[IVY]

Rising drug costs worry economist

Canadian Press


Tuesday, May 10, 2005


With spending on prescription drugs at a record $18 billion a year in Canada, a national system is needed to monitor medication use and evaluate whether newer, more expensive drugs are any better for patients than older, lower-cost alternatives, a health economist says.

Since 1996, Canadians have more than doubled their spending on prescription medications, from $7.6 billion to $18 billion in 2004, says Steve Morgan of the Centre for Health Services and Policy Research at the University of British Columbia. (Adding over-the-counter drugs takes the tab to $22 billion, while another $1.3 billion is spent on drugs in hospitals.)

"Growing at a pace of over $1.5 billion per year, prescription costs have sailed well past payments for all services provided by physicians ($16 billion)," Morgan writes in this week's issue of the Canadian Medical Association Journal.

"Given that the annual increase in prescription drug costs could finance the services of 3,500 new physicians every year, patterns of drug utilization and spending deserve careful scrutiny."

Two major factors are behind spiralling drug expenditures: Canadians are taking more prescription medications and the drugs are increasingly expensive, Morgan said in an interview from Vancouver.

But more than half the spending is for drugs to manage such chronic conditions as high blood pressure, high cholesterol, depression and gastrointestinal ailments like heartburn and ulcers, he said. "The drugs to treat all of those conditions, and the best available options, have been around for 10, 15 and, in some cases, 30 or more years."

Morgan stressed there is no question that higher-cost innovative medicines for cancer or rare, serious diseases should be prescribed when there are no acceptable options.

"But we don't know, and we can only suspect, that many of the people who are being prescribed new drugs first could have tried older alternatives before being put on to the high-cost one."

That's why an independent agency is needed to monitor what drugs are being prescribed to Canadians, for which medical conditions and whether they produce the expected benefits or raise unexpected risks, he said.

Vioxx, for instance, was initially touted as a wonder drug for arthritis, based on pre-approval testing. But once in wider use among patients, the medication was found to cause a risk of heart attack and stroke. Its maker, Merck & Co., pulled the drug from the market last fall. Bextra, a cox-2 inhibitor like Vioxx, was ordered off the Canadian market last month, also over safety concerns.

Morgan said a national drug safety agency or other body of experts could also evaluate older and newer drugs used for the same condition in post-approval, head-to-head studies - something pharmaceutical makers are not required to do and would be unlikely to undertake in a competitive marketplace.

These "me-too drugs" should not be approved until they have been rigorously tested in patient trials comparing them with existing medications, says an editorial accompanying Morgan's article. "Not only is there no need to hurry after these me-too compounds, but to do so is terribly expensive."

Dr. Joel Lexchin, a Toronto emergency physician and an associate professor at York University's school of Health Policy and Management, called Morgan's comments and the editorial "dead-on."

"What we do is we approve new drugs, we don't require that they be shown to be any better than existing products, and then we let the drug companies market those products as much as they want,'' Lexchin said.

Although direct-to-consumer drug promotion is prohibited in Canada, many Canadians see such advertising through U.S. television and other media. A 2003 study he co-authored showed that when patients exposed to direct-to-consumer advertising asked for drugs by name, doctors would pen a script for that medicine about 70 per cent of the time.

Lexchin estimates pharmaceutical companies spend up to $2 billion a year in Canada alone to promote their products to doctors - through office visits by sample-toting drug reps, advertising in professional journals and financial backing of medical conferences.

Furthermore, while many doctors believe their prescribing decisions are unaffected by such promotion, international studies have shown that physician information about specific drugs comes primarily from pharmaceutical companies.

"We need to impose much stricter controls on promotions of drugs, both to doctors and to consumers," Lexchin said. "And we need to be willing to spend the money to provide doctors with the kind of information around comparative safety and efficacy of drugs."

Morgan said Canadians should demand that government and health-care policy makers invest in a drug-evaluation system, in particular, one whose outcomes could be electronically delivered to doctors in their offices for reference while treating patients.

"It's just making sure we choose the right drug at the right time for the right patients," he said.

Without such a system, drug spending will continue to rise, by as much as $2 billion this year, Morgan predicted.

"It's our money. This is $22 billion coming out of the pockets of Canadians one way or another," he said. "I would challenge you to find another investment of that magnitude that wasn't made without asking: Is it value for money?"

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