Healthy Skepticism Library item: 16090

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Publication type: news

Evans M.
Heart drug spending soars in Canada: study
CBC News 2009 Jul 7
http://www.cbc.ca/health/story/2009/07/07/heart-drug-statins-prescription-stroke-spending.html

Full text:

The amount spent on drugs to prevent and treat such conditions as heart attack and stroke is soaring in Canada, say researchers, with cardiac medications now accounting for one in five of all prescriptions filled.

A study led by researchers at the Institute for Clinical Evaluative Sciences found spending on cardiovascular medications jumped 200 per cent between 1996 and 2006.

Figures for 2006, the latest data available, show total annual spending on heart drugs exceeded $5 billion, with statins used to lower cholesterol accounting for almost 40 per cent of the total.

If cardiac medication use continues to rise at a similar rate in the next 10 years, annual spending could reach $10.6 billion by 2020, the researchers predict.

“It’s important for people to know that the use of heart medications in Canada is becoming more common and it is very costly to the health care system,” said ICES scientist Cynthia Jackevicius, lead investigator of the study.

Jackevicius said there are several reasons cardiovascular drug spending is spiralling upwards:

Canada’s population is aging.
A greater proportion of people have high blood pressure, diabetes and obesity, elevating their risk for heart disease and stroke.
Inflation is bumping up prices.
“Those factors accounted for about two-thirds of this growth in the cost of heart medications,” Jackevicius, a pharmacist and clinical epidemiologist at Western University of Health Sciences, said from Pomona, Calif.

The study, published Tuesday in the Canadian Medical Association Journal, also found an increased reliance on newer, brand-name medications, as opposed to cheaper generics, over the decade, which accounted for almost a third of the growth in spending. As well, doctors are prescribing certain types of drugs more often as evidence mounts of their benefits – and they often carry a higher price tag than older classes of medications, such as beta blockers and diuretics.

Statins are a case in point. The drugs, which lower blood cholesterol levels, also have been found to cut the risk of having a heart attack and the rate of death from heart disease.

“So there are more people that would qualify for the use of statins over the years,” she said, noting that doctors have become more aggressive in treating the risk factors for heart disease and stroke.

ARB use jumps

There was also a huge jump in the use of ARBs (angiotensin receptor blockers), which are used to control high blood pressure, treat heart failure and prevent kidney failure in people with diabetes or high blood pressure.

“We saw their use increasing from the minute they got on the market,” Jackevicius said. “Their use has increased over 4,000 per cent over the 10-year period.”

“It was the highest rate of increase of any of the medication classes over that entire period. So that always raises questions when you have something taking off so quickly. Is there something so much better about that class of drugs?”

Doctors often prescribe an ARB when a patient can’t tolerate one of the more established ACE inhibitors, which cause a dry, annoying cough in up to 20 per cent of users.

“We still are surprised that the angiotensin receptor blockers, or ARBs, have increased their use so much,” she said. “It doesn’t seem completely warranted when the ACE inhibitors are very effective drugs and a lot of them now are off-patent and they would be less expensive …. So that is something that raised a bit of a red flag for us when we saw those numbers.”

While research has shown that pharmaceutical companies’ promotion of particular drugs can affect prescribing patterns, Jackevicius said it’s human nature to want to try something new – and physicians are no different.

“But with medications, newer isn’t necessarily better because the longer a drug has been around, we know a lot more about it, there’s more studies that have been done, we know more about its safety, about how it works,” she said.

“So you don’t just want it to be new and only change cholesterol or blood pressure. You want it to actually have an impact on what happens to people.”

Steve Morgan, associate director of the Centre for Health Services and Policy Research at the University of British Columbia, said cardiovascular treatments have accounted for the lion’s share of drug expenditures for some time, but he believes spending will likely come down in the future.

‘Everyone pays for all of this, especially [for] older patients over 65, from all of our taxes, so I think we all need to be aware of these increasing costs and take some responsibility for it.’
-Cynthia Jackevicius, researcher
“The primary ways in which that will be the case is not by using less of them, because I think when they are appropriately prescribed and appropriately taken, these medicines can provide great value,” Morgan, who was not involved in the research, said Monday from Vancouver.

Many of these drugs will soon be off-patent – including the world’s top-selling drug, the statin Lipitor, he said.

“The next 10 years will be different than the last, in part because these drugs are becoming generic.”

“And that provides a tremendous opportunity to the health system to secure savings on these drugs, which we’ve been buying for many years.”

But it’s not only still-patented, brand-name drugs racheting up medication expenditures, Jackevicius noted.

The cost of generic drugs could also be contributing to Canadians’ rising medication bill: the median cost of generics is higher in Canada than in 11 other developed countries and the researchers estimate that lower prices for the off-patent heart drugs alone could save $350 million a year.

Jackevicius said an epidemic of obesity, high blood pressure and diabetes is feeding the need for treatment – and the annual payout for heart drugs could be significantly reduced if people adopted healthier lifestyles. Patients prescribed heart drugs should ask their doctors if a generic medication would work in their case as well as a more expensive brand-name version, she said.

But in a related commentary, Dr. Robert Califf of Duke University Medical Center in Durham, N.C., said the higher costs linked to cardiovascular drug prescribing might result in a health benefit that would be worth the increase in spending.

“Indeed, the sustained and dramatic reduction in death and disability from cardiovascular disease is partially due to access to these medications,” he writes. “If greater use of cardiovascular medications controls blood pressure and lipid levels while also slowing progression of kidney disease … then the cost of medications could easily be offset by a reduction in hospital admissions.”