Over the past year, Schaeffer Center experts authored over 130 journal articles and 14 white papers, including insightful and timely work on the cost of insulin, the burden of COVID-19 and pharmacy deserts. Below is a look back at 15 of the most-read studies from 2021.
1. Health Technology Assessment in the U.S.: A Vision for the Future
Schaeffer Center and The Aspen Institute’s Health, Medicine & Society Program convened a year-long advisory panel to ascertain and recommend how health technology assessments could be improved within the U.S. healthcare system to better link the price of innovations to the benefits they provide for individuals and society.
2. COVID Vaccination Mandates for School and Work are Sound Public Policy
In July 2021, the Schaeffer Center published a white paper evaluating the effectiveness of workplace vaccine mandates, finding they are sound public policy. Karen Mulligan and Jeffrey Harris conclude that the federal government has an important role to play in endorsing these mandates while making sure vulnerable communities are protected.
3. Payment for Dialysis Services in the Individual Market
Monthly spending on outpatient dialysis services for end-stage kidney disease (ESKD) patients was three times higher for patients insured in the individual market compared to patients insured through Medicare. Erin Trish, Matthew Fiedler, Ning Ning, Eugene Lin, and Loren Adler find that a growing segment of patients with ESKD received coverage through a private payer, which raises concerns about dialysis facilities subsidizing ESKD patients’ individual market premiums.
4. Untangling the Cost of Insulin
Karen Van Nuys, Neeraj Sood, Rocio Ribero and Martha Ryan offered one of the most comprehensive looks at the insulin distribution chain, showing which players are profiting, and by how much, from selling insulin. They find middlemen now take home approximately 53% of the net proceeds from the sale of insulin, up from 30% in 2014.
5. Effect of COVID-19 Vaccine Allocation Strategies on Vaccination Refusal: A National Survey
Last winter, public officials had to decide which groups would receive priority for the limited quantities of newly approved COVID-19 vaccines. Wändi Bruine de Bruin and Dana Goldman co-authored research that finds that the number of people reporting they would eventually refuse a COVID-19 vaccine increases if they felt “overlooked” during the initial allocation process.
6. Disparities in County COVID-19 Vaccination Rates Linked to Disadvantage and Hesitancy
Despite widespread access, there are still wide discrepancies in COVID-19 vaccine coverage in communities across the U.S. John Romley, Matthew Crane and Ruth Faden find that 20% of U.S. counties have high levels of both vaccine hesitancy and social vulnerability and continue to be most at risk of failing to achieve high vaccination coverage. Furthermore, their analysis shows vaccine hesitancy and social vulnerability have independently impacted vaccine rates.
7. Fewer Pharmacies in Black And Hispanic/Latino Neighborhoods Compared With White Or Diverse Neighborhoods, 2007–15
An analysis from Jenny Guadamuz and Dima Qato reveals that Black and Latino neighborhoods in the 30 most populous U.S. cities had fewer pharmacies than white or diverse neighborhoods. “Pharmacy deserts” — like so-called food deserts — may be an overlooked contributor to persistent racial and ethnic health disparities.
8. Impacts of First-in-Class Drug Approvals on Future in-Class Innovation
Researchers evaluated whether there is a link between Food and Drug Administration approvals of first-in-class drugs and future innovation in that disease area. Alison Sexton Ward, Karen Van Nuys and Darius Lakdawalla identified multiple factors that together determine the outcomes in specific cases, showing that both economic theory and empirical evidence suggest a complex relationship between FDA approval decisions and future innovations.
9. Reassessing the Value of Minimally Invasive Technologies in the Era of COVID-19
Surges in hospitalization rates throughout the pandemic forced medical centers into difficult decisions, such as canceling scheduled elective surgeries or transferring ICU patients to step-down units sooner. Darius Lakdawalla, Dana Goldman, Karen Van Nuys, and Dan Mendelson examined the benefits of minimally invasive technologies, finding they can increase surge capacity to ensure hospitals are prepared for the next pandemic.
10. Evaluation of the Abbott BinaxNOW Rapid Antigen Test for SARS-CoV-2 Infection in Children: Implications for Screening in a School Setting
Neeraj Sood and colleagues compared the results of rapid antigen tests against PCR tests in kids ages 5-17. Their findings suggest that, when deployed regularly, less costly rapid antigen tests can be an effective tool for schools to identify students with high viral loads of COVID-19.
11. Measuring the COVID-19 Mortality Burden in the United States
Darius Lakdawalla, Bryan Tysinger, Hanke Heun-Johnson and Julian Reif calculated the mortality burden from the first year of the pandemic by measuring years of life lost. They find life-years lost from premature mortality were distributed almost equally across elderly and younger adults.
12. Advancing the Economics of Palliative Care: The Value to Individuals and Families, Organizations and Society
Many U.S. patients with serious illnesses do not receive palliative care to manage their pain and other symptoms through patient-centered care coordination and planning. This background paper, authored by chairs of an advisory panel established by the Schaeffer Center, sets the stage for a research agenda that advances palliative care in the United States and makes a case for funders to support this research.
13. The 340B Drug Pricing Program: Background, Ongoing Challenges and Recent Developments
The 340B Drug Pricing Program allows hospitals to purchase covered drugs at a discount as long as a percentage of their patients qualify for low-income Medicare or Medicaid benefits. Research by Karen Mulligan suggests that the program could be modified to better serve its aims of stretching federal dollars.
14. Comparison of Spending on Common Generic Drugs by Medicare vs Costco Members
Erin Trish, Laura Gascue, Rocio Ribero, Karen Van Nuys and Geoffrey Joyce compared Medicare Part D prescription drug prices with those paid by Costco members, finding that the federal government overpaid on roughly half of the most common generic medicines in 2018. The findings suggest the practices of intermediaries, who effectively negotiate drug prices on behalf of Medicare, don’t necessarily pass on the savings to beneficiaries and taxpayers.
15. Deaths Tied to Opioids Rose Among Less-Educated Whites Following L.A. County’s Stay-At-Home Order
Schaeffer Center experts partnered with the L.A. County Medical Examiner-Coroner’s Office to analyze whether the stay-at-home orders instituted at the beginning of the coronavirus pandemic impacted opioid-related fatal overdoses. Jason Doctor and the team find that stay-at-home orders implemented in L.A. County during March and April 2020 were associated with a shift in the demographics of those who suffered a fatal overdose.