CHICAGO—Patients with leukemia or lymphoma who undergo hematopoietic cell transplantation (HCT) and survive can expect full recovery to take 3-5 years, according to a study published in the May 19 issue of the Journal of the American Medical Association (JAMA).

Hematopoietic cell transplantation (receipt of bone marrow transplant or stem cells transplant) is an effective and widely used treatment for hematologic malignancies, according to background information in the article. The rate and predictors of physical and emotional recovery after HCT have not been adequately defined in long-term studies. Improved understanding of recovery could facilitate more accurate informed consent, permit better planning by patients, families, and medical teams, and enable the design of interventions to improve functional recovery.

Karen L. Syrjala, Ph.D., of the Fred Hutchinson Cancer Research Center, Seattle, and colleagues conducted a study to examine recovery of physical and mental health and return to work after HCT for treatment of leukemia or lymphoma. Patient function was assessed from pretransplantation to 5-year follow-up for 319 adults who had myeloablative (bone marrow suppression) HCT for treatment of leukemia or lymphoma. Of the 99 long-term survivors who had no recurrent malignancy, 94 completed 5-year follow-up.

The researchers found that physical recovery occurred earlier than psychological or work recovery. Only 19 percent of patients recovered on all outcomes at 1 year. The proportion without major limitations increased to 63 percent by 5 years.

"Results of this prospective longitudinal study show that recovery after HCT occurs gradually over 1 to 5 years as measured by improvement in physical function, return to work, depression, and treatment-related distress. Given adequate time, 84 percent of survivors returned to full-time work. At some point during treatment or recovery, 22 percent of the patients had symptoms consistent with clinical depression while an additional 31 percent had mild depressive symptoms. Higher levels of depression, lower levels of physical function, and less satisfaction with social support before HCT increased the risk of impaired physical and emotional recovery after the transplantation. Women had increased risk for depression, treatment-related distress, and delayed return to full-time work. Conversely, previous experience with chemotherapy or radiation therapy before beginning HCT seemed to facilitate recovery from the psychological aspects of this intensive treatment," the authors write.

CHICAGO—Significant increases in co-payments may reduce the use of medications and raise concern about adverse health consequences, according to a study published in the May 19 issue of the Journal of the American Medical Association (JAMA).

In background information in the article the authors write, "In recent years, many health plans have implemented policies to contain drug costs, including raising beneficiary co-payments, mandating use of generics, requiring mail-order services, and expanding use of formularies, all of which have large effects on total drug spending. For example, doubling co-payments reduced total drug spending by 19 percent to 33 percent in one multiyear study of 25 companies."

Dana P. Goldman, Ph.D., from RAND, Santa Monica, Calif., and colleagues examined how changes in benefit design among privately insured populations affect use of the most commonly used drug classes. The researchers analyzed data from pharmacy and medical claims from 1997 to 2000 for 30 large U.S. employers and 52 health plans covering 528,969 beneficiaries, aged 18 to 64 years, continuously enrolled for up to four years.

"Doubling co-payments was associated with reductions in use of eight therapeutic classes," the authors report. "The largest decreases occurred for nonsteroidal anti-inflammatory drugs (NSAIDS) (45 percent) and antihistamines (44 percent). Reductions in overall days supplied of antihyperlipidemics [cholesterol lowering] (34 percent), antiulcerants (33 percent), antiasthmatics (32 percent), antihypertensives (26 percent), antidepressants (26 percent), and antidiabetics (25 percent) were also observed." The researchers found that patients diagnosed as having a chronic illness and receiving ongoing care were not as likely to reduce their use of medications. "Use of antidepressants by depressed patients declined by 8 percent; use of antihypertensives by hypertensive patients decreased by 10 percent. Larger reductions were observed for arthritis patients taking NSAIDs (27 percent) and allergy patients taking antihistamines (31 percent). Patients with diabetes reduced their use of antidiabetes drugs by 23 percent."

CHICAGO—A temporary suspension of the initial dose of hepatitis B vaccine appears to have contributed to fewer newborns being vaccinated for hepatitis B in 2000 than in 1998, according to a study published in the May 19 issue of the Journal of the American Medical Association (JAMA).

In 1991, the Advisory Committee on Immunization Practices (ACIP) recommended that all children receive 3 doses of hepatitis B vaccine by 19 months of age, part of a comprehensive strategy to eliminate hepatitis B virus (HBV) transmission in the United States, according to background information in the article. The first dose should be administered within 12 hours of birth to infants whose mothers are hepatitis B surface antigen (HBsAg)-positive or of unknown HBsAg status; vaccination at birth of children of HBsAg-negative mothers is preferred but should not be delayed beyond the age of 2 months.

In July 1999, the recommendation to begin hepatitis B vaccination at birth was temporarily suspended because of concerns about exposure to mercury contained in the vaccine preservative thimerosal. The suspension was lifted in September 1999 when preservative-free hepatitis B vaccine became available.

Elizabeth T. Luman, M.S., of the National Immunization Program, Centers for Disease Control and Prevention, Atlanta, and colleagues evaluated both the immediate and residual impact of the suspension of the birth dose of hepatitis B vaccine on vaccination coverage. The study included an analysis of vaccination status of 41,589 U.S. children born before, during, and after the recommendation to suspend the birth dose.

"In the year before the suspension, [47 percent] of children received a hepatitis B vaccine dose on the first day. First-day coverage decreased to 11 percent among children born during the suspension. For children born in the 6 months after and in months 7 to 12 after the suspension, first-day coverage was 23 percent and 33 percent, respectively (compared with baseline at months 7-12 before the suspension)," the authors write. "This reduction represents 750,000 fewer newborns vaccinated during 2000 compared with 1998." They add that these reductions also represent an excess 182,000 children undervaccinated for hepatitis B at 19 months of age compared with 1998 coverage levels. Coverage with other recommended vaccinations did not decline over this time.

HIGHER PHARMACY CO-PAYS LINKED TO LESS MEDICATION USE, EVEN IN CHRONICALLY ILL PATIENTS WHO SHOULDN'T LESSEN USE