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• For Drugs that Save Lives, a Steep Cost
  Joseph Y Ting
  Published on: 19 June 2015

• Published on: 19 June 2015

  For Drugs that Save Lives, a Steep Cost

  • Joseph Y Ting, Adjunct associate professor, School of Public Health and Social Work

  This represents a thoughtful analysis of costly drugs. Recently, the potential overpricing of a device that allows safe bystander delivery of the established staple narcotic antagonist naloxone bears closer examination. As an emergency physician, I am cautious to avoid needle stick injuries when reversing overdoses in patients who are at high risk of HIV or hepatitis B/C. No matter how careful one is, the clinician still...

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  This represents a thoughtful analysis of costly drugs. Recently, the potential overpricing of a device that allows safe bystander delivery of the established staple narcotic antagonist naloxone bears closer examination. As an emergency physician, I am cautious to avoid needle stick injuries when reversing overdoses in patients who are at high risk of HIV or hepatitis B/C. No matter how careful one is, the clinician still incurs significant occupational exposure. I once accidentally stabbed myself in the hand with a central line finder needle used to treat a shocked woman with hepatitis C who became acutely agitated after naloxone. Months of distress and serological testing followed. Economic analyses of medical care should include safety concerns of frontline paramedics, police and hospital staff. Expensive non intravenous and non intramuscular devices that allow the opiate dependent patient to breath effectively reduces bystander and occupational exposures to life changing infections and could avert the need to transport to hospital emergency rooms.

  There is no doubt that cost effectiveness assessment of medical and surgical treatment improves the distribution of limited health care spending more equitably across a range of competing demands for funding. As adjudicated by patient focused outcomes (and now clinician safety), these analyses maximize overall health maintenance and gain in society by ensuring that scarce resources are deployed to patient cohorts that will attain the most benefit from a moderate to expensive intervention. The focus goes beyond living longer to living better with enhanced quality of life, social engagement, symptom and pain control and sustaining emotional wellbeing, factors important in cancer care.

  Further steps are required to exert material influence on how health dollars could be better spent. Publicly funded clinical trials could be obliged to examine and report cost implications of health gains when a treatment proves to be effective. Medical school curricula and residency programs should emphasize cost effectiveness assessment as much as the magnitude of therapeutic benefit. Clinical practice guidelines promulgated by specialist groups need to be rid of industry sponsors that bias recommendations towards favoring new expensive treatments that are no better than established options. It is also high time that we also critically appraise the health impact and cost-overruns from excessive and inappropriate medical and screening tests ordered by doctors with a vested interest in using them as much as possible.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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