Tag Archives: cardiovascular disease

The Cost of a Cure: What’s the Right Price?

Recently, two significant pharmaceutical breakthroughs have resulted in a renewed debate about the costs of drug therapy. In the last year, a new drug class for the treatment of Hepatitis C has been released by two different manufacturers and has been found to cure a once incurable chronic liver disease for nearly 90% of patients who are treated with a full course of therapy. The drug appears to be safe and highly effective—however, the cost of a curative course of therapy is nearly 80K dollars. As you might imaging, there are already barriers to access for many patients including those treated in the Veterans’ Affairs (VA) system as well as those on government based insurance programs such as Medicaid.

In the last several months, another remarkable, potentially “game changing” drug has been approved and released into the market. These drugs, made by Regeneron and Sanofi, are intended for patients who do not achieve adequate cholesterol reduction with standard statin therapy (the current standard of care).   According to some analyses, these drugs, when used in the appropriate patient population, may result in the prevention of thousands of cardiovascular related deaths. However, just as seen with the new hepatitis C drugs, the price tag for therapy is exorbitant—nearly 15K dollars annually. With the Hepatitis C drug, therapy is only required for approximately 12 weeks and then is no longer needed—with the cholesterol drug, the therapy will most likely be lifelong.

This month a study examining the cost effectiveness of these new cholesterol drug has been published and concluded that the drugs are far over-priced (nearly 3 fold) for the benefit that they produce. Based on a pure economic analysis, researchers concluded that the drugs should actually cost between 3K and 4K dollars annually rather than the current 15K price tag.

Did Healthcare Reform Forget Big Pharma?

The purpose of the Affordable Care Act (ACA) (as touted by supporting politicians and its authors) is to make health care accessible and affordable to all Americans. Certainly this is a noble goal and one that we should continue to strive to achieve. However, the legislation has failed to meet this mark. While addressing physician reimbursement and clinical behaviors (and limiting choice and physician autonomy), the ACA has done nothing to regulate the high price of pharmaceuticals. Big pharma is allowed to charge exorbitant prices (whatever the market will bear) without regulation. It is clear that pharmaceuticals must reclaim their research and development investments and make a profit—however, many of these drugs are far overpriced and pricetags are simply designed to exploit the system and maximize corporate (and CEO profits). IN addition, many of the most expensive drugs in the US are sold overseas and in Canada at a fraction of the cost. This seems to me to be clear evidence of the pharmaceutical industry taking full advantage of the inherent wealth in the US today.

However, Would it not follow that if we placed limits on the prices of new drugs and paid “fair and equitable” charges, that healthcare costs would significantly decline?

It seems our politicians have sought to attack the problem from a few angles and have failed to address other significant sources of excessive healthcare spending. While reimbursement for physicians and physician groups are set clearly in the crosshairs of the ACA, it appears industry and litigators are not even on the radar. There is hope—legislation is being introduced that will allow legal purchase of drugs from Canada for Americans. In addition, pharmaceutical companies would be required to disclose what they charge for the same drugs in other countries. I believe this is a step in the right direction. Lets continue to innovate and provide new therapies for ALL Americans. But lets do it in a way that is cost effective. The latest studies make it clear that these drugs are overpriced. We must find a way to negotiate a fair and reasonable price that promotes and rewards innovation BUT also provides access to the newest and most effective therapies for all who need it.

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The Cost of Childhood Obesity: Setting an Example for (Hope) & Change

Obesity and obesity related illness accounts for an enormous healthcare expenditure in the US today–approaching 150 billion dollars annually.  In an era of healthcare reform and cost containment, preventative medicine is essential to success.  Rather than rearranging networks, separating doctors from patients and limiting choice, our government may be more effective in reducing healthcare costs by focusing on slimming waistlines throughout the US.

According to a recent study in the Journal of the American Medical Association, nearly 30% of adults and 17% of children are classified as obese. According to the Centers for Disease Control, obesity in children has more than doubled in children and quadrupled in adolescents in the last 30 years.  Obesity rates in adults have remained constant–if not increased–over the study period.  In fact, in women over age 60, obesity rates have increased from 31 to 38%.   It is clear that obesity directly results in the development of diabetes, heart disease and other potentially debilitating chronic illnesses.

Data from previous studies clearly identifies habits developed in childhood as a primary determinant of obesity as an adult.  In fact, childhood obesity is almost always associated with obesity and health problems during adulthood.  This week, a study published in Pediatrics provided a specific cost analysis of childhood obesity and found that each obese child results in an individual $19,000 healthcare cost increase as compared to a child of normal weight.  Moreover, when the researchers multiplied the &19,000 figure by the number of 10 year olds who were estimated to be  obese in the US today, they calculated the total lifetime healthcare expenditure in this age group alone to be more than 14 billion dollars.

The adverse effects and negative impacts of obesity on our children stretch far beyond the staggering dollar figures that are illustrated in this most recent study.  Obese children are more likely to have risk factors for heart disease and are at increased risk for certain types of cancers.  Pre-diabetes is common in obese children and many develop Type 2 diabetes before adulthood.  Children with weight problems are more likely to suffer from depression and other mental health disorders including poor self esteem.  Development of such significant medical problems at an early age can prevent a child from truly enjoying the process of growing up and can limit choices and opportunities later in life.

Children of obese parents are far more likely to be obese themselves.  America is becoming a culture of sedentary adults (and now children)–increased calorie intake and diminished calorie output.  Our children model behaviors that they witness in adults and other mentors.  Modeling healthy habits such as regular physical activity and healthy eating can directly impact children and significantly reduce the chances of becoming obese.  Habits developed during childhood become part of our daily routine and are incorporated into our system of values and become second nature. If we, as adults, put a priority on diet and exercise early in life, we make it much easier for our children to develop and maintain a healthy lifestyle well into adulthood.

This most recent study should serve as a call to action–Americans are fat and are getting fatter.  The time to intervene is now.  We must set better examples for our children.  In a world full of fast food and calorie dense meal choices, we must do a better job demonstrating responsible lifestyle choices.  Fill the house with fruits and healthy snacks and avoid fast food meals whenever possible.  Help children learn to choose wisely.  Parents must encourage more outdoor activities, regular exercise and limit screen time.

As healthcare costs continue to rise,  we must focus on prevention.  Cardiovascular disease, diabetes, and high blood pressure are significant contributors to our overall healthcare costs and ALL of these diseases are more likely to occur in those who are obese.  As a nation, we must become more health conscious and make daily exercise and healthy eating part of our culture–only then will we be able to impact obesity and set an example for change.  Only then will we begin to reverse the obesity epidemic of the last 30 years and improve the lives of our children and the generations to come.

 

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Changing the Mindset in Medicine To Improve Outcomes: Prevention Rather Than Reaction

Much of my medical training in residency and fellowship was all about learning to react to particular clinical situations.  Long nights of call with exposure to a high volume of patients allowed me to quickly recognize common signs and symptoms, develop a working differential diagnosis and initiate testing and therapy right away.  This rapid fire exposure to disease was incredibly important in my development as a physician.  Moreover, the ability to react to clinical findings is essential in providing quality medical care as well as producing positive outcomes.

However, very little of my training focused on prevention.  Even today, residents and other physicians in training spend far more time treating disease rather than figuring out how to derail the disease process (even before it begins).  Certainly, we all learned about proper timing of routine screening tests for colon cancer, breast cancer, prostate cancer, etc.  In contrast, we did not spend much time learning effective ways in which we could counsel patients about lifestyle modification and risk reduction.  We did not talk much about how to educate patients about potential diseases that they may be at risk for and the potential negative impacts these diseases might have on an individual patient’s overall health status and quality of life.

Today in the Wall Street Journal, an article detailing a new report of an overall reduction in preventable cardiovascular death in the US today was published.  On first blush, this sounds like a very positive report–fewer Americans are dying of heart disease.  However, on closer examination, the data becomes quite disturbing–the largest reduction in preventable death was in the older population (greater than 75).  In the younger population (age less than 65) the decline was much less impressive.  Subgroup analysis revealed significant racial and geographic disparities as well–African Americans had a two fold higher rate in preventable cardiovascular death.  Residents of the southern states were also found to have much higher rates of preventable death.

Why is this?  What can we do to impact the large number of preventable cardiovascular deaths?

Based on this data, it seems to me that we are now seeing a large number of younger patients who are at risk for cardiovascular disease that are not being aggressively screened, evaluated and treated.  Many of these younger patients are not seeking medical attention until they experience their first (and often fatal) cardiac event.  According to the CDC nearly a quarter million of the 800K annual cardiovascular related deaths are preventable.  Long standing cardiovascular disease and its myriad of complications are expensive…in terms of dollars and in terms of human life.

The solution is all about prevention.  As cardiologists we must be more vigilant and screen young at risk populations more aggressively.  We must treat hypertension, hyperlipidemia and diabetes in younger patients.  We must spend more time counseling patients about lifestyle modification–not just smoking cessation.  Other healthcare providers in both primary care and in other specialties must also redouble their efforts on prevention.  We must all work together and refer patients who are at risk to the proper provider.  In addition, we must pay extra attention to higher risk groups such as minorities and we must focus efforts in geographies such as the south with higher than average preventable death rates.

Most importantly, we must all work to change the mindset in medicine.  Clinical competence and the ability to think on our feet and react is certainly essential and should remain a cornerstone of training.  However, we must also look a little deeper.  Obviously, we all love to be cast as the hero in the medical drama and save a life with an emergency procedure–however, it is just as heroic to prevent the emergency in the first place.  We must strive to train physicians who not only are able to react to disease and its presentations but who are also adept at recognizing risk and counseling patients to prevent negative outcomes later in life.

Ben Franklin had it right way back in the 1700s.  Even though we didn’t listen to Ben then, we have a real opportunity to listen and act now!  Remember–”an ounce of prevention is worth a pound of cure!”  Now that’s a low cost way to reduce the costs of healthcare AND save lives in the US today.

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