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Which Drug Works Best? And How Do You Tell?

APRIL 22, 2005 -- Harnessing the power of evidence-based medicine to determine the effectiveness of prescription drugs is an emerging and imperfect art, but refining it could help health care purchasers determine the best drug for the best price, experts said Friday.

"That level of information is critical to a functional marketplace around pharmaceuticals," said Mark Gibson, deputy director of the Center for Evidence-Based policy at the Oregon Health and Science University. Without such data, "it is very difficult to foster competition in the [pharmaceutical] industry," Gibson said at a Capitol Hill forum sponsored by the Alliance for Health Reform and The Commonwealth Fund.

Dr. Mark L. Berger, vice president of outcomes research and management in the U.S. human health division of Merck & Co., Inc., said the art of determining the "comparative effectiveness" of drugs continues to evolve because practitioners as well as patients themselves are demanding more information about pharmaceuticals.

Experts now examine practice variations and performance measures to compare how physicians practice medicine in different regions of the country and consumers ask many more questions now than before about their health care.

"Patients are demanding better information as part of a shared decision-making process," Berger said.

And there is evidence that arming medical providers and patients with such information can impact expenditures. Dr. Peter Sawicki, director of the German Institute for Quality and Economic Efficacy in Health Care, said when his agency released information about the effectiveness of Lipitor, a cholesterol-lowering drug, the number of prescriptions issued for the drug dropped to 5 percent of statins prescribed from 40 percent.

Health care providers "want to know if the really expensive drug is better" than a cheaper alternative, Sawicki said. Gibson said when practitioners are presented with data on the effectiveness of drugs, they can shift the market share of a drug by as much as 30 percent.

As part of the Medicare prescription drug law (PL 108-173), the Agency for Healthcare Research and Quality was to receive $50 million to address the scientific information needs and priorities identified by the Medicare, Medicaid, and State Children's Health Insurance Programs. About $15 million of that is in the president's fiscal 2006 budget.

Reviewing a drug for its effectiveness is a lengthy and complicated process that determines how the drug will work for the majority of patients, panelists said. While such information can guide purchasing decisions, it should not preclude physicians from prescribing a different drug if that drug is better for a particular patient, the speakers said.

Berger cited numerous problems with such reviews, such as a limited supply of information to assess comparative effectiveness and that there is no consensus about what represents adequate information to assess comparative effectiveness.

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