Alejandro Arrieta

Effects of Leisure and Non-Leisure Physical Activity on Mortality in U.S. Adults over Two Decades

PURPOSE To estimate the effects of the components of total physical activity, leisure-time and non-leisure activity, on all-cause mortality over two decades in a large, nationally representative sample of U.S. adults. METHODS We used the first National Health and Nutrition Examination Survey (NHANES I, 1971-1975) and its Epidemiologic Followup Study (NHEFS), which tracked deaths of NHANES I participants through 1992. Using multivariable Cox regression, and multiple imputation for missing values of control variables, we related baseline leisure-time and non-leisure physical activity to all-cause mortality during follow-up, controlling for other risk factors. Adults 35 through 59 years of age (N = 5884) and 60 through 74 years of age (N = 4590) were analyzed separately. RESULTS For persons aged 35-59, moderate non-leisure activity at baseline significantly reduced mortality risk over the next two decades by about 26%, high non-leisure activity by about 37%, compared with low non-leisure activity. For persons 60-74, risk reductions were 34% and 38%, respectively. Leisure-time activity was associated with lower mortality, but was not consistently significant when both types of activity were entered in the regressions. CONCLUSIONS Over two decades, non-leisure physical activity was associated with a substantial reduction in all-cause mortality. These results contribute to a growing number of studies that support the importance of measuring all physical activity.

Health reform and cesarean sections in the private sector: The experience of Peru.

OBJECTIVES To test the hypothesis that the health reform enacted in Peru in 1997 increased the rate of cesarean sections in the private sector due to non-clinical factors. METHODS Different rounds of the Demographic and Health Survey are used to estimate determinants of c-section rates in private and public facilities before and after the healthcare reform. Estimations are based on a pooled linear regression controlling by obstetric and socioeconomic characteristics. RESULTS C-section rates in the private sector grew from 28 to 53% after the health reform. Compared to the Ministry of Health (MOH), giving birth in a private hospital in the post-reform period adds 19% to the probability of c-section. CONCLUSIONS The health reform implemented in the private sector increased physician incentives to over-utilize c-sections. The reform consolidated and raised the market power of private health insurers, but at the same time did not provide mechanisms to enlarge, regulate and disclose information of private providers. All these factors created the conditions for fee-for-service paid providers to perform more c-sections. Comparable trends in c-section rates have been observed in Latin American countries who implemented similar reforms in their private sector, suggesting a need to rethink the role of private health providers in developing countries.

Economic Evaluation of PCSK9 Inhibitors in Reducing Cardiovascular Risk from Health System and Private Payer Perspectives

The introduction of Proprotein covertase subtilisin/kexin type 9 (PCSK9) inhibitors has been heralded as a major advancement in reducing low-density lipoprotein cholesterol levels by nearly 50%. However, concerns have been raised on the added value to the health care system in terms of their costs and benefits. We assess the cost-effectiveness of PCSK9 inhibitors based on a decision-analytic model with existing clinical evidence. The model compares a lipid-lowering therapy based on statin plus PCSK9 inhibitor treatment with statin treatment only (standard therapy). From health system perspective, incremental cost per quality adjusted life years (QALYs) gained are presented. From a private payer perspective, return-on-investment and net present values over patient lifespan are presented. At the current annual cost of

Updated Cost-effectiveness Assessments of PCSK9 Inhibitors From the Perspectives of the Health System and Private Payers: Insights Derived From the FOURIER Trial

14,000 to

Cost–Benefit Analysis of Home Blood Pressure Monitoring in Hypertension Diagnosis and Treatment: An Insurer Perspective

15,000, PCSK9 inhibitors are not cost-effective at an incremental cost of about

Economic Impact of Moderate‐Vigorous Physical Activity Among Those With and Without Established Cardiovascular Disease: 2012 Medical Expenditure Panel Survey

350,000 per QALY. Moreover, for every dollar invested in PCSK9 inhibitors, the private payer loses

The Impact of Comprehensive Pre-visit Preparation on Patient Engagement and Quality of Care in a Population of Underserved Patients with Diabetes: Evidence from the Care Management Medical Home Center Model

1.98. Our study suggests that the annual treatment price should be set at

The impact of the Massachusetts health care reform on unpaid medical bills.

4,250 at a societal willingness-to-pay of

Association Between Modifiable Risk Factors and Pharmaceutical Expenditures Among Adults With Atherosclerotic Cardiovascular Disease in the United States: 2012–2013 Medical Expenditures Panel Survey

100,000 per QALY. However, we estimate the breakeven price for private payer is only

Output congestion leads to compromised care in Peruvian public hospital neonatal units

600 per annual treatment. At current prices, our study suggests that PCSK9 inhibitors do not add value to the U.S. health system and their provision is not profitable for private payers. To be the breakthrough drug in the fight against cardiovascular disease, the current price of PCSK9 inhibitors must be reduced by more than 70%.