Reducing high blood cholesterol level with drugs: cost-effectiveness of pharmacologic management

Article Abstract:

Current guidelines from the National Cholesterol Education Program (NCEP) suggest that people with high blood cholesterol levels that do not fall as a result of diet therapy should take cholesterol-lowering medication. Such medication, however, can be expensive. Since several agents are available, a cost-effectiveness study of six medications was carried out. These were cholestyramine, colestipol, gemfibrozil, lovastatin, niacin, and probucol. This kind of analysis has special relevance for Medicare beneficiaries, who could incur considerable costs if they followed the NCEP recommendations. The cost-effectiveness analysis included considerations of effectiveness as noted in the medical literature, estimates of the direct medication costs, use of two models (a clinical trial and a primary care model) to figure cost-effectiveness, and performance of sensitivity analyses of the assumptions that supported the study. The results indicated that lovastatin, colestipol and cholestyramine cause the greatest reduction in levels of low-density lipoprotein cholesterol (LDL-C, the form in which cholesterol is carried into the walls of blood vessels), and niacin and gemfibrozil led to the biggest increases in high-density lipoprotein cholesterol (HDL-C) levels (also considered a beneficial change). The costs for one year of treatment varied from $327 (niacin) to $1,881 (lovastatin). In the clinical trial model, niacin has the lowest cost per 1 percent reduction in levels of LDL-C ($139). Gemfibrozil is approximately as effective as niacin, but costs more. Cholestyramine had the highest cost for a 1 percent reduction in LDL-C ($347). Niacin was the most cost-effective agent for raising HDL-C ($116 per percentage point of change), and cholestyramine, the least efficient ($1,695). In general, niacin, lovastatin, and gemfibrozil were the most cost-effective agents for improving blood cholesterol levels. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Finance, Drug therapy, Hyperlipidemia, Hypercholesterolemia, Anticholesteremic agents

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Avoiding bias in the conduct and reporting of cost-effectiveness research sponsored by pharmaceutical companies

Article Abstract:

Pharmaceutical companies are under pressure to prove their products and to be cost-effective. They also support the majority of academic research concerning this topic. In turn, investigators (particularly young researchers who require funding) benefit from their support. While most of these symbiotic associations lead to valid results, conflicts of interest can arise because companies always benefit more from favorable results. The authors performed 33 economic analyses of pharmaceutical companies in recent years; in this article, they evaluate industry-sponsored economic analysis. The important ethical issues confronting the industry-sponsored researcher are discussed. The subject of industry-sponsored economic analysis of drugs is not commonly discussed. Economic studies usually use nonstandardized methods of data analysis; involve subjective interpretation of results; compare only products already in use, rather than all those that could be approved; and are usually supervised by marketing departments. The entire field of economic analysis is relatively new and, as yet, unsupervised by any external agency. Because of the lack of standardization of measures, biases can be introduced; these are described. While intentional efforts to manipulate results are rare, the data are subject to several types of bias before they are released. Ways of reducing such tendencies include formulating agreements between companies and researchers as grants, rather than contracts, which would allow publication of the findings even if funding is withdrawn. All available drugs for treating a particular condition should be compared for cost-effectiveness, and researchers should be able to modify the company's suggested study design if necessary. Other suggestions are presented. Published studies should state clearly that they have followed such protocols to avoid the perception of conflict of interest. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pharmaceutical industry, Ethical aspects, Pharmaceutical research, Cost (Economics), Costs (Economics), editorial

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Substituting diagnostic services: new tests only partly replace older ones

Article Abstract:

One reason for the high operating costs experienced by hospitals may be the increased adoption of expensive new technology combined with a reluctance to abandon outdated diagnostic technologies. A study of 63 acute care hospitals indicated that an increase in the utilization of new diagnostic technologies is associated with large hospital size, more residency programs, high occupancy rates, and an urban location. Hospitals having a high percentage of family physicians or general practitioners have lower rates of adopting new diagnostic technologies. While new technologies generally are used to complement older tests the latter often provide the same information. Physicians may be more willing to use a new test if it is more accurate, easier to perform, less risky or less expensive than the older test. This data predated prospective payment by Medicare and may reflect an era when funds for capital expenditures were more easily obtained. New technology appears to be adopted gradually, as older technologies are slowly abandoned.

Analysis, Usage, Medical economics, Hospital utilization, Medical innovations, Medical technology, Diagnostic services, Cost shifting (Medical care)

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