Posted on July 3, 2017
This is the fifth in a series of 34 blogs based on a list of ‘Key Concepts’. Each blog will explain one Key Concept that we need to understand to be able to assess treatment claims.
The novelty and price of a treatment are two factors that can influence what we think about that treatment. We may all make certain assumptions rather automatically: surely the latest drug or a new treatment must be a significant improvement on an existing treatment? And surely a treatment that is expensive must be effective? Well, not necessarily…
The cost of EpiPens (easily injectable epinephrine devices) for severe allergic reactions was a big controversial topic recently. Their price had increased by more than 450% since 2004. What happened? You might assume that, to justify this price hike, EpiPens had been substantially improved in this time. But unfortunately not. Rather, the price hike was largely because there was practically only one company, Mylan, selling EpiPens at a time when the demand for EpiPens was increasing. With little regulation, Mylan were relatively free to increase the price of EpiPens multiple times, while increasing demand for EpiPens through marketing (or “raising awareness”).
Similarly, drug company Turing increased the price of Daraprim, a drug used to treat parasitic infections such as malaria, by over 5000% in 2015.
In Finland, a science journalist very publicly criticised doctors for prescribing lots of esomeprazole, a drug which is designed to decrease the secretion of stomach acid. Why? This drug was a new, minor variation from the established omeprazole.
Esomeprazole is an example of a ‘me-too’ drug; where industries create many very similar drugs which are not necessarily improvements on the existing version of the drug. In Canada, Morgan et al. concluded from their 2005 analysis that “In British Columbia, most (80%) of the increase in drug expenditure between 1996 and 2003 was explained by the use of new, patented drug products that did not offer substantial improvements on less expensive alternatives available before 1990”. ‘Me-too’ drugs are often a substantial, unnecessary financial drain and can give false hope to patients.
These are just a few examples but they clearly illustrate that just because a drug is expensive does not necessarily mean it is effective. Nor is it necessarily an improvement on a previous version of the drug.
The common assumptions that new and expensive treatments must be better than older, cheaper available treatments is wrong.
How do we know these assumptions are wrong?
In order to choose the safest, most effective, and best tolerated treatments, practitioners, funders, and patients cannot be distracted by all the extra noise that price and novelty can create. Ultimately, as argued throughout this series, we must compare all treatments fairly.