Evaluation of four disease management programs: evidence from blue cross blue shield of Louisiana

Aims: Chronic diseases impose a substantial healthcare burden. This study sought to evaluate the clinical and economic impact of new disease management (DM) programs, targeting four major chronic disease groups: diabetes, coronary heart disease (CHD)/hypertension (HTN), asthma/chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF)/chronic kidney disease (CKD).Materials and methods: Between March 1, 2015, and February 28, 2018, members with Blue Cross Blue Shield of Louisiana insurance were contacted and enrolled in a DM program if they were aged 18 years through 64 years, eligible for a DM program, and had not been previously enrolled in a DM program. Active enrollees of a DM program ("IN" group) were compared to members who were not yet enrolled ("OUT" group). Average per member per month (PMPM) costs were aggregated annually to document any descriptive trends. Multivariable model estimates were used to compare PMPM costs for all IN subjects and all OUT subjects. Total medical savings were evaluated for the following time intervals: 1-12 months, 13-24 months, and 25-36 months.Results: For all four DM programs, average costs PMPM trended upward over time for the OUT cohort, while they remained relatively stable for the IN cohort. Some evidence also showed that DM programs improved clinical outcomes, such as hemoglobin A1c values. A difference in difference analysis showed PMPM savings for all four programs combined of $31.61, $50.45, and $53.72 after 1, 2, and 3 years, respectively. Multivariable modeling results showed total savings after 3 years of $14,460,174 for all DM programs combined.Limitations: Although multivariable models adjusted for several clinical, demographic, and economic characteristics; it is possible that some important confounders were missing due to lack of data.Conclusions: DM programs implemented to control diabetes, CHD/HTN, CHF/CKD, and asthma/COPD are cost-effective and show some evidence of improved clinical outcomes.

The effect of oral deferoxamine on iron absorption in humans

Acute iron overdose is a serious cause of morbidity and mortality, however, optimal gastric decontamination procedures in iron overdose are unclear. In order to determine the effectiveness of oral deferoxamine mesylate solution in humans to prevent the absorption of iron in acute exposures, the following prospective case control crossover study was designed. Seven informed adult human volunteers were given an oral dose of 5 mg/kg elemental iron alone in a control phase and again in an experimental phase followed by a single equimolar dose of oral buffered deferoxamine solution. Plasma iron concentrations were determined spectrophotometrically for eight hours following administration of iron alone and following doses of iron with deferoxamine. There was no significant difference in peak iron concentration, time to peak iron concentration or area-under-the-curve between the two groups. Based on our results, equimolar doses of oral deferoxamine do not appear to decrease the absorption of low doses of oral iron in humans.

Peptide histidine isoleucine-induced elevations in ACTH and corticosterone in the rat

Peptide histidine isoleucine (PHI) is one of many neuropeptides found in both the periphery and the central nervous system (CNS). In the present work, we compared the effects of intravenous (IV) and hypothalamic (PVN) administration of PHI on plasma ACTH and corticosterone (CORT) secretion 2 h after the onset of light in fasted, freely moving male rats. The PVN administration of PHI (0.15, 0.30, 1.50, and 3.0 nmol/rat) elicited significant, dose-dependent increases in plasma ACTH and CORT concentrations that were maximal at 15 min postadministration and fell gradually over 60-120 min. The highest dose of PHI increased ACTH and CORT to 821% and 340% of time-matched control levels, respectively. The IV injection of PHI (3.0 nmol/rat) also raised plasma ACTH and CORT levels in these animals. However, the peak response (at 15 min postinjection) to the same dose of PHI was much lower following IV administration (ACTH 188% of control; CORT 210% of control) than after PVN administration. These results suggest that endogenous PHI may be a physiological regulator of ACTH and CORT secretion in rats and that the PVN is a major site for its action.