US healthcare is shown to be cost-effective
New research has concluded that the US healthcare system is cost-effective in terms of extended life expectancy. The study by Alison B Rosen and Sandeep Vijan, University of Michigan Health System (MI, USA), together with David Cutler, Health Economist at Harvard University (MA, USA), has revealed that improved healthcare in the USA over the last 40 years has led to increased life expectancy. The average life expectancy for a US resident born in the year 2000 is approximately 77 years, compared with 70 years for a resident born in 1960. Approximately 3.5 of these increased years of life are attributed to improved healthcare. Other factors, such as fewer smokers and fewer deaths from accidents, suicide and homicide account for the remaining increase in life expectancy.
The study, published in the August 2006 issue of New England Journal of Medicine, concludes that the cost per added year of life is US$19,900. When compared with the value of an added year of life, quoted by insurance companies as US$50,000–200,000, it seems the US healthcare system is cost-effective. “Over the last 40 years, we have been getting good return on our money,” states Allison B Rosen.
However, life expectancy for senior citizens has only increased by 3.5 years since 1960 and the calculated cost of each added year of life for those aged 65 years and older is US$84,700. David Cutler comments “The foremost cause of concern posed by rising medical costs is the tremendous strain coming from increased costs for the elderly…The cost per year of life for seniors is three times higher today than it was in the 1970s.”
Avandia shown to reduce Type 2 diabetes risk
The largest ever study on diabetes prevention has revealed that Avandia® (GlaxoSmithKline, UK) can significantly reduce the risk of patients with prediabetes developing Type 2 diabetes. A total of 5269 subjects were involved, across 191 clinics and 21 countries. The study, which was lead by researchers at McMaster University in Hamilton (ON, Canada), examined the possible preventive effects of Avandia (generic name rosiglitazone) and Altace® (Sanofi-Aventis, NJ, USA and King Pharmaceuticals, TN, USA), also known as remipril. Patients were either given Avandia, Altace (a blood pressure drug), a combination of the two or a placebo. All subjects were encouraged to exercise and eat healthily throughout the course of the 3-year trial.
The results for the Avandia arm of the trail were encouraging; only 12% of individuals taking Avandia developed diabetes, compared with 26% of patients receiving the placebo. It was calculated that Avandia reduces the chance of a prediabetes patient developing diabetes by up to 62%. This suggests that 144 cases of diabetes may be prevented for every 1000 patients given the preventive treatment.
Avandia has been available since 1999 as a treatment for Type 2 diabetes and had sales of GB£1.3 bn in 2005. The results of the Avandia trial, called Diabetes REduction Approaches with ramipril and rosiglitazen Medications (DREAM), are published in The Lancet and may help to boost sales of the drug. However, adverse effects have led to the results receiving mixed reactions. Side effects of Avandia include increased risk for heart failure, with 14 people in the Avandia group developing the condition, compared with just two in the placebo group. Some doctors believe the risks associated with Avandia are minimal compared with the potential benefits, while others believe controlled diet and exercise is the best preventive measure for diabetes. Julie Ingelfinger comments “Ongoing attention to diet and exercise remains our best hope for reducing the rising rate of diabetes.”
Report reveals flaws in US FDA drug directory
A report by the US government’s Department of Health and Human Services (HHS) Office of Inspector General (August 2006) has discovered major flaws in the National Drug Code (NDC) Directory. The directory, which serves as a database of prescription and over-the-counter drugs, is compiled by the US FDA. Under the Drug Listing Act of 1972, pharmaceutical companies are required to report all drug products to the FDA. However, the report reveals that approximately 9200 medications are not listed and 34,200 listings are either no longer on the market or have errors. The report states that the incomplete directory is ‘primarily due to insufficient reporting by drug firms’; however, the FDA has not taken criminal or regulatory action against the noncompliant companies.
Following the release of the report, the FDA has put forward new proposals to help improve the usefulness of the directory. Under the new proposal, the NDC listing number must be displayed on drug labels and drug companies would be required to submit electronical updates to the FDA every 6 months.
Mike Leavitt, HHS secretary comments: “Having drug makers submit drug information electronically will help to keep an accurate, up-to-date inventory of drugs on the market. This will help us to maintain more accurate information and make it easier for us to respond to drug emergencies, such as drug recalls and drug shortages.”
Acupuncture looks promising for the UK National Health Service
Researchers at the University of York and Sheffield University (UK) have concluded that acupuncture is cost-effective for the treatment of lower back pain. A study of 241 patients with low back pain was carried out over a 2-year period. Patients followed either regular National Health Service (NHS) care or underwent ten acupuncture treatments over a course of 3 months, in addition to regular NHS care. Little difference was noticed between the two groups after 3 months; however, improvements in pain scores in the acupuncture group were noticed after 12 months, with increased improvements after 24 months.
Whilst costs over the 2-year period for the acupuncture group were higher than for the regularly treated group, the cost per quality adjusted life year (QALY) gained was reasonably low and benefits, such as reduced painkiller usage, were seen. The National Institute for Health and Clinical Excellence (NICE) gives a threshold of GB£20,000 for the cost per QALY gained when deciding if a service should be provided by the NHS. Calculated at GB£4241, the cost per QALY gained by integrating acupuncture into the treatment course falls well below this threshold. Low back pain costs the UK an estimated GB£10 bn a year in benefit costs and loss of productivity.
Statutory regulation of acupuncture has now been proposed by the government.
Chief Executive of the British Acupuncture Council, Mike O’Farrell commented: “Our hope is that after regulation, which is probably 2008, the decision makers will have increased awareness and confidence to offer acupuncture more widely.”
Two papers (by the same team) covering the study have been published by the British Medical Journal.
Television advertising may not boost individual drug sales
Direct to Consumer (DTC) advertising increases the number of visits to doctors but may not boost sales of particular drugs, new research has revealed. New regulations on television advertising for prescription drugs were introduced in 1997 by the US FDA, leading to a rapid increase in spending on advertising. A team at Medical University of South Carolina (MUSC, SC, USA) examined the effect of DTC advertising on sales of Vioxx® (Merck & Co.) and Celebrex® (Pfizer Inc.), both cyclooxygenase (COX)-2 inhibitors used for the treatment of osteoarthritis, over the time period 2000–2002. The results revealed that increased advertising of both drugs resulted in increased prescriptions for Vioxx, but not for Celebrex. Strong marketing efforts by drug representatives may influence the prescription numbers.
Lead author of the study, David W Bradford, Director of MUSC’s Center for Health Economic and Policy Studies, comments on the results: “We found that for both Vioxx and Celebrex, DTC [advertising] tended to increase visits by patients with osteoarthritis to their physicians…Once the patients got to the doctor office, advertising was not the biggest factor affecting prescribing. In fact, we tended to find class level effects.”
The report is published in the September/October issue of Health Affairs.
‘Historical control’ used in new statistical method
A new technique for use in clinical trials has been developed by statisticians at St Jude Children’s Research Hospital (TN, USA). In the new method, all subjects receive the new treatment and there is no traditional control group, rather a ‘historical control’ instead, as described in the report published in the August issue of Statistics in Medicine. The historical control group consists of patients who have previously received the existing treatment in a clinical trial. Using this new method, researchers can analyze the results at various stages during the trial and thus determine if the trial should be stopped early.
First author of the paper, Xiaoping Xiong, comments “It’s not always possible to do a standard randomized controlled trial when there are a limited number of patients available to participate, or when patients do very poorly on the standard treatment that the new treatment is intended to replace…In such cases, the best option is to design a trial that allows all participants to get the new treatment and use previously treated patients as a historical control group.”