Not the Progress, the Access is the Point

Better drugs do not necessarily
save more people; © PixelQuelle.de

“For every dollar Congress gives the National Institutes of Health to develop blockbuster treatments, it spends only one penny to ensure that Americans actually receive them,” said Steven H. Woolf, M.D., professor and director of research in Virginia Commonwealth University’s Department of Family Medicine and a member of the National Academy of Sciences’ Institute of Medicine. “Health improvement would be far greater if we worried less about making incremental improvements on existing treatments and more on the system barriers that impede Americans from receiving those treatments correctly.”

Woolf said a mathematical construct proves the point. He used two case studies - one involving statins and the other antiplatelet drugs - to show that the billions of dollars spent on new generation drugs saved fewer lives and prevented fewer strokes than if the existing drugs had been taken by all patients who could benefit.

Woolf illustrated the concept with an example of a theoretical disease that claims 100,000 lives a year. If a drug is available that reduces the mortality rate from that disease by 20 percent, it has the potential to save 20,000 lives each year. But if only 60 percent of eligible patients receive the drug, only 12,000 deaths will be averted. Closing the gap in care — making it available to 100 percent of eligible patients — would save 8,000 additional lives.

To save 8,000 additional lives by making a better drug and without closing the gap in care — delivering the better drug to only 60 percent of eligible patients — the drug’s lowering of mortality would have to be increased from 20 percent to 33 percent. Woolf calls this the “break-even point” and notes that it is an unrealistic goal for many treatments. The study shows that the billions invested in statins and clot-busting drugs failed to reach the break-even point, thus saving fewer lives than if gaps in care had been rectified.

MEDICA.de; Source: Virginia Commonwealth University