The contribution of. improved outcomes and economic growth. Frank Lichtenberg. Content

Transcription

1 The contribution of pharmaceutical innovation to longevity, improved outcomes and economic growth Frank Lichtenberg Lisbon 1 May 211 Content Contribution of new medicines to longevity increase Evidence based on aggregate data Evidence based on patient-level data Use of new medicines reduces need for other health care resources The impact of new medicines on productivity and ability to work 1

2 Today, People Live 1 Years Longer Than in

3 Contribution of innovative drugs to longevity increase in Germany German life expectancy at birth increased by 1.4 years during the period About one-third (,45 years or 32%) of the increase in life expectancy was due to the replacement of older drugs by newer drugs. Estimated cost per life-year gained from the use of newer drugs is (without taking reduced resource used due to medicines into account). F. Lichtenberg, The contribution of pharmaceutical innovation to longevity growth in Germany and France, Pharmacoeconomics (In press) 5 New treatments reduced mortality rates in Canada Introduction of the new treatments in the last three decades reduced the risk of mortality by 51% for the overall study population Recent drug innovation, in particular medications launched after 199, had a significant beneficial impact on the survival of elderly Canadians. Lichtenberg, F.R., et al., The impact of drug vintage on patient survival: a patient-level analysis using Quebec's provincial health plan data. Value Health, (6): p

4 Substantial contribution by new drugs to improved survival: overall population Estimated survival curves by drug vintage use. Lichtenberg, F.R., et al., The impact of drug vintage on patient survival: a patient-level analysis using Quebec's provincial health plan data. Value Health, (6): p Substantial contribution by new drugs to improved survival: asthma subpopulation Estimated survival curves by drug vintage use Lichtenberg, F.R., et al., The impact of drug vintage on patient survival: a patient-level analysis using Quebec's provincial health plan data. Value Health, (6): p

5 Substantial contribution by new drugs to improved survival: cancer subpopulation Estimated survival curves by drug vintage use. Lichtenberg, F.R., et al., The impact of drug vintage on patient survival: a patient-level analysis using Quebec's provincial health plan data. Value Health, (6): p Substantial contribution by new drugs to improved survival: CVD subpopulation Estimated survival curves by drug vintage use. Lichtenberg, F.R., et al., The impact of drug vintage on patient survival: a patient-level analysis using Quebec's provincial health plan data. Value Health, (6): p

6 Availability of innovative drugs 7 new molecules and 2 new drug classes for treating HIV were introduced No. of HIV/AIDS Rx's per person with HIV/AIDS Lichtenberg, F.R., The impact of increased utilization of HIV drugs on longevity and medical expenditure: an assessment based on aggregate US time-series data. Expert Rev Pharmacoecon Outcomes Res, 26. 6(4): p The Amount of Availabel Innovative HIV Medicines Correlates With Survival 3,5-4% Change in avge. drug util. 3 2,5 2 1,5 1,5 -, Change in average no. of HIV Rx's % change in mortality rate % -3% -25% -2% -15% -1% -5% % 5% 1% ange in mortality rate (inverted scale) % cha -1 15% Source: Lichtenberg (28), Biomedical innovation, longevity, and quality of life, Presentation at Swiss Congress of Health Economics and Health Sciences 6

7 Decreasing mortality rates in HIV/AIDS Prob. of survival 9% 8% 7% 6% 5% 4% 3% 2% 1% % HIV/AIDS Survival functions: 1993 vs. 2 Survival function 1/1/1993 Survival function 1/1/2 54% 3% Years since diagnosis 1.Lichtenberg, F.R., The impact of increased utilization of HIV drugs on longevity and medical expenditure: an assessment based on aggregate US time-series data. Expert Rev Pharmacoecon Outcomes Res, 26. 6(4): p Increase in life expectancy due to new HIV medicines 3 Due to new medicines 25 2 Years predicted with 1993 drug utilization 21 actual 1.Lichtenberg, F.R., The impact of increased utilization of HIV drugs on longevity and medical expenditure: an assessment based on aggregate US time-series data. Expert Rev Pharmacoecon Outcomes Res, 26. 6(4): p

8 Dramatically decreasing needs for hospitalization Drug utilization and hospital utilization by AIDS patients 25 1, prescriptions per patient hospital admissions per patient,8,6,4 5, Lichtenberg, F.R., The impact of increased utilization of HIV drugs on longevity and medical expenditure: an assessment based on aggregate US time-series data. Expert Rev Pharmacoecon Outcomes Res, 26. 6(4): p Cancer 8

9 Decreasing cancer mortality rates in Germany Sharp increase in 5-year cancer relative survival rate in the US 7 All cancer sites US ,9 62,2 65, ,1 5,4 51,6 53,5 56, Year of diagnosis 9

10 Chemotherapy innovation contributed by 74% to the increase in the 1-year survival Cancer survival rates, : actual vs predicted in the absence of chemotherapy innovation Frank R. Lichtenberg (28) "Pharmaceutical Innovation and U.S. Cancer Survival, : Evidence from Linked SEER- MEDSTAT Data," Forum for Health Economics & Policy: Vol. 1: Iss. 1 (Frontiers in Health Policy Research), Article 1. Decreasing cancer mortality despite increasing insidence Changes of Cancer Incidence and Mortality Rates % 55% 5% 45% 4% 35% 3% 25% 2% 15% 1% 5% % -5% -1% Cases Deaths -15% -2% -25% All cancers but skin melanoma Breast Prostate Uterus Colorectal Stomach Lung Female Lung Male Cases 9.93% 18.51% 54.25% -1.17% 8.27% % 21.46% -.86% Deaths.37% -2.97% 1.48% -9.49%.2% % 21.11% -3.8% Source: Own chart based on: Wilking et al. (29), Comparator Report on Patient Access to Cancer Drugs in Europe, 1

11 A 1 % reduction in cancer mortality is worth nearly $5 billion* *Kevin M. Murphy and Robert H. Topel, The Value of Health and Longevity, Journal of Political Economy, 26, vol. 114, no. 5 CVD 11

12 Decreasing CVD mortality rates in OECD countries s) population (standardised rate Deaths per 1 35, 3, 25, 2, 15, 1, 5,, OECD Health Data 29 - Version: November 9 Cerebrovascular diseases as cause of mortality Australia Austria Canada Denmark Finland France Germany Greece Hungary Iceland Ireland Italy Netherlands New Zealand Norway Portugal Spain Sweden Switzerland United Kingdom United States Age-adjusted mortality rates, Diseases of heart 5 Cerebrovascular diseases Source: Health, United States, 29, Table

13 CVD mortality rates in Germany and launch of new drugs Top 1 (ranked by no. of standard units) CVD drugs in 25 Switzerland vs. Austria SWITZERLAND (N=1,93,135) AUSTRIA (N=1,89,382) HYDROCHLOR OTHIAZIDE % C9D ANGIOTEN- II ANTAG, COMB HEPARIN 191 3% C5B VARICOSE THERAPYTOPIC THERAPY,TOPIC AL ATORVASTATI N % C1A CHOLEST&TRIG LY.REGULATOR METOPROLOL % C7A B- BLOCKING AGENTS,PLAIN HYDROCHLOR OTHIAZIDE % C9B ACE INHIBITORS COMBINAT HYDROCHLOR OTHIAZIDE % C9B ACE INHIBITORS COMBINAT METOPROLOL % C7A B-BLOCKING AGENTS,PLAIN AMLODIPINE 199 3% C8A CALCIUM ANTAGONIST PLAIN CRATAEGUS OXYACANTHA. 3% C1X ALL OTHER CARDIAC PREPS FUROSEMIDE % C3A DIURETICS TORASEMIDE % C3A DIURETICS BISOPROLOL % C7A B-BLOCKING AGENTS,PLAIN AMLODIPINE 199 2% C8A CALCIUM ANTAGONIST PLAIN ATENOLOL % C7A B- BLOCKING AGENTS,PLAIN SIMVASTATIN % C1A CHOLEST&TRIG LY.REGULATOR GINKGO BILOBA % C4A CEREBR/PERIPH VASOTHERAP SIMVASTATIN % C1A CHOLEST&TRIGLY. REGULATOR HEPARIN 191 3% C5B VARICOSE 26 THERAPY,TOPICAL 13

14 $ Post-1995 cardiovascular Standard Units (Sus) as a percentage of total SUs in 24, by country 27 Use of newer CVD drugs implies lower mortality rates and reduced costs Use of newer cardiovascular drugs has reduced hospitalization, average length of stay and ageadjusted cardiovascular mortality rate Hospitalization Costs of new drugs The decrease in expenditure on cardiovascular hospital stays is about 3.7 times as large as in per capita increase for cardiovascular drugs. Frank R. Lichtenberg, 29. "Have newer cardiovascular drugs reduced hospitalization? Evidence from longitudinal countrylevel data on 2 OECD countries, ," Health Economics, John Wiley & Sons, Ltd., vol. 18(5), pages

15 New drugs and decreasing consumption of other health care resources Increase in drug vintage index

16 Use of newer drugs reduced consumption of health care resources States that had larger increases in drug vintage had smaller increases in the number of hospital and nursing-home admissions. $ per person Increased drug costs 1951 Decreased costs for admissions to hospitals and nursing homes Costs for admissions inverted Lichtenberg, Frank, The effect of using newer drugs on admissions of elderly Americans to hospitals and nursing homes: state-level evidence from , Pharmacoeconomics 24 Suppl 3, 26, Patient-level evidence about the relationship between use of newer drugs and cost of events People consuming newer drugs had significantly fewer 8 71 hospital stays and decreased 7 costs for all non-drug 6 medical expenditures. 5 $ 4 Reducing the age of the drug results in a substantial net reduction in the total cost of treating the condition Increased cost for drugs Decreased costs for other resources Costs for other resources inverted F. R. Lichtenberg, "Are the Benefits of Newer Drugs Worth Their Cost? Evidence from the 1996 MEPS," Health Affairs, 2 (5) (September/October 21), pp

17 Branded vs generic drugs Since reducing the age of the drug results in a substantial net reduction in the total cost of treating the condition, if only generic drugs were used instead of actual mix of 6 % branded and 4% generic, costs would increase. Estimates indicate that denying people access to branded drugs would increase total treatment costs, not reduce them, and would lead to worse outcomes. F. R. Lichtenberg, "Are the Benefits of Newer Drugs Worth Their Cost? Evidence from the 1996 MEPS," Health Affairs, 2 (5) (September/October 21), pp The impact of pharmaceutical use on hospital care and overall medical expenditures Number of hospital bed-days declined most rapidly for those diagnoses with the greatest increase in the total number of drugs prescribed and the greatest change in the distribution of drugs. An increase of 1 prescriptions p is associated with 16.3 fewer hospital days F. R. Lichtenberg, "Do (More and Better) Drugs Keep People Out of Hospitals?"American Economic Review, 86 (May 1996), pp

18 The effect of drug vintage on activity limitations and perceived health status People who used newer drugs had better posttreatment health than people using older drugs for the same condition. They were more likely to survive, their perceived health status t was higher, h and dthey experienced fewer activity, social, and physical limitations. 7. F. R. Lichtenberg and S. Virabhak, "Pharmaceutical-Embodied Technical Progress, Longevity, and Quality of Life: Drugs as 'Equipment for your Health'," Managerial and Decision Economics 28: (27) Cost impact of PPI Therapeutic substitution in British Columbia Medically unnecessary drug switching by compliance with TS policy appears to be independently associated with higher overall health care resources. Average total cost Average costs per patient 6 4, 5 35, 4 3, 3 25, C$ TS Pariet only Other PPI C$ 2, 15, 1, 5,, TS Pariet only Other PPI -2-5, PPI cost Physician cost Hospital cost -3-1, -4-15, Skinner, B.J., J.R. Gray, and G.P. Attara, Increased health costs from mandated Therapeutic Substitution of proton pump inhibitors in British Columbia. Alimentary Pharmacology & Therapeutics, (8): p

19 The impact of reference pricing on switching behaviour and health care utilisation: the case of statins in Germany Switching occurred significantly more often in patients with low-income 7% 6% 5% 4% 3% 2% 1% % 12% Switching behaviour after RP implementation * * 65% 38% * 11% * 2% 2% * 39% 31% No switch 1 switch > 1 switch Non adherent (MPR<,8) Atorvastatin Other statin *P<,1 Stargardt, T., The impact of reference pricing on switching behaviour and healthcare utilisation: the case of statins in Germany. European Journal of Health Economics, (3): p The impact of reference pricing on switching behaviour and health care utilisation: the case of statins in Germany Patients initially on atorvastatin discontinued to a larger extent than other. Non adherence and discontinuation in patients previously treated with Atorva and other statins % 15 Non adherence Discontinuation 1 5 Atorva Other Stargardt, T., The impact of reference pricing on switching behaviour and healthcare utilisation: the case of statins in Germany. European Journal of Health Economics, (3): p

20 Link to productivity and ability to work Cumulative number of drugs approved for three conditions relative to the cumulative number of drugs approved for that condition in ,8 2,6 2,4 2,2 diabetes migraine asthma 2 1,8 1,6 1,4 1, Year 2

21 Availability of new drugs and Americans' ability to work The probability of being unable to work, limited in work, and having ever been hospitalized, and the number of work-loss days and restricted-activity days, are all inversely related to the stock of drugs approved 3 to 5 years earlier. The estimates imply that the growth in the lagged stock of all drugs reduced the unconditional probability of being unable to work due to the 47 sample conditions by 1.8% per year during the period Have new drugs increased society s ability to produce goods and services? The estimated benefit of the new drugs, in terms of the value of the increase in workforce participation and hours, is almost nine times as great as the estimated cost of the new drugs. Inability to work 6 If no new drugs had been introduced during , the probability bilit of being unable to work in 1996 would have been 29% higher than it actually was 5.2% instead of 4.%. Probability No new drugs New drugs Lichtenberg, Frank, "Availability of new drugs and Americans' ability to work," Journal of Occupational and Environmental Medicine 47 (4), April 25,

22 Has pharmaceutical innovation reduced Social Security Disability growth? 3,9% 3,7% 3,5% 3,3% 3,1% predicted actual 3,65% 3,42% 2,9% 2,7% 2,62% 2,5% Lichtenberg, F R, Has pharmaceutical innovation reduced Social Security Disability growth?, International Journal of the Economics of Business, forthcoming. 43 Summary Contribution of new medicines to longevity increase Evidence based on aggregate data Evidence based on patient-level data Use of new medicines reduces need for other health care resources The impact of new medicines on productivity and ability to work 22

23 Patients In Germany and UK Get Access To New Medicines Most Quickly Source: efpia, The Pharmaceutical Industry in Figures (21), under Articles The Impact of Drug Vintage on Patient Survival: A Patient-Level Analysis Using Quebec s Provincial Health Plan Data The quality of medical care, behavioral risk factors, and longevity growth Availability of New Drugs and Americans Ability to Work Has pharmaceutical innovation reduced Social Security Disability growth? The contribution of pharmaceutical innovation to longevity growth in Germany and France,

24 24