Study: Doctors prescribe expensive drugs instead of those preferred under medical guidelines

Wednesday, April 21st 2004, 12:00 am

By: News On 6

CHICAGO (AP) _ Doctors often prescribe newer, more expensive drugs for high blood pressure instead of the ones recommended under medical guidelines, and the practice is costing the nation more than $1 billion a year, researchers say.

The researchers did not examine why, exactly, doctors go with the costlier drugs, but they speculated that aggressive drug-company advertising may be one reason.

The study of Pennsylvania's drug-assistance program looked at more than 133,000 patients who filled more than 2 million prescriptions for hypertension medicine in 2001. The prescriptions cost the state $48.5 million.

About 40 percent of the time, patients were prescribed different drugs than those called for under medical guidelines, according to the study in Wednesday's Journal of the American Medical Association.

Getting doctors to prescribe the preferred treatments would have saved the state $11.6 million in 2001, the study found.

The researchers, Drs. Michael A. Fischer and Jerry Avorn of Harvard's Brigham and Women's Hospital, said that nationally, the savings could amount to $1.2 billion a year on high blood pressure medicine alone.

The study found that calcium channel blockers accounted for the most spending, about $17 million, with an average cost of $33.39 a prescription. The least expensive drugs, diuretics called thiazides, cost $5.33 a prescription.

The Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure recommends that thiazides be used as the first-line treatment in cases of hypertension without other complications.

Tom Snedden, director of Pennsylvania's PACE prescription-drug program for senior citizens, said the study reinforces the ongoing need for reasonable restrictions on drug utilization, which began in 1992. PACE _ for Pharmaceutical Assistance Contract for the Elderly _ was expanded in January to reach as many as 1 million Pennsylvanians, although the number of participants is much smaller.

Snedden said the problem of doctors prescribing unnecessarily expensive medications is evident in all areas of medical treatment, not just hypertension. Attacking it will require educating doctors and patients, as well new program policies that will take time to develop.

``This has been a problem for the 20-year history of the program,'' he said. ``It's just getting worse.''

As for the role of pharmaceutical industry advertising, Fischer said, ``I think it's a really important area for further study. There's advertising both to consumers and physicians.''

Dr. Hoangmai Pham, senior health researcher at the Center for Studying Health System Change, said advertising is only part of the story. She said patients often believe the best care is the costliest and push for more expensive treatments.

Also, ``a lot of times physicians inherit patients and people are loath to switch regimens, especially if they seem to be working. This paper provides one more reason why you might stop and reconsider,'' she said.

Pham, who was not involved in the study, said she believes similar savings could be found throughout the health care system without compromising patient care.

``It's only one of many circumstances in which better quality doesn't cost more and can actually cost less,'' she said.