Research Roundup: HIV Treatment Costs, Antibiotic Policies, Binge Drinking And More

JAMA Internal Medicine: HIV Antiretroviral Therapy Costs In The United States, 2012-2018
The United States has the highest antiretroviral treatment (ART) prices yet the lowest rate of HIV viral suppression (54%) compared with all other well-resourced countries, including Britain, Australia, and Canada.1 High ART costs are among many structural barriers that lead to poor treatment access and adherence, contributing to suboptimal HIV outcomes in the United States.2 We sought to characterize costs of recommended initial ART regimens in the United States from 2012 to 2018 and the magnitude of cost changes over time. (McCann et al, 2/3)

Health Affairs: Non-Infection-Related And Non-Visit-Based Antibiotic Prescribing Is Common Among Medicaid Patients
Ambulatory antibiotic stewardship policies focus on prescribing decisions made when patients present to clinicians with possible infections. They do not capture antibiotics prescribed outside of clinician visits or without clear indications for use. Antibiotic prescribing for vulnerable patients in the US has not been comprehensively measured. We measured the frequency with which all filled antibiotic prescriptions were associated with infections and in-person visits for Medicaid patients in the period 2004–13. We found that among 298 million antibiotic fills (62 percent for children) for 53 million patients, 55 percent were for clinician visits with an infection-related diagnosis, 17 percent were for clinician visits without an infection-related diagnosis, and 28 percent were not associated with a visit. Non-visit-based antibiotic prescriptions were less common for children than for adults and more common in the West than in other US regions. Large fractions of antibiotic prescriptions are filled without evidence of infection-related diagnoses or accompanying clinician visits. Current ambulatory antibiotic stewardship policies miss about half of antibiotic prescribing. (Fischer, Mahesri, Lii and Linder, 2/1)

American Academy Of Pediatrics: Longitudinal Associations Of 12th-Grade Binge Drinking With Risky Driving And High-Risk Drinking
Binge drinking prevalence in W1 to W3 was 27.2%, 23.8%, and 26.8%, respectively. Twelfth-grade binge drinking was associated with a higher likelihood of DWI, RWI, blackouts, and risky driving in W4 to W7 and extreme binge drinking in W7. Adolescents who binged ≥3 times in high school were more likely to DWI, RWI, blackout (W4 to W7), be involved in extreme binge drinking (W7), and report riskier driving several years after high school. In some waves, parental practices appeared to have enduring effects in protecting against DWI, RWI, and blackouts. (Vaca et al, 2/1)

Annals of Internal Medicine: Declining Use Of Primary Care Among Commercially Insured Adults In The United States, 2008–2016
Visits to [primary care providers] PCPs declined by 24.2%, from 169.5 to 134.3 visits per 100 member-years, while the proportion of adults with no PCP visits in a given year rose from 38.1% to 46.4%. Rates of visits addressing low-acuity conditions decreased by 47.7% …. Out-of-pocket cost per problem-based visit rose by $9.4 (31.5%). Visit rates to specialists remained stable…, and visits to alternative venues, such as urgent care clinics, increased by 46.9%. (Ganguli et al., 2/4)