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Improving Health Care Value by Considering Cost-effectiveness

Mar, 25/09/2018 - 02:00
To the Editor Dr Pandya proposed a definition of low-value care based on the cost-effectiveness of the interventions and not exclusively on their effectiveness. The author presented several examples of interventions that improve the health of patients but are not worth the additional costs to achieve the health gains (eg, health care services with cost-effectiveness ratios >$100?000 to $150?000 per quality-adjusted life-year [QALY] may be effective but inefficient).

Improving Health Care Value by Considering Cost-effectiveness—Reply

Mar, 25/09/2018 - 02:00
In Reply I agree with the points raised by Dr Sacristán. Although services that increase costs and lower health are clearly no-value care, incremental cost-effectiveness analysis can be used to draw the lines between high-value and low-value care when there are trade-offs between health and cost outcomes. These trade-offs can be in either the higher-cost/higher-effectiveness or the lower-cost/lower-effectiveness quadrants of the cost-effectiveness plane.

Adjusted Data for 2013 Birth Cohort in a Table

Mar, 25/09/2018 - 02:00
The Original Investigation entitled “Association of US State Implementation of Newborn Screening Policies for Critical Congenital Heart Disease With Early Infant Cardiac Deaths,” published in the December 5, 2017, issue of JAMA, should have included data for the 2013 birth cohort only through June 2013. The column of 2013 data in Table 2 has been updated with adjusted numbers. In addition, a sentence in the Results section and a sentence in the Limitations section describing the 2013 rate of death due to congenital heart disease have been removed. This article was corrected online. This article was also corrected in February 2018 for an error in the data collection period in the abstract.

Incorrect Values in Results Subsections

Mar, 25/09/2018 - 02:00
In the Original Investigation entitled “Global Mortality From Firearms, 1990-2016” published in the August 28, 2018, issue of JAMA, incorrect values were reported in 2 sections. The fourth sentence in the second paragraph of the Levels and Trends in Aggregate Firearm Injury Deaths section should have read, “Aggregate firearm injury death rates decreased between 1990 and 2016 in most countries; however, rates increased in 41 countries, of which 3 were significant changes (20 of these increases were in the GBD super region of Latin America and the Caribbean [data are reported alphabetically by country or territory]; Figure 1, Figure 2, Figure 3, Figure 4, Figure 5, Figure 6, Figure 7, Figure 8).” Additionally, the third sentence in the Patterns by Age and Sex section should have read, “Globally, among children aged 0 to 14 years, there were an estimated 7220 deaths (95% UI, 5690-8200) from a firearm-related injury in 2016, a rate of 0.4 deaths (95% UI, 0.3-0.4) per 100?000 persons, and there were 2.4 times more firearm deaths for boys than girls in this age group (eTable 12 and eTable 13 in the Supplement).” This article was corrected online.

Omission of Conflicts of Interest

Mar, 25/09/2018 - 02:00
In the Letter to the Editor entitled “Opioids vs Nonopioids for Chronic Back, Hip, or Knee Pain,” published in the August 7, 2018, issue of JAMA, conflict of interest disclosures were omitted. Dr Singh’s full disclosure should have read “Dr Singh reported receiving grant funding from Takeda and Savient and consulting fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta/Horizon, Allergan, WebMD, UBM, Medscape, Fidia, and the American College of Rheumatology; serving as principal investigator for an investigator-initiated study funded by Horizon Pharma through a grant to DINORA, a 501(c)(3) entity; being a member of the executive committee of Outcome Measures in Rheumatology, a member of the American College of Rheumatology’s (ACR) annual meeting planning committee, the Veterans Affairs Rheumatology field advisory committee, chair of the ACR Meet the Professor Workshop and Study Group subcommittee, and editor and director of the University of Alabama at Birmingham Cochrane Musculoskeletal Group Satellite Center on network meta-analysis.” This article was corrected online.

Unit of Measure Error

Mar, 25/09/2018 - 02:00
In the JAMA Clinical Evidence Synopsis entitled “Aspirin Plus Clopidogrel vs Aspirin Alone for Preventing Cardiovascular Events Among Patients at High Risk for Cardiovascular Events” published in the August 14, 2018, issue of JAMA, there was a unit of measure error in the Evidence Profile box. Toward the end of the secondary outcomes section, “bleeding resulting in a decrease of greater than 2 mg/dL in hemoglobin level” should have been “bleeding resulting in a decrease of greater than 2 g/dL in hemoglobin level.” This article was corrected online.

Cystic Fibrosis in Art

Mar, 25/09/2018 - 02:00
This JAMA Arts & Medicine article features work in which artists living with cystic fibrosis express their experiences.

Runner Heal Thyself

Mar, 25/09/2018 - 02:00
I amass injuries like a scoutrarities, high in tariff,applied like badgesor bandages

The Daily Press and the “Futilities of Contemporary Science”

Mar, 25/09/2018 - 02:00
The American public has so long been accustomed to accept the daily press as its mentor in all things which concern human welfare that the pronouncements of its printed columns are sometimes given an undeserved consideration. However sound and enlightening the almost infinite variety of items published in the newspapers may be as a rule, however convincing and worthy the editorial notices may appear when they analyze the current problems of politics, economics, finance or literature, it not infrequently happens that the reputation of science suffers. Our great metropolitan dailies attempt to secure experts in the domain of so-called “humanistic” studies to guide them in public expression of policies or achievements. All too often science is treated as something apart from the worthier interests of the thinking public; and as a consequence the presentation of scientific achievement often occurs in a crude way that makes errors of statement glaring to the intelligent, or else degrades reports of scientific progress by the employment of ignorant facetiousness.

Gallbladder Cancer

Mar, 25/09/2018 - 02:00
This JAMA Patient Page describes the symptoms, diagnosis, and treatment of gallbladder cancer.

JAMA

Mar, 25/09/2018 - 02:00