Drugs Save Lives, And Money

Lest we be accused of never reporting the good news, I was impressed by two studies that came out today, one from the health economics journal Health Affairs and the other from the Journal of the American Medical Association. Both showed that people who consistently take their medicine after heart attacks suffer fewer second incidents in the following year, and, as a result, save the health care system a lot of money.

Unfortunately, that's not how things work in our insurance company-based health care system, where high individual co-pays force many heart patients to stop refilling their prescriptions once they've gotten a few months beyond the first attack. Niteesh K. Choudhry, a physician at Brigham and Women’s Hospital in Boston and an assistant professor at Harvard Medical School, and colleagues reviewed the medical histories of patients hospitalized for a second heart attack and found that fully half had stopped taking their cholesterol-lowering and blood pressure control medications. Why? The average out-of-pocket expense was about 32 percent of the cost of the drugs.

By eliminating that co-pay, Choudhry estimated, it would raise the compliance rate to better than three-fourths of the patients. The result would be the elimination of 15 heart attacks, strokes or hospitalizations for congestive heart failure for every 100 patients kept on the drugs. In other words, by absorbing an additional $644 per patient by eliminating co-pays, insurance companies would save nearly $6,000 per patient. (When every hospitalization runs tens of thousands of dollars, you can easily see why.)

Meanwhile, the JAMA study (subscription required) by Jeppe Rasmussen and colleagues at the government-funded Institute for Clinical Evaluative Sciences in Toronto showed that not all drugs were equally effective in preventing second heart attacks. Statins for lowering cholesterol were most effective; beta-blockers for lowering blood pressure were next best, and calcium channel blockers were not effective at all, according to their study.

They had a different goal in mind when they set out to do their research. They wanted to disprove the "healthier adherer" hypothesis, which suggests that people who take their drugs religiously -- no matter what they are -- tend to do better. Well, not only did they disprove that, but they proved that some drugs are better than others, the kind of comparative research that drug companies never do.

This brings me to a story in many papers today that reported on a study out of Harvard that showed that beverage studies funded by industry overwhelmingly favored their sponsor's products. Meanwhile, those independently-funded or government-funded were much less likely to do so. I was a co-author on that study, having done some of the technical work in analyzing the funding sources.

Several reporters called me to ask: So, what's the solution? I said, whenever possible, government agencies should rely on government- or non-profit-funded research for regulatory decision-making. If that's not possible because of costs, the government should create an independent institute that can serve as a screen for industry research funding. In other words, the institute would act as a firewall between the hypothesis-driven researcher and the source of his or her funds.

Don't hold your breath. But as the folks up in Canada showed, you can get some wonderful serendipitous results that way.

Posted by gooznews at January 9, 2007 10:06 PM