Annals of Internal Medicine tip sheet for 1 Jan. 2013

(Press-News.org) 1. Distributing Naloxone to Heroin Users May be a Cost-effective Way to Reduce Overdose Deaths

Distributing naloxone to heroin users to use to reverse overdose may be a cost-effective strategy to reduce overdose-related mortality. Opioid overdose is a leading cause of accidental death in the United States and accounts for half of the mortality among heroin users. Naloxone is a short-acting opioid antagonist that can reverse opioid overdose. Researchers developed computer models to estimate the cost-effectiveness of distributing naloxone to heroin users for use at witnessed overdoses. In the simulation, researchers compared the cost-effectiveness of distributing naloxone to 20 percent of heroin users with no distribution. Cost-effectiveness was expressed in terms of costs, quality-adjusted life-years (QALY), and incremental costs per QALY gained. The researchers found that naloxone distribution prevented 6.5 percent of all overdose deaths for each 20 percent of heroin users that received a naloxone kit, or one overdose death would be prevented for every 164 naloxone kits distributed. The computer model suggests that the death prevention effect was greater among younger heroin users. According to the authors of an accompanying editorial, naloxone use is limited in the lay population because the U.S. Food and Drug Administration has yet to approve a formulation of naloxone that can be delivered without injection. According to the authors, making naloxone available to prevent overdose deaths should be a priority, but taking steps to prevent opioid dependence is also an important issue that should not be overlooked.

Note: For an embargoed PDF, contact Megan Hanks or Angela Collom. Reporters can reach the lead author, please contact Eileen Shields at Eileen.Shields@sfdph.org or 415-554-2507.

2. Patients with HIV May Benefit from Quadruple the Standard Dose of Seasonal Flu Vaccine

Administering a quadruple dose of seasonal flu vaccine may help better protect HIV-infected patients from serious illness or death from influenza. In a randomized, double-blind, controlled trial, 190 HIV-positive adults were randomly assigned to receive either a standard dose (15 mcg of antigen per strain) or a high dose (60 mcg/strain) of the influenza trivalent vaccine. Participants were included if they were indicated for a flu vaccine and were receiving stable antiretroviral therapy as recommended by current guidelines. The researchers found that the high dose patients achieved greater immune response as measured by their levels of seroprotective antibodies at 21 to 28 days after vaccination. Adverse event rates were similar in the two intervention groups. According to the researchers, these findings could have implications for future vaccination efforts in the HIV-positive population.

Note: For an embargoed PDF, contact Megan Hanks or Angela Collom. You can reach the lead author directly at Pablo.Tebas@uphs.upenn.edu or 215-615-4321.

3. Observation Article: Foodborne Illness Could Have Sinister Causes

Doctors should consider the intentional addition of medicine to food as a potential cause of foodborne disease outbreaks. The World Health Organization suggests possible sources of foodborne disease outbreaks are pathogenic bacteria, viruses, protozoa, parasitic worms, natural toxins, and chemicals, but not medicines. A 2010 foodborne disease outbreak in Beijing, China was a result of clonidine, a medication used to treat hypertension and ADHD, being intentionally added to lunch ingredients. Eighty travelers who had just finished lunch in a Beijing restaurant began to feel faint. Within a few hours they developed dizziness, weakness, lethargy, dry mouth, and nausea, among other troublesome symptoms. At a nearby hospital, the travelers were treated for low blood pressure and low heart rate. With no response to treatment, the patients were referred for a screening for common toxins and drugs. The screening found clonidine in the patients' systems. The patients were treated for clonidine poisoning and symptoms resolved in all patients within 48 hours. After six days, all patients had been discharged from the hospital and at one year no patients had residual symptoms. An investigation found that two persons put clonidine into the starch used to make certain dishes (the kitchen staff would not notice the addition because starch and clonidine are both white, odorless powders) to gain a competitive advantage for a nearby restaurant.

Note: For an embargoed PDF, please contact Megan Hanks or Angela Collom.

4. Limited Evidence to Connect Cost of Health Care to Quality

Researchers need more evidence to determine the connection between health care quality and cost. The nation's heath care costs are rising at an unsustainable rate, making it a priority to control costs. But there is uncertainty as to whether improvements in quality will cause costs to go up or down. Researchers reviewed 61 published studies to determine the association between health care quality and cost. Of 61 included studies, 21 reported a positive or mixed-positive association between higher cost and quality; 18 reported a negative or mixed-negative association between higher cost and quality; and 22 reported no difference, an indeterminate association, or a mixed association. The limited evidence available suggests no clear relationship between cost and quality. The researchers conclude that more research is needed focusing on what types of spending are most effective in improving quality and what types of spending are wasteful. The authors of an accompanying editorial addressing efficient use of health care resources agree that more detailed and timely data is needed to make good medical, operational, and policy decisions. They call for provider organizations to be more transparent about the cost and price of services and for physicians to actively seek the information. They also suggest that those who fund research should support studies that evaluate cost and quality of interventions.

Note: For an embargoed PDF, contact Megan Hanks or Angela Collom. To speak with the lead author, please contact Warren Robak at media@rand.org or 310-451-6913.

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