More drugs do not always mean better care: studies

Spending more on drugs does not always translate into healthier patients, U.S. researchers reported on Wednesday.

And in a second study, researchers found that when government insurers crack down on payments for certain drugs, doctors are less likely to prescribe them unnecessarily.

The two studies, published in the New England Journal of Medicine, suggest that government regulations and perhaps healthcare reform can be used to cut costs and improve care.

In one study, Yuting Zhang of the University of Pittsburgh Graduate School of Public Health found big variations in how much doctors and hospitals spend on drugs to treat Medicare patients across the United States.

But there was no correlation between that spending and how well patients did.

“That contradicts the idea that high spending leads to better prescription practices,” Zhang said in a statement.

Her team used data from the records of 500,000 patients using Medicare, the federal health insurance plan for the elderly.

In regions with higher overall per capita medical spending, they found that patients were also more likely to be given prescriptions for riskier drugs.

“Higher spending can be justified if it’s for drugs that are necessary and appropriate and improve patients’ health,” Zhang said.

In June, the Commonwealth Fund, which advocates and does research focusing on healthcare reform, reported that Americans spend twice as much on healthcare as residents of other developed countries—$7,290 per person—but get lower quality and less efficiency [ID:nN23595216].

President Barack Obama had pledged to reform U.S. healthcare but critics of the law he signed in March say it does little to address such problems. Republicans who seized control of the House of Representatives on Tuesday have promised to change as much of the healthcare reform bill as they can.

CUTTING COSTS

A second study found that when Medicare stopped paying so much for a drug that could be used inappropriately, doctors used it less often—and more effectively.

Dr. Vahakn Shahinian of the University of Michigan Medical School and colleagues studied a hormone-based treatment for prostate cancer called androgen deprivation. It helps stop production of testosterone, which fuels prostate tumors.

The Medicare Modernization Act of 2003 changed policies for how doctors get paid for injected drugs, including this one.

Shahinian and his colleagues looked at data from 54,925 men treated for prostate cancer from 2003 to 2005. During that time, reimbursements for hormone therapy fell from $356 to $176 per dose.

“The rate of inappropriate use of androgen deprivation therapy declined substantially during the study period, from 38.7 percent in 2003 ... to 25.7 percent in 2005,” they wrote.

“We found that physicians respond to reimbursement, but they respond in a way that appears to be beneficial to the patient. They don’t tend to cut out necessary care, but they tend to cut out unnecessary or inappropriate care,” Shahinian said.

“There’s a growing realization that these treatments might have more side effects than we first realized,” Shahinian added.

Dr. Paul Griner of the University of Rochester said in a commentary that medical schools should teach students about costs, citing estimates that unnecessary or inappropriate tests and procedures account for as much as 20 percent of healthcare spending.
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By Maggie Fox, Health and Science Editor

WASHINGTON