The British Medical Journal just published a significant article about drug prices. (Morgan SG et al. "Breakthough" drugs and growth in expenditure on prescription drugs in Canada. Br Med J 2005; 331: 815-816.)
Some have suggested that rising health care costs are in part attributable to new, innovative, effective treatments. Morgan et al used existing categorizations by the Canadian Patented Medicine Price Review Board to classify all new prescription drugs available in Canada since 1990 as "breakthrough" - "the first drug to treat effectively a particular illness or which provides substantial improvement over existing drug products," to which Morgan and colleagues added later drugs added in the same chemical class; "me-too," other new drugs patented since 1990 that did not provide substantial improvements over existing drugs. Drugs available before 1990 were categorized as vintage brand or vintage generic.
The investigators then broke down drug expenditures in British Columbia from 1996 to 2003 by drug type.
Breakthrough drugs accounted for 6% of expenditure and 1% of use in 1996, and 10% and 2% in 2003.
"In contrast, me-too drugs accounted for 44% of use and 63% of expenditure by 2003."
They concluded, "In British Columbia most 980%) of the increase in drug expenditure between 1996 adn 2003 was explained by the use of new, patented drug products that did not offer substantial improvements on less expensive alternatives available before 1990. The rising costs of using these me-too drugs at prices far exceeding those of time tested competitors deserves careful scrutiny." Furthermore, "given that the list of top 20 drugs in global sales includes newly patented version of drugs in long established categories (that is, marketed before 1990) - such as angiotensin converting enzyme inhibitors, statins, selective serotonin reuptake inhibitors, and proton pump inhibitors - me-too drugs probably dominate spending trends in most developed countries."
This says something very important about the bizarre financial incentives prevalent not only in the US health care system, but throughout at least the developed world. We spend huge amounts on expensive drugs that provide little advantage over cheaper alternatives, and then seem to not have enough money for primary and generalist care, for acute care, to handle unexpected crises, to provide care to the less fortunate, etc., etc., etc. In the US, we seem to have plenty of capacity to treat erectile dysfunction and restless leg syndrome, but not enough capacity to make a vaccine for avian influenza (see this article) . What is wrong with this picture?