June 26, 2003
Purdue research: Better pharmaceuticals cost more
WEST LAFAYETTE, Ind. Costlier pharmaceuticals may provide a better quality of life for patients willing to spend the extra money, according to a study at Purdue University.
The Purdue pharmacists analyzed the relationship between a number of different pharmaceutical products and the health improvements reported by patients who took them. Their study found a strong correlation between the price of pharmaceuticals and their impact on patient quality of life.
"These results are not limited to drugs for any single ailment," said Matthew Murawski, associate professor of pharmacy administration in Purdue's School of Pharmacy, Nursing and Health Sciences. "We compared the level of improvement reported by patients suffering from many different conditions and found when it comes to improving your health, you typically get what you pay for. This conclusion flies in the face of the conventional wisdom that says pharmaceuticals are unnecessarily overpriced."
The research, which was co-authored by Purdue's Marko Mychaskiw and Jeffrey Sturdej, a former student of the Purdue professors who is now a pharmacist in Milwaukee, appears in the April-June issue of Drug Information Journal.
Drug cost is a much debated issue in contemporary medicine. A common sentiment, said Murawski (pronounced Murr-AH-ski), is drug companies charge excessive prices for drugs, which are protected by patent to the point of monopoly.
"Pharmaceutical companies, however, can just as easily counter that drug development is a excruciatingly complex and time-consuming process, which translates into great expense on their part," Murawski said. "They claim it is their prerogative to recoup the cost of developing new, better products. If only one company had the right to sell cars, for example, wed probably question the auto pricing system as well."
The research team surveyed previous academic research to find studies that measured the impact of medications on patients on the basis of quality-of-life questionnaires, converted the results into a common scale and compared quality of life improvement to the cost of the medications.
"Typically, the quality of life questionnaires that were used might include anywhere from 20 to 100 items about the activities a patient was able to perform," Murawski said. "The questionnaire would ask, for example, whether the patient had trouble running a mile before they began treatment, whether they had trouble sleeping through the night and so forth."
The Purdue researchers settled on a sample of questionnaires from more than 40 groups of patients suffering from a variety of illnesses from hay fever to arthritis. Each group was treated with a pharmaceutical designed for its particular ailment.
"Each of these 40-odd groups had between 50 and 1,000 patients," said co-researcher Marko Mychaskiw (pronounced my-CHASS-cue), assistant professor of pharmaceutical economics and marketing. "We found what you might expect statistically with such large numbers of participants. Each group had a bell-curve shaped distribution of complaints, with the mildest and most severe cases on either end."
What was unexpected was how much the bell curves "shifted" toward improvements in patient quality of life. The researchers' statistical analysis clearly showed patients experienced more improvement in those groups that had received a more expensive pharmaceutical no matter what the ailment.
"It surprised us that the actual disease being treated appeared to be an irrelevant factor," Murawski said. "The results show that, whatever condition you have, the higher priced a product is, the more your quality of life will improve."
Murawski said the results of the team's research suggest the government should not interfere with market prices of pharmaceutical prices because it might be a disincentive for long-term drug development.
"One implication of this study is if legislators enact regulations that artificially reduce medication prices, it might reduce the rate at which new drugs are being discovered," he said." Given the long lag time for drug development, lower drug costs now might mean fewer quality drugs for our children."
Mychaskiw said their studys results, while certain to provoke controversy, were based on well-established forms of statistical analysis.
"The accuracy of our statistical model is not really open to question," he said. "But we acknowledge in the paper that there may be shortcomings in both the questionnaires themselves and where our raw data came from. We are vigorously pursuing additional funding to resolve these issues."
For the moment, Murawski said the current results point to one conclusion that merits attention.
"The real finding here is that the relationship between drug price and quality of life exists," he said. "We don't know for sure what the causal link between them is, just that the two variables are related. We hope that more work can be done on this subject, which is obviously important to many millions of people in this country."
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between Health-Related Quality of Life
and the Price of
and Jeffrey Surdej
Objective: The objective of this study was to examine the relationship between a pharmaceutical product's impact on health-related quality of life (HRQOL) and differential product price. Methods: Design: An exhaustive search of the literature was conducted to acquire all HRQOL evaluations of pharmaceutical products that utilized a test-retest experimental approach. Data Collection: Effect sizes were calculated from the data extracted for 31 products. Average wholesale price for each product and similar products in the corresponding therapeutic class were collected, as well as the number of products in the class, availability of a generic and the percent of generics in the class, and whether the product was the lowest cost product in the class. Cost per day of therapy at the recommended starting dose and the ratio of the product cost to the lowest cost product in class were calculated. Analysis: Multivariate linear regression and analysis of variance models were constructed where either average wholesale price or cost per day of therapy was the dependent variable and effect size, therapeutic class, and other cost data were independent variables. Diagnostics were performed to verify model assumptions. Results: Using multivariate linear regression, the number of months on the market, ratio of drug price to lowest price drug in class, number of drugs in the class, and average effect size were significant, with a model R-square = 0.65. In the reduced model, the percent of generics in the therapeutic class was removed and the remaining independent variables were significant, with a model R-square = 0.61. Diagnostics revealed no violations of model assumptions. Conclusions: There is sufficient evidence to suggest that there is a direct positive relationship between a pharmaceutical product's ability to cause improvement in HRQOL and the price of the product. In addition, the number of products within a therapeutic class influenced drug price. This is interpreted as providing evidence for the validity of HRQOL measurement, and for the existence of product competition in the pharmaceutical industry. Further research should be conducted to evaluate the impact of prescription medications on HRQOL, and to identify and characterize the effects of drug and marketplace variables on drug prices.