Cardiovascular and Economic Outcomes After Initiation of Lipid-Lowering Therapy With Atorvastatin vs Simvastatin in an Employed Population

The High Cost of Cancer Drugs and What We Can Do About It

“…One can argue that a monopoly as described previously herein would be temporary at best because eventually similar drugs of the same class would emerge, offering competition that should in theory act as a price check. However, owing to some of the factors described previously herein, the price check offered by generics in nonmalignant diseases [21][22][23] is effectively neutered in the case of cancer. For example, in nonmalignant diseases, a new and improved treatment that simply offers incremental benefits over established treatment but costs considerably more than the generic version will not be able to maintain a high price if the incremental benefits do not provide value to the patient.…”

Interpreting Hazards: The Increasing Importance of Antidote to Anecdote in Managed Care

“…7 In an accompanying editorial, Culler and Weintraub pointed to comparative effectiveness research, citing the analysis by Simpson et al, as a key to future health reform efforts that will require informed choices from among available treatment options.…”

“…This editorial examines some of the most common problems in claims of risk reduction and provides a checklist for hazard avoidance by MCO decision makers (Table 1). 6 Much Ado About Nothing: The Hazard of Clinically Insignificant Effect Sizes A December 2009 retrospective cohort analysis conducted by Simpson et al 7 used administrative claims data from 23 large employer groups to examine the 2-year outcomes of employed patients aged 18-64 years who were initiated for either primary or secondary prevention on simvastatin, which today is available as a generic drug for approximately $25 per month, 8,9 versus brand atorvastatin, which is priced at approximately $90-$125 per month 10,11 when both products are obtained in 90-day supplies for their recommended starting doses. 12,13 In a sample of 13,584 patient pairs matched on initial drug dose (low, medium, high), baseline cardiovascular events, average wage, and a propensity score for use of atorvastatin that was "generated from a logistic regression model .…”

“…developed by entering all studied baseline characteristics into a stepwise selection algorithm," the authors found what they described in the study abstract as "a reduced risk of cardiovascular events" and "reduced indirect costs" associated with atorvastatin treatment. 7 In this study sponsored by the manufacturer of brand atorvastatin, Simpson et al concluded that because of cost offsets for medical services and indirect costs, primarily "medically related absenteeism," a focus on drug acquisition cost by health care payers choosing statin products is misleading. "Although it can be relatively straightforward to…”

The Protean Role of Health Care Delivery Organizations in Comparative Effectiveness Research

“…In the current issue of Mayo Clinic Proceedings, Simpson et al 4 illustrate the complexities of the relationship between CER and health care delivery organizations. Their observational study showed a benefit between cardiovascular outcomes and total cost equivalency with atorvastatin use compared with simvastatin in a large population of patients with employer-based health insurance.…”