USA: Changing the Economics of Treating Chronically Ill Patients


08/07/2011 ― Using generics as a way to lower health care costs; © SXC ― Brigham and Women's Hospital

As a family physician, I am tired of the rhetoric from Dr. Terry Rogers and King County Medical Blue Shield (The Times, Nov. 21). For seven years they have been saying that the cost-effective providers will be rewarded, yet year after year, the high spending goes on in hospitals and specialty care, while the cost-conscious family physicians feel the pinch of declining reimbursements for basic medical care.

A study concludes that preventive health care is considerably less costly than previous industry estimates, because earlier studies projected financial impact based on costs of branded medications. Today, the cost to consumers and the health care system are significantly lower because generics are broadly available for most chronic diseases, the researchers said.

For example, an influential 2008 study looking at preventing cardiovascular disease used branded medications to estimate the cost for lowering LDL cholesterol at $83,327 per quality adjusted life year (QALY), a financial measure that evaluates the impact of improving the quality of life for patients with chronic diseases.

Today, recalculating for the same treatment using generic alternatives would be $17,084 per QALY, or 20 percent of the original estimate.

With more than 70 percent of health care costs in the U.S. spent treating patients who have one or more chronic disease, the researchers said generic medications are changing the economics of treating chronically ill patients.

"Prevention of cardiovascular disease, the most common cause of death in the U.S., is central to any policy discussion about overall health care costs. Approximately 80 million Americans have some form of cardiovascular disease with annual costs in the U.S. reaching $475 billion. Cardiovascular disease prevention can be largely accomplished with low-cost generic medications," they said.

"There is no question prevention is more affordable with the use of generics," said William H. Shrank, MD, MSHS, of Harvard and Brigham and Women's and lead author of the study. "Policy makers looking to improve and expand health care options should make sure generics are readily accessible for chronically ill patients. In addition, the topic of generics and effective preventive treatment should be central to any debate on making health care more affordable."

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