Proving value a challenge for comparative effectiveness and pharmaceutical technologies

The Wall Street Journal reports that "an examination of one of the best-known examples of a comparative-effectiveness analysis shows how complicated such a seemingly straightforward idea can get" as officials look for savings in the health care system." One study, called Courage, "found that the most common heart surgery -- a $15,000 procedure that unclogs arteries using a small scaffold or stent -- usually yields no additional benefit when used with a cocktail of generic drugs in patients suffering from chronic chest pain." Stent implants dropped 13 percent in the month after the study was released, but they soon began to rise again and are now at pre-study levels of one million per year.

"Without a way to keep insurers from covering procedures that studies find ineffective, projects like Courage face an uphill climb. The health-care bills passed by the House and Senate have provisions to disseminate study results, but wouldn't require private insurers or Medicare to adjust coverage or payments to doctors in response to findings" (Winstein, 2/11).

Reuters reports, in the meantime, that drug makers and information technology companies are joining forces to make the case for pharmaceuticals' value to insurers and governments. They hope to use smart gadgets and other non-traditional areas for drug makers. For instance, "Johnson & Johnson's Lifescan unit has an iPhone application that lets users upload readings from their connected blood glucose monitors to their Apple phone." Some observers note that the alliance could produce a serious  "cultural gap" between IT companies, which have "rapid innovation cycles" and the drug industry, notorious for its slow pace in developing drugs and getting them approved. "The prize, however, is worth fighting for. By monitoring clinical data and ensuring that patients take the right medicines at the right time, drug companies should be able to demonstrate their products really work, ensuring reimbursement by governments or insurers and helping to justify high prices" (Hirschler, 2/11).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.