When I read criticisms of doctors prescribing expensive medications that might not benefit patients at all, I think of Zetia (ezetimibe) as the poster child. News came out last week after the IMPROVE-IT trial that seemed to pump it up, but what we learned from this large trial may surprise you and let you down at the same time.
- Billions and billions of dollars have already been spent on Zetia—despite not knowing whether it has any benefit to you other than lowering LDL cholesterol a little bit. Does it improve your mortality or lower your risk of heart attack? We don’t know.
- It’s attractive because it’s one of the only non-statin options for lowering cholesterol and does not cause muscle pain or elevation of liver function tests.
- It will cost you and your health insurance plan more money. A 30-day supply is about 200 dollars.
- Despite this recent study making the news (done on people who had just had a heart event in the last 10 days), if you are a patient without heart attack in the last 10 days the question of any benefit to you is still completely unknown.
- What did this new study tell us about Zetia? That 50 people who have just had an acute coronary event have to be treated with both simvastatin and Zetia (compared to simvastatin alone) for 7 years to prevent ONE death, heart attack or stroke. What? Yep.
- It’s about the high dose statins, not Zetia. What guidelines in the United States do recommend you take after a coronary event is atorvastatin (Lipitor) 80 mg or Crestor 40 mg for high risk patients, and that does save lives.
- So remember what we know about Zetia. For a price of 200 dollars a month if you add it to simvastatin and take it for 7 years after having a heart event there is a one in 50 chance that this compound will help you.
- We have no idea if LDL lowering with ezetimibe should be widely used elsewhere other than in high risk patients after a heart event.
Valcyte is used for the prevention and treatment of cytomegalovirus (CMV). CMV is a common virus related to the family of viruses that cause chickenpox, herpes simplex, and mono.
There is no cure for CMV—once you have been infected, the virus will be in your body for life. However, it is not always active, and medications like valganciclovir can help treat CMV in children or anyone with a weakened immune system.
Brand name Valcyte is available both as a 450 mg tablet and a 50 mg/ml oral solution (which will be mixed by the pharmacist before you receive it).
At the moment, only the 450 mg tablet has generic approval.
How is valganciclovir usually taken, and who is it for?
For adults, valganciclovir is indicated for prevention of CMV in kidney, heart, and kidney-pancreas adult transplant patients at high risk. For heart or kidney-pancreas transplant patients, the usual maintenance dose is two tablets per day for 100 days post-transplantation; for kidney transplant patients it’s 200 days.
Valganciclovir is indicated for the treatment of CMV of the eye (retinitis) in adults with AIDS. The usual maintenance dose is also two tablets taken once daily.
For children four months to 16 years of age, valganciclovir is indicated for the prevention of CMV in kidney and heart transplant patients at high risk. The maintenance dose is calculated and based on body surface area for children.
What type of medication is valganciclovir?
Valganciclovir is a CMV nucleoside analogue DNA polymerase inhibitor. This is basically a fancy term for an antiviral.
It works by interfering with the production of a particular virus within the body. This stops the development and spreading of the virus throughout the body and gives your immune system a chance to recover and fight back.
What are the most common side effects?
The most common side effects of this medication for both children and adults include but are not limited to: diarrhea, nausea, vomiting, fever, shaky movement, low blood cell counts, and rejection of the transplanted organ.
Valganciclovir can also make you feel sleepy, dizzy, unsteady, confused, or cause seizures. You shouldn’t operate heavy machinery, drive, or participate in dangerous activities while taking it until you know how it may affect you.
Why is the generic approval of Valcyte so exciting?
After receiving an organ transplant of any kind the pill burden can be tremendous. Patients and their caregivers are often sent home with several medications, which can run up a large pharmacy bill, and Valcyte is no exception.
The cost for 60 tablets of Valcyte is around $4000 if you do not have prescription insurance, and for expensive medications like Valcyte, insurance companies often require prior authorization. For more info on prior authorizations and specialty pharmacies, see our previous post here.
Specialty pharmacies will often assist transplant patients with their costly medications, and some manufacturers offer assistance programs as well, but costs can still be significant.
The approval of generic Valcyte will hopefully decrease the initial cost for your prescription insurance which in turn will result in a cost savings for you. Generic availability may also decrease the prior authorizations required by insurance.
What if my doctor wants to keep me on brand-name Valcyte?
The manufacturer, Genentech, has a patient assistance program that can help reduce the cost of the medication. Genentech Transplant Access Services (GTAS) offers various assistance programs for Valcyte patients who are insured, uninsured, or have Medicare.
It’s been a quiet influenza season so far—very quiet. It’s November and Los Angeles, for example, has seen almost no flu activity. This is good but failing to prepare may mean preparing to fail so though we are inundated with info about the flu, here are 10 flu facts you may not know:
- During the month of October, there has been almost no flu activity in Los Angeles County (LAC) and across the country. This was not true last year where we had an earlier season.
- Early reports nationwide show flu A H3N2 is the most commonly identified strain, which is included in the 2014 – 2015 season influenza vaccine (Yipee!).
- Not the flu. If you were sick during the summer and fall, you had another respiratory virus like rhinovirus and enterovirus not “the flu” from influenza.
- How good is the vaccine? Looking back a few years, the flu shot was ok but not great. Overall vaccine effectiveness for the 2012 – 2013 season was estimated to be 56%. It’s still the best tool we have.
- Over-the-counter meds. Because you can spread influenza to others by coughing, sneezing, or talking, we encourage you to stay home if you have the flu. Use the over-the-counter (OTC) medicines to help manage your symptoms if you have mild to moderate influenza. A shocking fact is that OTC meds like Tylenol, Mucinex, decongestants, etc. provide an estimated $102 billion in annual savings for the US healthcare system. Using OTC meds = decreased use of the healthcare system and you won’t be in the waiting room getting others sick. Don’t get me wrong, if you have severe symptoms, like shortness of breath or if you can’t keep food down, you need to see your doctor.
- Which flu shot should I get? If you are over 65 look for the high dose trivalent vaccine if you can find it, that is better for you than the standard dose trivalent vaccine. Quadrivalent influenza vaccines may be used interchangeably with trivalent vaccines.
- Go for the Quad if you can. The quadrivalent influenza vaccine, which covers four strains instead of three, has been around for two years. The quad reduces influenza cases, hospitalizations, and deaths compared with a trivalent vaccine. Not everyone has it but if you have access to it, get it.
- Pass the flu please. How do you get it? Most experts believe that flu viruses spread mainly by droplets made when people with flu cough, sneeze, or talk. These droplets can land in the mouths or noses of people who are nearby. Less often, a person might also get flu by touching a surface or object that has flu virus on it and then touching their own mouth, eyes, or possibly their nose.
- Period of contagiousness. You may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick. Most healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5 to 7 days after becoming sick. Stay home if you can, really.
- How serious is the flu? Every flu season I have seen at least one death due to Influenza at our hospital. Influenza can be complicated by pneumonia, which is a serious infection or inflammation of the lungs, and this is how it kills you. Influenza is the only infectious disease still in the top 10 causes of death in the United States. In some age groups it’s top 6.
Approximately 29 million Americans, or 9.3 percent of the U.S. population, have diabetes, and of those, one out of four don’t know they have it. With so many affected by diabetes, the costs associated with it are a growing problem. More than 1 in 10 health care dollars in the U.S. are spent directly on diabetes and its complications. As of 2012, the total healthcare costs for diagnosed diabetes in the U.S. is roughly $245 billion, an increase of 41 percent since 2007. That includes direct medical costs of $176 billion worth of hospital and emergency care, doctor visits, and medications. And according to the American Diabetes Association, a person with diabetes spends on average $13,700 per year on care.
National Diabetes Month, held every November, is not only a time of year to raise awareness and hold discussions about diabetes prevention and treatment, but to discuss the harm that high care costs can cause. A recent poll conducted by Consumer Reports Best Buy Drugs found that when people can’t afford their health care, they resort to potentially dangerous actions—putting off doctor’s appointments and medical procedures, not filling prescriptions, skipping medication doses, and even taking expired prescriptions.
If you think you might have diabetes (read about symptoms here), don’t delay—schedule an appointment your doctor right away and get tested. Type 2 diabetes is a complicated disease that more than doubles the risk of developing and dying of heart disease. It also raises your risk of stroke, nerve damage, blindness, impotence, amputation, premature death, and other serious health problems. Detecting it early on is both lifesaving as well as money-saving.
If it turns out you do have diabetes, talk with your doctor about lifestyle changes, such as weight loss and dietary changes that can help you control the disease. Those measures can be as effective medication, especially in the early stages of diabetes and can result in lower long-term medical costs, from, for instance, insulin and other injectable diabetes drugs.
If you and your doctor determine that medication makes sense, try metformin first. In recent years, a strong medical consensus has emerged in the U.S., Europe, and Australia that most newly diagnosed people with diabetes who need a medicine should first be prescribed this drug. If metformin fails to bring your blood glucose into the normal range, you may need a second drug—either glipizide or glimepiride are good options. These medicines are available as low-cost generics, costing from $4 to $35 a month, and work just as well as newer classes of diabetes drugs. In fact, a number of the newer drugs do not lower blood sugar as well as metformin, glipizide, or glimepiride.
To further trim costs, take advantage of state and local programs that you may be eligible for, for example, the nonprofit group NeedyMeds offers help finding diabetes-specific prescription assistance programs that help you afford your medicines. Partnership for Prescription Assistance and RxAssist are similar programs that offer help affording care and you don’t need to be uninsured to qualify for assistance.
Thanks to the Affordable Care Act, you cannot be denied coverage because of preexisting conditions, such as diabetes, and many insurance companies now offer disease management programs for people with diabetes or other chronic diseases. Medicare helps pay for the diabetes services, supplies, and equipment and for some preventive services for people who are at risk for diabetes, although coinsurance or deductibles may apply. And some pharmacies will offer programs to help monitor your condition and keep tabs on your blood sugar.
- Ginger Skinner
Ginger Skinner is a writer for Consumer Reports Best Buy Drugs, a public education project dedicated to helping you talk to your doctor about prescription drugs, and helping you find the most effective and safest drugs for the best price. To stay up to date on Best Buy Drugs news and advice, connect with them on Facebook, Google+, and Twitter, and sign up for the free monthly e-alerts.
Each year, the Great American Smokeout takes place on the third Thursday of November, sponsored by The American Cancer Society. This year’s Smokeout is on November 20, 2014!
The first Great American Smokeout took place at Union Square in San Francisco, California on November 16, 1977 and it has successfully continued for 39 years and counting.
The goal is to encourage tobacco users to think about kicking their habit—whether it’s cigarettes, cigars, pipes, or other forms of tobacco—for 24 hours. Hopefully by trying to quit for 24 hours, smokers will be inspired to make the decision to stop forever.
This event not only supports the decision to make a life-long commitment to quit smoking but also tries to raise public awareness of the harm and danger smoking can cause.
What are some of the dangers of smoking?
We all know that smoking is harmful to the lungs and can cause lung cancer, but the dangerous effects of smoking don’t stop there.
Smoking can cause many other types of cancer, including cancers of the mouth, throat, larynx, esophagus, bladder, kidney, pancreas, cervix, and stomach.
Smoking can also cause many other health-related issues like heart disease and stroke.
Are there benefits to quitting even if you’ve been a long-time smoker?
Yes. Regardless of whether you are a long time smoker, a new smoker, or anywhere in between, the benefits of quitting begin almost immediately. Here’s a timeline outlining the immediate and future benefits of quitting tobacco.
- Within 20 minutes after your last tobacco use, heart rate and blood pressure drop
- Within 12 hours, levels of carbon monoxide in the blood return to normal
- 2 weeks to 3 months after quitting, circulation and lung function improves
- 1 to 9 months after quitting, coughing and shortness of breath decrease and your cilia (tiny hairs lining the lungs to keep them clean) start to regain normal function
- 1 year after quitting, your excess risk of coronary artery disease is reduced to half of that of a current smoker
- 5 years after quitting, your cervical cancer risk is equal to that of a nonsmoker (for women), your stroke risk is equal to that of a nonsmoker, and your risk for cancers of the mouth, throat, esophagus and bladder are cut in half
- 10 years after quitting, your risk of dying from lung cancer is reduced to half of that of a current smoker, and your risk of larynx and pancreatic cancers decrease
- 15 years after quitting, your risk of coronary heart disease is equal to that of a nonsmoker
Are there medications that can help with quitting smoking?
Yes—smoking cessation products (used to help you quit smoking) can help you with your goal of becoming tobacco free. There are both over-the-counter (non-prescription) and prescription medications available.
You’ve probably heard of nicotine patches, gum, and lozenges, all of which are available in your local pharmacy without a prescription.
Some other options that do require prescription include
For more information and other prescriptions that might help, see the American Cancer Society’s overview here.
What are some other ways to get help with quitting smoking?
There are many non-medication options for smoking cessation.
Behavioral therapy, including clinical intervention and individual or group counseling works for many people. You can do this face-to-face or even online.
If you prefer to quit on your own, there are a lot of great resources out there. Check out some of these sites for more help:
- Quit for Life Program from The American Cancer Society
- Quit Smoking from The Centers for Disease Control and Prevention (CDC)
- Quit Tobacco: Make Everyone Proud from The Department of Defense
- Stop Smoking from The American Lung Association
- Smoking Cessation 101 from the FDA
- 1-800-QUIT-NOW, the National Tobacco Quit line