Drugs: Cost or Value?

Treatment is for all; everyone gets access to the best treatments.

Drugs save lives, but most expensive drugs in terms of total healthcare costs only make us feel well. Should we divert more money to those that have direct impact on total rates of mortality?

Most major lifesaver drugs are for management of cardiovascular disease; from a population perspective we are not doing as well in cancer.

If everyone got the drugs they needed to manage their cardiovascular disease, one third fewer deaths would occur from this condition.

In the future, personalized medicine will make drug therapy more expensive. Everyone will be genotyped and we will predict who will get nasty side effects from a particular drug and who will benefit most. For example, some people respond different to statins than others and this can be tested.

New and better treatments will increase life expectancy with more elderly people with medical needs Most of those over 70 are on chronic therapy and taking multiple medications. At 70, three quarters of people are taking cardiovascular drugs with 62% on blood pressure lowering drugs and 25% taking statins. This is not including any other medicines they may be taking for other conditions.

Taking an individual medicine and analyzing its cost in isolation is not really a good approach. The true cost of a medicine is better calculated using a more holistic approach. For example, aspirin is a cheap drug, but those on aspirin are three times more take an anti-ulcer treatment at the same time. So in terms of preventing secondary cardiovascular events in people who have cardiovascular disease aspirin is cheap, but the true cost is underestimated.

Non-compliance is a hidden healthcare cost. What should be done when clinical measurements raise a doctor’s suspicions that their patient is binning the drugs they prescribe? Why should those who do not comply get more to waste? Why should others then go without treatment when overall costs are high?

Healthcare costs are greatest for conditions with no previous treatments, designer drugs, investigations, new technologies and best treatments. Pharmaceutical companies need to recoup investment costs and make profits, but costs should not preclude treatment offerings to everyone within reason or be exclusive.

The most cost effective management favours more common low burden illnesses over rarer high burden diseases.  In general, health economists and many professionals prefer cost effectiveness, whereas most of the general public think that everyone should have the option of treatments in an ideal society.


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