NEW YORK (Reuters) ? Intuit, the maker of accounting and tax preparation software posted a narrower loss for its first quarter than a year earlier as the growth of the products it makes for small business customers helped it weather one of its seasonally slower quarters.
Intuit has built a small-business division, which helps companies process credit-card transactions, manage employee payrolls and build websites, into a $1.5 billion-a-year operation. It was larger by revenue than the company's consumer tax division last year.
Revenue in the small business unit increased 13 percent in the quarter to $384 million.
"We're posting double digit growth in small business when the economy is still in the tank," Chief Executive Brad Smith told Reuters in an interview.
That unit helped boost Intuit results in one of its seasonally weaker quarters when people are not thinking about filing their taxes yet. Intuit's most profitable products are its tax software for consumers.
But Smith said the tax season is coming up quickly and that the company has high expectations for the performance of its TurboTax software, which now attracts customers increasingly on the Internet.
"We're expecting to have a great tax season," he said, adding the products come out after November 25.
The company forecast second-quarter revenue of $1 billion to $1.02 billion and earnings per share, excluding items, in the range of 43 cents and 47 cents. Wall Street's average expectation is for 43 cents per share for the second quarter.
It posted a first-quarter net loss of $64 million, or 21 cents per share, compared to a loss of $70 million, or 22 cents per share a year earlier.
Adjusted for stock compensation and other charges, the company reported a loss of 10 cents per share, which beat Wall Street's estimates by two cents.
Intuit's revenue rose 12 percent in its first quarter to $594 million, which beat analysts' average estimates of $580.6 million, according to Thomson Reuters I/B/E/S. (Reporting by Liana B. Baker, editing by Bernard Orr and Carol Bishopric)
NEW YORK ? Justin Verlander breezed to the AL Cy Young Award on Tuesday in a unanimous vote after the Detroit Tigers' ace won the pitching version of the Triple Crown.
Verlander dominated the balloting in much the same way he humbled hitters with his 100 mph fastball, sharp curve and wicked slider.
Now, the big question of the baseball awards season: Will he also be chosen the AL MVP next Monday?
"Do I think it's possible? Yes. Would I like to win it? Of course," Verlander said during a conference call from his home in Virginia. "It's kind of a weird scenario."
"Pitchers are on the ballot," he said. Bolstering the case of all pitchers, Verlander pointed to "the tremendous effect we have on the day of our game."
No starting pitcher has won the honor since Roger Clemens in 1986, with Dennis Eckersley the last reliever to get it in 1992. Many observers say pitchers shouldn't win the MVP, period, contending they already have their own award. Verlander's year, though, has ratcheted up the debate in a crowded MVP field that includes Curtis Granderson, Jacoby Ellsbury, Jose Bautista, Miguel Cabrera and more.
Verlander led the majors in wins by going 24-5 and topped baseball with 250 strikeouts. His 2.40 ERA was the best among AL pitchers who qualified for the title.
Verlander drew all 28 first-place votes in balloting by members of the Baseball Writers' Association of America and finished with 196 points.
Jered Weaver (18-8, 2.41) of the Los Angeles Angels was the only other pitcher listed on every ballot and second with 97 points. James Shields of Tampa Bay was third with 66, followed by CC Sabathia of the New York Yankees with 63. Tigers reliever Jose Valverde, who was perfect in 49 save chances, was fifth with 28.
Verlander pitched his second career no-hitter, won 12 straight starts down the stretch and helped the Tigers take the AL Central, their first division title since 1987.
In many games, the 28-year-old righty was simply unhittable. He pitched a no-hitter on May 7 at Toronto, missing a perfect game just by an eighth-inning walk on a full-count delivery.
In his next start, he held Kansas City hitless for 5 2-3 innings. Johnny Vander Meer is the only pitcher to throw back-to-back no-hitters.
Later in the season, the 6-foot-5 star took a pair of no-hit bids into the eighth inning ? one of those came on July 31 against Weaver and the Angels, a 3-2 win at Detroit.
"I felt like it was a statement game," Verlander said. "A lot of people had eyes on that game."
Verlander also led the majors with 251 innings, all while issuing a career-low 57 walks. He pitched four complete games, including two shutouts.
This was the ninth time there was a unanimous winner of the AL Cy Young and first since Johan Santana in 2006, when he won the AL pitching Triple Crown. This was the fourth time a Detroit pitcher won it, with Denny McLain earning the award in 1968 and tying for the honor in 1969, and reliever Willie Hernandez winning in 1984.
McLain, in 1968, and Hernandez went on to win the AL MVP awards, too.
A four-time All-Star, Verlander became the first former AL Rookie of the Year to also take the Cy Young. This win included a $500,000 bonus to his $12.75 million salary in 2011.
The only thing missing from Verlander's pitching resume is a World Series title. He is 3-3 with a 5.57 ERA in eight career postseason starts, and went 2-1 in the playoffs this year as the Tigers reached the AL championship series before losing to Texas.
Clayton Kershaw of the Los Angeles Dodgers is the favorite to win the NL Cy Young when the results are released Thursday. He won the NL pitching Triple Crown, leading with a 2.28 ERA and 248 strikeouts and tying for wins at 21.
The AL and NL Managers of the Year will be announced Wednesday.
Tamoxifen causes significant side effects in male breast cancer patientsPublic release date: 16-Nov-2011 [ | E-mail | Share ]
Contact: Laura Sussman lsussman@mdanderson.org 713-745-2457 University of Texas M. D. Anderson Cancer Center
Many men discontinue treatment, increasing their chances for recurrence
HOUSTON About half of male breast cancer patients who take the drug tamoxifen to prevent their disease from returning report side effects such as weight gain and sexual dysfunction, which prompts more than 20 percent of them to discontinue treatment, according to researchers at The University of Texas MD Anderson Cancer Center.
The study, which is the largest to date of how the estrogen-blocking drug is tolerated in men with breast cancer, was published today in the journal Annals of Oncology.
"While tamoxifen is effective in treating breast cancer in men, little is known about its toxicity," said Sharon Giordano, M.D., associate professor of medicine in MD Anderson's Department of Breast Medical Oncology and senior author of the study. "This research will help doctors and patients better understand the side effects men experience. With this information, patients can make more informed decisions about treatment risks and benefits."
Few Empirical Studies of Rare Disease
Only about 2,000 men are diagnosed with breast cancer in the United States each year, but its incidence is increasing. Since the disease is so rare, little published evidence exists to guide treatment decisions, and most are based on what works in women. There is limited data about the toxicity of anti-hormonal treatments in men.
Male breast cancers are almost always hormone-receptor positive. Tamoxifen blocks the growth-promoting action of estrogen on cancer cells, and it usually is prescribed to men after surgery.
MD Anderson is one of the nation's most active centers for treatment of male breast cancer. As a fellow working with Giordano, lead author Naveen Pemmaraju, M.D., now an assistant professor in MD Anderson's Department of Leukemia, saw a number of these patients.
"I was struck by how rare the disease is and how little published literature there is about it," he said. "I noticed many of these men were stopping tamoxifen therapy early, and the side effects seemed to be different from those generally reported in women."
Side Effects Different From Women
Researchers analyzed the medical records of 64 male breast cancer patients treated at MD Anderson between 1999 and 2009. Diagnoses included stages I, II and III. Patients received tamoxifen for an average of four years.
More than half (53 percent) had one or more drug-related side effect. The top two complaints were weight gain (22 percent) and sexual dysfunction (22 percent). Twenty percent of men stopped taking the drug prematurely because of adverse effects. Of 13 men who discontinued tamoxifen early, four were directed by physicians to stop for medical reasons.
Pemmaraju says men seem to experience different side effects than women, probably because their hormonal environment is different. For example, men have lower levels of estrogen and higher levels of testosterone.
After adjusting for patient age and disease stage, researchers found the outlook for men with breast cancer who take tamoxifen is similar to that of women.
Awareness, Discussion Are Key
Pemmaraju said the study shouldn't change the practice of prescribing tamoxifen for men, but he suggests doctors may want to counsel patients about the side effects and the benefits of continuing the medication.
"I hope this study will help raise awareness in patients and physicians, generate discussion about the side effects and begin to tease out details of why treatment is discontinued," he said.
Further Study Needed
Pemmaraju said the study shows the need for future research to help understand the problems and benefits of tamoxifen.
"It would be valuable to prospectively assess male breast cancer patients and collect data on them at the start of tamoxifen therapy and then follow them through the years to get a better sense side effects and tolerability," he said.
###
Other MD Anderson researchers involved in the study include Mark Munsell, M.S., Department of Leukemia; and Gabriel Hortobagyi, M.D., Department of Breast Medical Oncology.
About MD Anderson
The University of Texas MD Anderson Cancer Center in Houston ranks as one of the world's most respected centers focused on cancer patient care, research, education and prevention. MD Anderson is one of only 40 comprehensive cancer centers designated by the National Cancer Institute. For eight of the past 10 years, including 2011, MD Anderson has ranked No. 1 in cancer care in "Best Hospitals," a survey published annually in U.S. News & World Report.
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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Tamoxifen causes significant side effects in male breast cancer patientsPublic release date: 16-Nov-2011 [ | E-mail | Share ]
Contact: Laura Sussman lsussman@mdanderson.org 713-745-2457 University of Texas M. D. Anderson Cancer Center
Many men discontinue treatment, increasing their chances for recurrence
HOUSTON About half of male breast cancer patients who take the drug tamoxifen to prevent their disease from returning report side effects such as weight gain and sexual dysfunction, which prompts more than 20 percent of them to discontinue treatment, according to researchers at The University of Texas MD Anderson Cancer Center.
The study, which is the largest to date of how the estrogen-blocking drug is tolerated in men with breast cancer, was published today in the journal Annals of Oncology.
"While tamoxifen is effective in treating breast cancer in men, little is known about its toxicity," said Sharon Giordano, M.D., associate professor of medicine in MD Anderson's Department of Breast Medical Oncology and senior author of the study. "This research will help doctors and patients better understand the side effects men experience. With this information, patients can make more informed decisions about treatment risks and benefits."
Few Empirical Studies of Rare Disease
Only about 2,000 men are diagnosed with breast cancer in the United States each year, but its incidence is increasing. Since the disease is so rare, little published evidence exists to guide treatment decisions, and most are based on what works in women. There is limited data about the toxicity of anti-hormonal treatments in men.
Male breast cancers are almost always hormone-receptor positive. Tamoxifen blocks the growth-promoting action of estrogen on cancer cells, and it usually is prescribed to men after surgery.
MD Anderson is one of the nation's most active centers for treatment of male breast cancer. As a fellow working with Giordano, lead author Naveen Pemmaraju, M.D., now an assistant professor in MD Anderson's Department of Leukemia, saw a number of these patients.
"I was struck by how rare the disease is and how little published literature there is about it," he said. "I noticed many of these men were stopping tamoxifen therapy early, and the side effects seemed to be different from those generally reported in women."
Side Effects Different From Women
Researchers analyzed the medical records of 64 male breast cancer patients treated at MD Anderson between 1999 and 2009. Diagnoses included stages I, II and III. Patients received tamoxifen for an average of four years.
More than half (53 percent) had one or more drug-related side effect. The top two complaints were weight gain (22 percent) and sexual dysfunction (22 percent). Twenty percent of men stopped taking the drug prematurely because of adverse effects. Of 13 men who discontinued tamoxifen early, four were directed by physicians to stop for medical reasons.
Pemmaraju says men seem to experience different side effects than women, probably because their hormonal environment is different. For example, men have lower levels of estrogen and higher levels of testosterone.
After adjusting for patient age and disease stage, researchers found the outlook for men with breast cancer who take tamoxifen is similar to that of women.
Awareness, Discussion Are Key
Pemmaraju said the study shouldn't change the practice of prescribing tamoxifen for men, but he suggests doctors may want to counsel patients about the side effects and the benefits of continuing the medication.
"I hope this study will help raise awareness in patients and physicians, generate discussion about the side effects and begin to tease out details of why treatment is discontinued," he said.
Further Study Needed
Pemmaraju said the study shows the need for future research to help understand the problems and benefits of tamoxifen.
"It would be valuable to prospectively assess male breast cancer patients and collect data on them at the start of tamoxifen therapy and then follow them through the years to get a better sense side effects and tolerability," he said.
###
Other MD Anderson researchers involved in the study include Mark Munsell, M.S., Department of Leukemia; and Gabriel Hortobagyi, M.D., Department of Breast Medical Oncology.
About MD Anderson
The University of Texas MD Anderson Cancer Center in Houston ranks as one of the world's most respected centers focused on cancer patient care, research, education and prevention. MD Anderson is one of only 40 comprehensive cancer centers designated by the National Cancer Institute. For eight of the past 10 years, including 2011, MD Anderson has ranked No. 1 in cancer care in "Best Hospitals," a survey published annually in U.S. News & World Report.
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?
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
NEW YORK?? Amy Winehouse had written all the songs that were to appear on her third album. She even picked out song titles.
But music producer Salaam Remi said the soul singer, who died over the summer, was not rushing to release that new material, instead planning to drop a jazz album first with a "supergroup" including ?uestlove of the Roots.
"She had written down everything she wanted to do," Remi said Tuesday.
Only two of the tracks Winehouse wrote were recorded and appear on her compilation album, "Lioness: Hidden Treasures," out Dec. 5 in the United Kingdom, and a day later in America.
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Winehouse died from accidental alcohol poisoning at age 27. Her body was found at her London home July 23.
Remi, who worked on the singer's two albums, "Frank" and "Back to Black," produced most of the upcoming CD, saying Winehouse was a perfectionist when it came to composing music.
"She was taking her time with it, and at the end of the day all of her songs are somewhat autobiographical, so she had to live through something, then get out of it and then look back at it to be able to write about it," he said.
Story: Posthumous Amy Winehouse album set for release
"Who knows what will happen in the future with that," he said of the songs she penned.
Remi held a press listening for "Lioness" on Tuesday. The 12-track set features covers and stripped-sounding versions of released Winehouse songs, with some completed in one take.
Slideshow: Amy Winehouse (on this page)
Before her third album would come out, Remi said, Winehouse wanted to record with Roots drummer ?uestlove and saxophone player Soweto Kinch.
"There were a bunch of other names bouncing around," Remi said.
Story: Coroner: Amy Winehouse died from too much alcohol
?uestlove did make the new album, though. He appears on the track "Half Time." There's also a song by an 18-year-old Winehouse, another about her ex-husband's infidelity and "Best Friend," which opens with the line: "I can't wait to get away from you."
Remi has produced for the Fuguees, Nas, Jazmine Sullivan and Nelly Furtado. He produced the song "Block Party" from TLC member Lisa "Left Eye" Lopes, and Winehouse sought him out after hearing the track. Remi says that Winehouse usually wrote songs while playing the guitar and that the new album sounds just as good as her critically acclaimed predecessors.
He also said he wanted to release new material from the late singer before others did so.
"Before somebody comes up with some weird song ... this is what it really is," he said. "This is the quality."
Copyright 2011 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
WP Engine, a powerful hosted WordPress platform for existing WordPress.org users, has raised $1.2 million in new funding led by Silverton Partners with angels Eric Ries, Loic Le Meur, Dharmesh Shah, Jeremy Benken, Bill Boebel, Rob Walling participating. Automattic, the company behind WordPress.com, also made a strategic investment in WP Engine. WP Engine, which launched in July of 2010, provides a enterprise-level hosting service for WordPress.org users who are tired of managing servers and doing IT work themselves. WP Engine makes sure blogs have super fast page load times, and scale when hit with a ton of traffic.
LONDON?? Ever since she can remember, Katherine Cummings knew she had been born into the wrong body.
"I knew I was transgendered as far back as memories go," said the 76-year old, formerly called John, who works at Australia's Gender Center for people with gender issues. "Four years of age or so."
Since her 1930s childhood, the lives of transgender people have improved dramatically in many countries. But discrimination remains widespread. Hundreds of transgender people are killed every year and many live in constant fear of attack.
"Transgenders often suffer violence, physical and social, from their families, including spouses, parents, children and siblings," Cummings said.
She spoke to Reuters ahead of the annual Transgender Day of Remembrance (TDOR) on Sunday commemorating those who have been killed because of their gender identity.
Founded after the 1998 murder of transgender woman Rita Hester in Massachusetts, the day now has a global following.
In the first nine months of 2011, 116 transgender people were murdered globally, according to Trans Murder Monitoring (TMM), a project coordinated by non-profit association Transgender Europe.
Their research indicates there have been at least 681 reports of murders in 50 countries since 2008.
It was at the age of 51, after marrying and fathering three children, that Cummings was finally ready for gender reassignment.
Despite the pervasive discrimination, she says gender activists are winning some battles. Cummings points to significant developments over the last decade, such as the recent ruling that Australians can change their gender on passports without surgery ? to male, female or indeterminate.
"I feel, on the whole, looking back over the past few decades, that matters are slowly improving," said Cummings, whose book about her transition, "Katherine's Diary," won the Australian Human Rights Commission's 1992 non-fiction award.
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Seven of this year's murders were in the United States, TMM said. Washington. D.C., made headlines this year after a series of attacks against transgender people ? one of them the fatal shooting of 23-year-old transgender woman Myles Mclean.
"I look forward to the day that no one has to hide or be killed, or bullied or teased or rejected simply for being the person they believe themselves to be," said Eva-Genevieve Scarborough, 56, who is helping organize a remembrance event in Riverside, California.
"Society needs to be made aware that atrocities such as the murder of trans folks are still happening all around the world."
Many transgender people seek surgery or hormones to change their physical gender. Others don't, some by choice and some because discrimination or lack of means stop them accessing medical help.
Discrimination also damages their employment opportunities. And activists worldwide are battling to remove 'gender identity disorder' from lists of officially recognized mental illnesses.
Most of the murders of transgender people TMM recorded this year occurred in Latin America ? 29 in Brazil, 22 in Mexico, 11 in Venezuela and 10 in Columbia, as well as murders in 10 other Latin American countries.
TMM also noted murders in Turkey, Pakistan, India, Indonesia, Malaysia, the Philippines, and Poland.
United Nations human rights chief Navi Pillay said in May that hate crimes against lesbians, gay men, bisexuals and transgender people are on the rise around the world.
"Transgender people face the worst challenges, regardless of which country they are coming from or situated in," Liesl Theron, executive director of Gender dynamiX, an organization supporting transgender and transsexual rights in South Africa, told Reuters.
"Usually trans people are on the fringes of society, and the most marginalized."
In a 2008 paper on transgender people in Africa, she cited examples of transgender women across the continent being beaten and imprisoned.
"Most African countries still have some form of legal action, legislation and laws against homosexuality and sodomy (which includes all forms of being a trans person)," she wrote.
Poor access to medical services is the number one challenge in much of Africa, she added.
Theron quoted one Ugandan activist as saying that doctors often refuse to treat transgender people and even sometimes tip off police, leading to arrests.
Trans people in Uganda have been forced to resort to self-medication with dangerous long-term implications, the activist added.
In South Africa, the transgender community has won some victories ? the Department of Home Affairs agreed this October to change the gender and forenames of a transgender woman. Yet people awaiting gender-reassignment surgery still join a seven-year waiting list.
Slowly, gender rights are improving in many countries. But the discrimination is proving hard to stamp out.
"Humanity has an ingrained need for a 'pecking order,' that sets some people up as superior to others," said Cummings of Australia's Gender Center. "Transgender (people) will be a target for bigots for a long time."
On the other side of the world, British children's charity Mermaids works to help children who, like Cummings nearly eight decades ago, feel they were born in the wrong body.
Testimonies published on the charity's website, written by children with gender identity issues, bring home the confusion and harassment faced by so many.
"As a child, I acted as my real self, but then the bullying started," reads an extract from a poem that one of these children, Sophie, wrote at the age of 15.
"Why was I born a lie?" the piece ends.
Copyright 2011 Thomson Reuters. Click for restrictions.
Contact: Lori J. Shanks ljshanks@partners.org 617-534-1604 Brigham and Women's Hospital
Eliminating cost-sharing does not influence a combined outcome of major vascular event or revascularization
Boston, MA The use of specific medications following a heart attack has been shown to reduce cardiovascular events and mortality, however; while highly effective, the rate of adherence to these medications is poor. Researchers from Brigham and Women's Hospital (BWH) evaluated whether eliminating co-payments for these medications would increase adherence and improve outcomes in patients who have had a heart attack. The findings will be presented as a Late Breaking Clinical Trial at the American Heart Association Scientific Sessions on November 14 and simultaneously published online in the New England Journal of Medicine.
"The elimination of co-payments for certain medications following a heart attack resulted in improved patient adherence to the medications and positively impacted rates of major vascular events," said Niteesh Choudhry, MD, PhD, lead author of the paper and a researcher in the Division of Pharmacoepidemiology and Pharmacoeconomics at BWH as well as an Associate Professor of Medicine at Harvard Medical School. "While the elimination of cost sharing did not significantly alter the trial's primary end-point, which included revascularizations along with vascular events, the intervention was successful in reducing rates of important clinical outcomes, lowering the amount that patients spent on medications and other non-drug health services, and did not increase overall health care costs."
Researchers utilized the existing structures that Aetna, a health insurance company, uses to process care and claims for their subscribers and enrolled 5,855 patients who had been discharged from a hospital following a heart attack into their study. They randomly assigned 2,845 patients to an insurance plan that provided full prescription medicine coverage and 3,010 patients to a plan that provided typical prescription medicine coverage, which includes cost-sharing. The medications that were covered by both plans are all routinely prescribed to patients following a heart attack and included statins, beta-blockers, angiotensin-converting-enzyme (ACE) inhibitors, and angiotensin-receptor blockers. Researchers tracked adherence to the medications, the number of major vascular events, which included readmission for fatal or non-fatal heart attack, unstable angina, heart failure or stroke, and the incidence of revascularization, which included a stent or angioplasty. They also determined the out-of-pocket cost for the patient and overall health care spending for each patient.
Choudhry and colleagues found that the rate of the combined endpoint of major cardiovascular events or revascularization was not significantly improved by the elimination of copayments for prescription medicines. However, when all events were considered, and not only first events, rates of this outcome were reduced significantly by 11 percent in the intervention group. They also report that when taking revascularizations out of the equation, rates of first vascular event were reduced significantly by 14 percent and the individual outcomes, which include the rates of readmission for another heart attack, angina, heart failure and stroke, were all reduced. Additionally, total healthcare spending for patients during follow up did not significantly increase, and out-of-pocket costs for patients were lower in the intervention group, a relative reduction of 26 percent.
"This research shows that by eliminating co-pays for patients who are prescribed medications that are proven to be effective, patients will use them more. In this specific study, adherence to these medications increased four to six percentage points," Choudhry said. "Even with this improvement, overall adherence to these medications is very low, with less than half of patients who are prescribed these medications actually taking them. While cost-related underuse represents 'low-hanging fruit' and the intervention we evaluated appears cost-effective, more work is needed to identify other effective strategies for increasing adherence as a way to improve patient care and simultaneously lower the cost of providing care to these patients," Choudhry said.
###
This research was funded by Aetna and the Commonwealth Fund.
Brigham and Women's Hospital (BWH) is a 793-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. BWH is the home of the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery. The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), www.brighamandwomens.org/research , BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 900 physician-investigators and renowned biomedical scientists and faculty supported by more than $537 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org
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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Contact: Lori J. Shanks ljshanks@partners.org 617-534-1604 Brigham and Women's Hospital
Eliminating cost-sharing does not influence a combined outcome of major vascular event or revascularization
Boston, MA The use of specific medications following a heart attack has been shown to reduce cardiovascular events and mortality, however; while highly effective, the rate of adherence to these medications is poor. Researchers from Brigham and Women's Hospital (BWH) evaluated whether eliminating co-payments for these medications would increase adherence and improve outcomes in patients who have had a heart attack. The findings will be presented as a Late Breaking Clinical Trial at the American Heart Association Scientific Sessions on November 14 and simultaneously published online in the New England Journal of Medicine.
"The elimination of co-payments for certain medications following a heart attack resulted in improved patient adherence to the medications and positively impacted rates of major vascular events," said Niteesh Choudhry, MD, PhD, lead author of the paper and a researcher in the Division of Pharmacoepidemiology and Pharmacoeconomics at BWH as well as an Associate Professor of Medicine at Harvard Medical School. "While the elimination of cost sharing did not significantly alter the trial's primary end-point, which included revascularizations along with vascular events, the intervention was successful in reducing rates of important clinical outcomes, lowering the amount that patients spent on medications and other non-drug health services, and did not increase overall health care costs."
Researchers utilized the existing structures that Aetna, a health insurance company, uses to process care and claims for their subscribers and enrolled 5,855 patients who had been discharged from a hospital following a heart attack into their study. They randomly assigned 2,845 patients to an insurance plan that provided full prescription medicine coverage and 3,010 patients to a plan that provided typical prescription medicine coverage, which includes cost-sharing. The medications that were covered by both plans are all routinely prescribed to patients following a heart attack and included statins, beta-blockers, angiotensin-converting-enzyme (ACE) inhibitors, and angiotensin-receptor blockers. Researchers tracked adherence to the medications, the number of major vascular events, which included readmission for fatal or non-fatal heart attack, unstable angina, heart failure or stroke, and the incidence of revascularization, which included a stent or angioplasty. They also determined the out-of-pocket cost for the patient and overall health care spending for each patient.
Choudhry and colleagues found that the rate of the combined endpoint of major cardiovascular events or revascularization was not significantly improved by the elimination of copayments for prescription medicines. However, when all events were considered, and not only first events, rates of this outcome were reduced significantly by 11 percent in the intervention group. They also report that when taking revascularizations out of the equation, rates of first vascular event were reduced significantly by 14 percent and the individual outcomes, which include the rates of readmission for another heart attack, angina, heart failure and stroke, were all reduced. Additionally, total healthcare spending for patients during follow up did not significantly increase, and out-of-pocket costs for patients were lower in the intervention group, a relative reduction of 26 percent.
"This research shows that by eliminating co-pays for patients who are prescribed medications that are proven to be effective, patients will use them more. In this specific study, adherence to these medications increased four to six percentage points," Choudhry said. "Even with this improvement, overall adherence to these medications is very low, with less than half of patients who are prescribed these medications actually taking them. While cost-related underuse represents 'low-hanging fruit' and the intervention we evaluated appears cost-effective, more work is needed to identify other effective strategies for increasing adherence as a way to improve patient care and simultaneously lower the cost of providing care to these patients," Choudhry said.
###
This research was funded by Aetna and the Commonwealth Fund.
Brigham and Women's Hospital (BWH) is a 793-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. BWH is the home of the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery. The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), www.brighamandwomens.org/research , BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 900 physician-investigators and renowned biomedical scientists and faculty supported by more than $537 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org
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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
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Public release date: 16-Nov-2011
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