There’s much interest these days in finding ways to contain health care costs in the United States. Just last week, a congressional hearing examined prescription drug prices. It wasn’t the first time, and it won’t be the last.
Commentator Andrew Lam is a retinal surgeon in Springfield, Mass., and author of the book “Saving Sight.” Lam says when doctors decide which drugs to prescribe, they also need to consider the bottom line, more so than they currently do.
I’m lucky to have access to a few miracle drugs. The drugs are eye injections that treat the number one cause of blindness in Americans over sixty-five — wet, age-related macular degeneration or AMD. The drugs not only stop patients from losing vision; in some cases, they can bring sight back .
I’ll never forget the atmosphere when clinical trial results for the drug Lucentis were first announced. The crowd of ophthalmologists, typically bored at a conference like this, suddenly came alive with excitement. This drug was going to change everything.
Then we learned the drug’s price: $2,000 for each monthly dose of Lucentis. Treatment would cost a jaw-dropping $24,000 per year, per eye.
But something surprising happened. Doctors tried treating wet AMD with Avastin, a similar drug made by the same company. It was originally designed to treat cancer. Studies show it works just as well as Lucentis. The cost? Only $50 per dose.
Avastin’s manufacturer did not pursue FDA approval for its use in AMD. They stand to make far more money when doctors use Lucentis.
So how do doctors decide which one to recommend? When making treatment decisions, we often ask ourselves, “How would I treat my mother, or myself?”
But what if there also needs to be a second question? When two treatments both work well, how about, “What can I do to help keep healthcare costs down?”
A recent survey of retina specialists shows that about two-thirds use Avastin as their treatment of choice. The rest prefer Lucentis, or another expensive drug called Eylea.
Doctors who favor the expensive medicines do so for a variety of reasons. They may believe certain types of patients respond better to them, or like that one could be given less frequently, or dislike that Avastin comes from a compounding pharmacy rather than straight from the manufacturer.
But the decision to use a medicine that costs $50 versus an alternative that costs $2,000 has an enormous impact. Medicare and American taxpayers could save billions if more doctors switched to Avastin. And in a healthcare system with limited resources, doctors must consider the cost of their treatment decisions.
I discuss all the drug options with my patients. I tell them I would happily choose Avastin for my mother or myself.
We have an ethical duty to treat our patients effectively. But for the good of society as a whole, shouldn’t we also have a duty to recommend the most cost-effective care?