sj-docx-1-sat-10.1177_11782218221126972 – Supplemental material for Associations Between Copays, Coverage Limits for Naloxone, and Prescribing in Medicaid

Supplemental material, sj-docx-1-sat-10.1177_11782218221126972 for Associations Between Copays, Coverage Limits for Naloxone, and Prescribing in Medicaid by John C Messinger, Aaron S Kesselheim, Seanna M Vine, Michael A Fischer and Rachel E Barenie in Substance Abuse: Research and Treatment</p

Sodium-Glucose Co-Transporter 2 inhibitors and the Short-term Risk of Bladder Cancer: An International Multi-Site Cohort Study

   Objective: To determine whether sodium-glucose co-transporter 2 (SGLT2) inhibitors, compared with glucagon-like peptide-receptor agonists (GLP-1RAs) or dipeptidyl peptidase-4 (DPP4) inhibitors are associated with an increased risk of early bladder cancer events. Research Design & Methods: We conducted a multi-site, population-based, new-user active comparator cohort study using the United Kingdom Clinical Practice Research Datalink, Medicare fee-for-service, Optum© Clinformatics® Data Mart, and MarketScan Health from January 2013 through December 2020. We assembled two cohorts of adults with type 2 diabetes initiating (1) SGLT2 inhibitors or GLP-1RAs, and (2) SGLT2 inhibitors or DPP4 inhibitors. Cox proportional hazards models were fit to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of incident bladder cancer. The models were weighted using propensity score fine stratification. Site-specific HRs were pooled using random-effects models. Results: SGLT2 inhibitor (n=453,560) and GLP-1RA (n=375,997) users had a median follow-up ranging from 1.5-2.2 years. Overall, SGLT2 inhibitors were not associated with an increased risk of bladder cancer, compared with GLP-1RAs (HR=0.90; 95% CI: 0.81-1.00). Similarly, when compared with DPP-4 inhibitors (n=853,186), SGLT2 inhibitors (n=347,059) were not associated with an increased risk of bladder cancer (HR: 0.99, 95% CI: 0.91-1.09) over a median follow-up ranging from 1.6-2.6 years. Results were consistent across sensitivity analyses. Conclusions: Contrary to previous randomized controlled trials, these findings indicate that the use of SGLT2 inhibitors is not associated with an increased risk of bladder cancer when compared with GLP-1RAs or DPP4 inhibitors. This should provide reassurance on the short-term effects of SGLT2 inhibitors on bladder cancer incidence.</p

The impact of using reinforcement learning to personalize communication on medication adherence: findings from the REINFORCE trial

Abstract Text messaging can promote healthy behaviors, like adherence to medication, yet its effectiveness remains modest, in part because message content is rarely personalized. Reinforcement learning has been used in consumer technology to personalize content but with limited application in healthcare. We tested a reinforcement learning program that identifies individual responsiveness (“adherence”) to text message content and personalizes messaging accordingly. We randomized 60 individuals with diabetes and glycated hemoglobin A1c [HbA1c] ≥ 7.5% to reinforcement learning intervention or control (no messages). Both arms received electronic pill bottles to measure adherence. The intervention improved absolute adjusted adherence by 13.6% (95%CI: 1.7%–27.1%) versus control and was more effective in patients with HbA1c 7.5- < 9.0% (36.6%, 95%CI: 25.1%–48.2%, interaction p < 0.001). We also explored whether individual patient characteristics were associated with differential response to tested behavioral factors and unique clusters of responsiveness. Reinforcement learning may be a promising approach to improve adherence and personalize communication at scale

Cost effectiveness of childhood obesity interventions: Evidence and methods for CHOICES

INTRODUCTION: The childhood obesity epidemic continues in the U.S., and fiscal crises are leading policymakers to ask not only whether an intervention works but also whether it offers value for money. However, cost-effectiveness analyses have been limited. This paper discusses methods and outcomes of four childhood obesity interventions: (1) sugar-sweetened beverage excise tax (SSB); (2) eliminating tax subsidy of TV advertising to children (TV AD); (3) early care and education policy change (ECE); and (4) active physical education (Active PE). METHODS: Cost-effectiveness models of nationwide implementation of interventions were estimated for a simulated cohort representative of the 2015 U.S. population over 10 years (2015-2025). A societal perspective was used; future outcomes were discounted at 3%. Data were analyzed in 2014. Effectiveness, implementation, and equity issues were reviewed. RESULTS: Population reach varied widely, and cost per BMI change ranged from $1.16 (TV AD) to$401 (Active PE). At 10 years, assuming maintenance of the intervention effect, three interventions would save net costs, with SSB and TV AD saving $55 and$38 for every dollar spent. The SSB intervention would avert disability-adjusted life years, and both SSB and TV AD would increase quality-adjusted life years. Both SSB ($12.5 billion) and TV AD ($80 million) would produce yearly tax revenue. CONCLUSIONS: The cost effectiveness of these preventive interventions is greater than that seen for published clinical interventions to treat obesity. Cost-effectiveness evaluations of childhood obesity interventions can provide decision makers with information demonstrating best value for the money