Tuesday, September 8, 2009

It's health care delivery, stupid

A recent article about the National Institutes of Health in Parade Magazine describes how funding of basic medical research has led to life-saving advances in cancer therapy. The problem with focusing exclusively on basic research, however, is that many patients in the disorganized U.S. health system do not receive recommended treatments, and, therefore, cannot benefit from them.

Making sure that the right therapy is delivered to the right patient at the right time is known as optimizing “health care delivery.” To date, investing in health care delivery has taken a back seat to investing in new therapies. On a governmental level, the Agency for Healthcare Research and Quality has an annual budget of $320 million, about one percent of the $32 billion budget of the National Institutes of Health and the $32 billion spent annually by pharmaceutical companies on new drug development.

In a 2005 article in the Annals of Family Medicine, Drs. Steven Woolf and Robert Johnson of Virginia Commonwealth University illustrate the concept of a “break even point” at which creating a new drug saves as many lives as maximizing the delivery of older drugs. They demonstrate convincingly that modestly improving the proportion of eligible patients who are prescribed the older (and less expensive) drugs aspirin and pravastatin to prevent strokes and heart attacks would produce far greater health benefits than investing hundreds of millions of dollars in developing drugs that work only slightly better (clopidogrel and rosuvastatin).

The authors concede that marketing campaigns for new drugs sometimes improve care delivery by calling physicians’ attention to under-recognized diseases. On the other hand, simple paper and electronic reminder systems are more successful at improving adherence to evidence-based treatment guidelines, at significantly less expense than what it costs to develop a new drug.


Note: the above posting is adapted from an article I wrote in the July 1, 2006 issue of American Family Physician.