Hostname: page-component-7bb8b95d7b-5mhkq Total loading time: 0 Render date: 2024-09-18T13:39:34.689Z Has data issue: false hasContentIssue false

Low-Cost Therapeutic Agents: Uses and Abuses

Published online by Cambridge University Press:  10 March 2009

John P. Bunker
Affiliation:
University College London School of Medicine

Abstract

The past quarter century has seen a transformation of the pharmaceutical industry from blind empiricism to the design of drugs to act as agonists or antagonists at specific receptor sites. As truly effective technology, many have led to marked savings in cost. Savings have been achieved when therapeutic drugs, often highly specific, can be substituted for surgery and other invasive procedures and when therapeutic drugs can be used to prevent illness and the need for treatment. Further savings are achieved with the reduced prescription of ineffective drugs. It is estimated that therapeutic drugs and vaccines contribute about half of medicine's contribution to increased life expectancy and improved quality of life in this century at about 7% of national expenditures for medical care in the United States.

Type
Special Section: The Use And Abuse Of Low-Cost Technologies
Copyright
Copyright © Cambridge University Press 1997

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Abelson, P. H.Improvements in health care. Science, 1993, 260, 11.Google Scholar
2.Andersen, M., & Schou, J. S.Are H2 receptor antagonists safe over the counter drugs? British Medical Journal, 1995, 309, 493–94.Google Scholar
3.Bates, D. W., Cullen, D. J., Laird, N., et al. Incidence of adverse drug events and potential adverse drug events: Implications for prevention. Journal of the American Medical Association, 1995, 274, 2934.Google Scholar
4.Black, J.A personal view of pharmacology. Annual Review of Pharmacolology and Toxicology, 1996, 36, 133.CrossRefGoogle ScholarPubMed
5.Bunker, J. P.Medicine matters after all. Journal of the Royal College of Physicians, 1995, 29, 105–12.Google Scholar
6.Bunker, J. P., Frazier, H. S., & Mosteller, F. The role of medical care in determining health: Creating an inventory of benefits. In Amick, B. C., Levine, S., Tarlov, A. R, & Chapman, D. C. (eds.), Society and health. Oxford, UK: Oxford University Press, 1995.Google Scholar
7.Every, N. R., Parsons, L. S., Hlatky, M., et al. , for the Myocardial Infarction Triage and Intervention Investigators. A comparison of thrombolytic therapy with primary coronary angioplasty for acute myocardial infarction. New England Journal of Medicine, 1996, 335, 1253–60.Google Scholar
9.Garattini, S.Cultural shift in Italy's drug policy. Lancet, 1995, 346, 56.Google Scholar
8.Ferner, R. E.Dispensing with prescriptions. British Medical Journal, 1994, 308, 1316.Google Scholar
10.Garattini, S., & Garattini, L.Pharmaceutical prescriptions in four European countries. Lancet, 1993, 342, 1191–92.Google Scholar
11.Goldman, L., Sia, S. T. B., Cook, E. F., et al. Costs and effectiveness of routine therapy with long-term beta-adrenergic antagonists after acute myocardial infarction. New England Journal of Medicine, 1988, 319, 152–57.Google Scholar
12.Hitchings, G. H.Health care and life expectancy. Science, 1993, 262, 1632.CrossRefGoogle ScholarPubMed
13.Jonsson, B., & Bebbington, P. E.What price depression? The cost of depression and the cost-effectiveness of pharmacological treatment. British Journal of Psychiatry, 1994, 164, 665–73.CrossRefGoogle ScholarPubMed
14.Kalish, S. C., Bohn, R. L., & Avorn, J.Policy analysis of the conversion of histamine2 antagonists to over-the-counter use. Medical Care, 1997, 35, 3248.Google Scholar
15.Lindgren, B.The cost-benefit approach to pricing new medicines: Doxazocin versus beta-blocker treatment in Sweden. American Heart Journal, 1990, 119, 748–53.Google Scholar
16.Lowe, C. J., Raynor, D. K., Courtney, E. A., et al. Effects of self medication programme on knowledge of drugs and compliance with treatment in elderly patients. British Medical Journal, 1995, 310, 1229–31.Google Scholar
17.Mark, D. B., Hlatky, M. A., Califf, R. M., et al. Cost effectiveness of thrombolytic therapy for tissue plasminogen activator as compared with streptokinase for acute myocardial infarction. New England Journal of Medicine, 1995, 332, 1418–24.CrossRefGoogle ScholarPubMed
18.Smith, P. Personal communication 1996.Google Scholar
19.Sonnenberg, A., & Townsend, W. F.Costs of duodenal ulcer therapy with antibiotics. Archives of Internal Medicine, 1995, 155, 922–28.Google Scholar
20.Soumerai, S. B., McLaughlin, T. J., Ross-Degnan, D., et al. Effects of limiting Medicaid drug-reimbursement benefits on the use of psychotropic agents and acute mental health services by patients with schizophrenia. New England Journal of Medicine, 1994, 331, 650–55.Google Scholar
21.Soumerai, S. B., Ross-Degnan, D., Avorn, J., et al. Effects of Medicaid drug-payment limits on admission to hospitals and nursing homes. New England Journal of Medicine 1991, 325, 1072–77.Google Scholar
22.Soumerai, S. B., Ross-Degnan, D., Gortmaker, S., & Avorn, J.Withdrawing payment for nonscientific drug therapy: Intended and unexpected effects of a large-scale natural experiment. Journal of the American Medical Association, 1990, 263, 831–39.Google Scholar
23.Stuart, B., & Grana, J.Are prescribed and over-the-counter medications economic substitutes? A study of the effects of health insurance on medicine choices by the elderly. Medical Care, 1995, 33, 487501.CrossRefGoogle ScholarPubMed
24.Thomas, L.The lives of a cell. New York: Bantam, 1974.Google Scholar
25.Weinstein, M. C., & Stason, W. B.Cost-effectiveness of interventions to prevent or treat coronary heart disease. Annual Review of Public Health, 1985, 6, 4163.CrossRefGoogle ScholarPubMed