Independent pharmacies and online coupons help patients save money on drugs

After finding that prices for some common antibiotics can vary by up to $100 in one metropolitan area, experts suggest that patients could save money by shopping for their drugs online or at independent pharmacies. However, few Americans actively comparison shop for health care, according to a separate study.

Lung cancer screening could save money as well as lives, research shows — ScienceDaily

Lung cancer screening is likely to be cost-effective, particularly if it also identifies other tobacco-related conditions in high-risk people, suggests new research published in the Journal of Thoracic Oncology (JTO).

The authors of the study, a multidisciplinary team from Canada, suggest that combining CT screening for multiple conditions with efforts to stop smoking and manage the treatment of non-cancer heart and lung disease could make screening even more cost-effective.

Lung cancer affects millions of families around the world, and treatment is becoming more and more expensive. Healthcare systems are struggling to afford the drugs and give people access to new cancer medicines, so prevention and early detection are increasingly important. By diagnosing smoking-related diseases early on, it could be possible to improve people’s lives, both in length and in quality, more affordably. However, there are currently no national lung cancer screening programs in place, because there was little evidence that the benefit in terms of life improvement would outweigh the financial cost.

The new research shows that large-scale lung cancer screening programs could be economically viable if they targeted high-risk people and were also used to identify non-cancer conditions such as chronic obstructive pulmonary disease (COPD).

Lead author Dr. Sonya Cressman, of The Canadian Centre for Applied Research in Cancer Control, and The British Columbia Cancer Agency in Canada, said: “We need to think about how we manage lung cancer and focus on more economically viable strategies, including prevention and screening. Screening those at a high risk gives us the chance to prevent and treat a range of tobacco-related illnesses, and could also offer access to care for individuals who could be otherwise stigmatized or segregated from receiving treatment.

Dr. Cressman and the team looked at patient-level data from two major screening trials: the National Lung Cancer Screening Trial (NLST) and the Pan-Canadian Early Detection of Lung Cancer Study (PanCan). They built an economic model to simulate the costs and benefits of introducing lung cancer screening programs for high-risk people — those who had a 2% or higher chance of developing lung cancer within six years.

The researchers found that focusing on high-risk people could reduce the number of people who need to be screened by more than 80%. They calculated the cost of screening to be $20,724 (in 2015 Canadian dollars) per year of life saved; this means the screening would be considered cost-effective compared to the benchmark of $100,000 that is often paid for other cancer interventions in national healthcare.

They also concluded that the overall cost-effectiveness of the program could be substantially improved if the health of the people being screened were to improve. Combining CT screening with smoking cessation and management of cardiac care and chronic obstructive pulmonary disease would ultimately improve the cost-effectiveness of lung cancer screening, they say.

“With increasing economic pressure from rising drug costs and a strong industry influence, I was attracted to the area of lung cancer screening as a way to harness existing potential within our healthcare system,” commented Dr. Cressman. “Working with this team of investigators has driven the success of the study. The project arose from a strong multidisciplinary collaboration bringing together experts from across Canada who are passionate about public health and willing to invest their protected time in finding ways to optimize the way lung cancer care is delivered.”

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Money Management in 20s and 30s

Dear E. Jean: I spend my days managing other people’s careers in the fashion industry. I look after their money and oversee enormous project budgets, but I’m 29 and spend zero time on my own finances.

Beyond contributing to the 401(k) provided by my employer, I’m clueless about managing my own portfolio intelligently and fear I’ll have no money when I’m old. I try to save a little each month for emergencies. But after SoHo rent, dinners out, doggy day care, a quick trip with girlfriends to Reykjavík, clothes, shoes, bachelorette parties, hopping over to Prague with my boyfriend for a long weekend, etc., I’m lucky to have anything left to give to charity, let alone a few bucks for emergencies.

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I earn a decent salary. But do I earn enough to warrant a financial adviser? (And where do I find a reputable one?) Is advice from my friend’s investment-banker boyfriend enough? —Bag Lady of 2052

Bags, Old Girl: Ahhh, you and I have more in common than you know. I don’t suppose there’s a woman alive more equipped to advise you—I’m a specialist in not saving money. But first let me tell you a little story about my friend.

People send me many questions about cads. I also answer queries about chumps, heels, half-wits (see the first question), scoundrels, jerks, degenerates, dingbats, creeps with 19 guns in their basements, and so on. But in the whole quarter century I’ve been romping along at the Ask E. Jean desk, one of the lowest chaps I ever ran across was Mr. Bunco.

Mr. Bunco is my friend’s own personal cad and financial adviser.

She says I may go public with their affair because although I’ve warned people against twits, pimps, lechers, and fiends, I haven’t warned them nearly enough against pinstriped polecats like Mr. Bunco.

So listen, Bags: My friend broke up with Bunco because he lied and cheated and boy, did Mr. Bunco neglect her! While the man was peppering her inbox with newsletters about “14-year highs,” her retirement account (IRA)—which Mr. Bunco promised on his website to “tailor to her individual financial objectives,” and which was supposed to be increasing, so my friend could retire one day and embark on a glamorous spree—was leaking (believe me, leaking!) money.

Indeed, after 22 years, her IRA had less money in it than at its inception. Had she e-mailed her Social Security and bank routing numbers to the Nigerian prince whose brother, the astronaut, is stranded in space, she’d be sitting prettier.

Oh, I know what you’re thinking, Miss Bags: E. Jean, come on! Your friend should never have given her hard-earned money to a sweet-talking con man who preys on pitiful ignoramuses like her.

But noooo. Mr. Bunco is worshiped with unceasing delight in the financial press. He occupies the 41st floor of a Wall Street tower with marble floors so expensively shiny that when my friend stepped off the elevator to meet him, she could look up her own skirt.

My friend: I’m unhappy.

Mr. Bunco: I’m sorry you’re unhappy.

My friend: The market has tripled since 2009. How can I have less money in my IRA than I started with 22 years ago?

Mr. Bunco: Let me explain….

They were in his conference room, which looked like one of the larger bathrooms in Hearst Castle, and my friend said it took Mr. Bunco 41 minutes to tell her why her having less money in her IRA than she started with 22 years ago was all her fault. She thought about giving him a running kick out his 41st-floor plate-glass window, but instead she took the elevator to the lobby, called me, and confessed the whole story, including how much she had remaining in her IRA.

And what was that amount? Twice the money I had in my IRA! It turns out I’m a bigger idiot than she is. So I will now endeavor to pound three pieces of advice into your head, Miss Bags:

1. Contribute the full amount your company matches to your 401(k). This is the most painless way to put away money for when you are, as you so poetically put it, “old.” And then watch your portfolio like a hawk! (The defects of my character are endless, but this defect is the most asinine: I never even opened my monthly statements.)

2. Ask the richest women you know who their financial advisers are. Pick the one who’ll help you set smart, doable financial goals and oblige you to stick to them. I recommend Ellevest (no relation to ELLE magazine), a brilliant, low-fee, easy-to-grok investment platform for women. Using the Ellevest projections, I saw that a 29-year-old who earns $50,000 a year and invests 20 percent of her income will have $1,040,230 or more according to the majority of market scenarios at age 66. More than a million! So, yes. Whatever your salary, you do need a financial adviser or a service like Ellevest. And I suppose at this point I should tell you to check if the adviser is a fiduciary, but, frankly, it means diddly-squat. Mr. Bunco was a fiduciary. If you don’t keep your eye on him or her, a fiduciary (a person who supposedly puts your financial interests ahead of his or her own) can lose your money as fast as a nonfiduciary.

3. Don’t shun your fund. I’m pretty good at making money, but terrible at saving it. Check yourself out: has a calculator for figuring how much you should be putting up for a rainy day. Warning: The numbers will shock you so badly that you’ll exchange Prague for a ride around Coney Island on roller skates. Which actually sounds quite fun.

As for me? I’ve transferred my “wealth” to Betterment, an automated investing service, and now robots are working for me.

Who needs a pricey financial consultant when the Betterment algorithms are eliminating human judgment, following the market as a whole, rebalancing my portfolio of index funds and ETFs, harvesting my tax losses (a tax-saving investment strategy), and machine learning and improving as they trade. As the Betterment robots get smarter, I get richer. How rich, Miss Bags? I made more money in one month with Betterment than my friend made in a decade with that chump Bunco.