheimers-transmission-medical-procedure-builds-case-prion-theory

Allarity loses rights to Novartis cancer drug over missed payments

 Already reeling from the controversial termination of its CEO, Allarity Therapeutics has now been told that Novartis is rescinding the rights to a troubled cancer drug after the biotech failed to keep up with its payments.

Allarity, under its previous Oncology Venture moniker, licensed the rights to the small molecule multi-kinase inhibitor dovitinib from Novartis back in 2018. But Allarity revealed in an SEC filing yesterday that the Big Pharma had written to the biotech a week ago “indicating their decision to terminate the agreement based on material breach for lack of financial payment.”

Novartis had once touted dovitinib as a highly promising kidney cancer drug based on the strength of mid-phase data. But by the time Allarity got interested, the candidate had shown itself unable to outperform Bayer’s Nexavar in a phase 3 trial of metastatic renal cell cancer patients previously failed by anti-angiogenic therapies.

Allarity was willing to give the drug a second chance. It licensed the asset in return for an undisclosed package of upfront and milestone payments, hoping to prove dovitinib’s worth by using its DRP biomarker platform to better select tumor patients who could benefit.

By 2022, the company was forced to abandon plans to develop the drug as a monotherapy for a type of advanced kidney cancer after the FDA responded to Allarity’s application with a refusal to file letter. The biotech responded by refocusing its pipeline on combination therapies.

As part of that retooled strategy, Allarity launched a phase 1b/2 study of stenoparib, a PARP inhibitor, in combination with dovitinib for second-line or later treatment of metastatic ovarian cancer.

In the filing yesterday, Allarity said it remains “fully committed and primarily focused” on a phase 2 trial of stenoparib in ovarian cancer. The biotech reiterated that “encouraging results” were seen from the first five evaluable patients in December 2023 from that study.

With dovitinib snatched back from Allarity’s pipeline, it’s unclear whether this is the end of the road for the multi-kinase inhibitor. Fierce Biotech has asked Novartis whether it has any plans to pick up development of the drug.

The loss of the dovitinib license isn’t the only drama at Allarity. The company first revealed in December that CEO James Cullem was leaving the company. In yesterday’s filing, Allarity explained that Cullem had been fired “for ‘cause’ under his employment agreement,” although Cullem has apparently disputed this rationale.

Allarity also attached Cullem’s letter resigning from the biotech’s board last week, in which the former CEO accused the company’s directors of “acts and omissions … that I consider directly injurious to the company, its shareholders and its creditors.”

“We and our continuing members of the board disagree with the claims made by Mr. Cullem in the resignation email and take exception to Mr. Cullem’s characterizations of facts and his conclusions,” the company added in yesterday’s filling.

Cullem had only been in the CEO role since June 2022, when he took over after Steve Carchedi stepped down to “pursue other opportunities.” Cullem has been replaced by co-founder and board member Thomas Jensen.

https://www.fiercebiotech.com/biotech/amid-ceo-turmoil-allarity-loses-rights-novartis-cancer-drug-over-missed-payments

Roche, pipeline bulging from deal spree, axes 8 oncology and neurology programs

 Roche has removed eight phase 1 and 2 oncology and neurology candidates from its pipeline as part of a set of “trade-offs” intended to “increase the overall portfolio value and speed up development.”

In the fourth quarter (PDF), Roche removed eight drug candidates and replaced them with eight different prospects, shifting the balance of its pipeline away from neurology and, to a lesser extent, oncology and toward immunology, cardiovascular and metabolism in the process. The number of neurology prospects fell from 18 to 12, although one of those was moved to another part of the pipeline.

CEO Thomas Schinecker said the the resources will be shifted "to projects we want to accelerate." He also foreshadowed similar pipeline cuts to come in the first quarter during a fourth quarter earnings call Thursday. 

Basmisanil is one of the candidates Roche is kicking to the curb. The drugmaker trialed the GABAA α5 receptor negative allosteric modulator in ischemic stroke and schizophrenia patients from 2016 to 2019. The discovery of an EEG biomarker of dup15q, a developmental disorder, spurred interest in treating the syndrome by reducing GABA activity in the brain and led Roche to start enrolling patients in a phase 2 trial in 2022. ClinicalTrials.gov lists the study as recruiting, but Roche removed the asset from its pipeline. 

Roche also axed balovaptan, a small-molecule vasopressin V1A receptor antagonist that previously made it to phase 3 in autism spectrum disorder only to fail to move the needle. The drugmaker tried again in the aftermath of the failure, kicking off a phase 2 study in post-traumatic stress disorder. Roche finished that trial last year and promptly removed balovaptan from its pipeline. 

News of the other neurology changes preceded the fourth-quarter update. AC Immune said Roche had returned the Alzheimer’s disease prospects crenezumab and semorinemab last month, and details of the decision to drop Angelman syndrome candidate rugonersen emerged via the patient community last year. 

On the oncology side, Roche removed three phase 1 candidates from the pipeline. The drugmaker dealt a second blow to the hopes of treating solid tumors by targeting FAP. Having already stopped studying a FAP-IL-2v candidate, Roche removed the solid tumor FAP-CD40 prospect RG6189 from its pipeline in the fourth quarter. A phase 1b trial of a FAP-4-1BBL candidate, RG7827, is continuing.  

The other two axed oncology assets are the EGFRvIIIxCD3 bispecific antibody RG6156, which Roche was studying in brain cancer, and another bispecific designed to bind to HLA-G on tumor cells and CD3 on T cells. 

Roche’s clear-out was accompanied by an influx of other assets, including candidates acquired through the takeovers of Carmot Therapeutics and Telavant. A longer-term bet delivered a clinical candidate, too, with Roche moving a covalent inhibitor of WRN, the synthetic lethal target at the heart of a $135 million deal with Vividion Therapeutics, into phase 1.

https://www.fiercebiotech.com/biotech/roche-pipeline-bulging-deal-spree-axes-8-oncology-and-neurology-programs-speed-rd