“A Medicare drug benefit program that supports prices at the high end of the current range could yield substantially less health for the elderly,” say Louise B. Russell, Ph.D., and Nancy Wolff, Ph.D., of Rutgers University, writing in the current issue of the American Journal of Preventive Medicine.
Russell and Wolff reviewed the results of studies that had examined the costs and health effects of using medications in the elderly. The five studies were published between 1990 and 2000 and all data were adjusted to the value of the dollar in 2000.
Based on these studies, Russell and Wolff estimated how many years of life would be added for every $1 million spent if the medications were sold at the average wholesale price (AWP), 20 percent below the AWP and 40 percent below the AWP.
Federal purchasers pay approximately 40 percent to 50 percent less than the AWP. Managed care plans typically pay more than do federal purchasers, and individuals without prescription drug insurance usually pay the highest prices.
Three of the reviewed studies investigated the use of a group of drugs called statins, which reduce cholesterol levels.
Using the results of these studies, Russell and Wolff estimated that, in elderly patients with a history of myocardial infarction, reducing the cost of these drugs by 40 percent nearly doubles the extension of life statins are capable of producing.
At 40 percent below the AWP, every $1 million buys enough statins to extend by 90 years collectively the lives of the U.S. population of heart patients between the ages of 75 and 84 years. This dropped to 63 years of life when the medications were priced at 20 percent below the AWP and was only 48 years at the AWP.
America spent $8.2 billion on cholesterol-lowering drugs in 2000, according to a report from the National Institute for Health Care Management Research and Educational Foundation.
“Much of the discussion regarding the addition of a prescription drug benefit to Medicare has centered on issues of cost -- budgetary cost to Medicare and out-of-pocket costs to the elderly. Important and easily measured, costs have overshadowed the health consequences of the benefit,” say Russell and Wolff.
Instead, they suggest that “it is important to evaluate drug benefit proposals in terms of health effects per dollar, not just dollars.”
Russell and Wolff conducted the study as faculty members of Rutger’s Institute for Health, Health Care Policy and Aging Research.
The American Journal of Preventive Medicine, sponsored by the Association of Teachers of Preventive Medicine and the American College of Preventive Medicine, is published eight times a year by Elsevier Science. The Journal is a forum for the communication of information, knowledge and wisdom in prevention science, education, practice and policy. For more information about the Journal, contact the editorial office at (619) 594-7344.
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American Journal of Preventive Medicine