Why the Benefits of Medicines – Not Just Costs – Must Be a Part of the Conversation

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By Robert W. Dubois, MD, PhD, NPC Interim President and CEO

In the perpetual debate over the cost of prescription drugs, it’s easy to throw context out the window. Medications account for only about 17% of what we spend on health care in the United States, yet it dominates the discussion, while payments for hospitals and physicians account for far more of the pie yet far less of the conversation.

But that’s only half the story: not only do medicines come with a smaller cost than is generally assumed, benefit – measured by the impact on the health of our nation -- is generally underappreciated as well. Our research at the National Pharmaceutical Council found that physicians attribute 56% of improvement in outcomes for eight different conditions to medications, with all other medical interventions making up the remainder.

That finding has now been bolstered by a new paper in Health Affairs from Harvard’s David Cutler and his collaborators that puts the overall impact of prescription medicines in sharp relief, showing that 35% of the 3.3 year improvement in life expectancy between 1990 and 2015 could be explained by medications, almost three times more than all other medical interventions combined. (Public health accounted for 44% of the gains.)

The paper doesn’t pull punches about what the work means, noting that the benefit of medicines “has received somewhat less attention” than health behaviors and social circumstance. It concludes that the findings “underscore the central role of medications overall in explaining reduced mortality” and calling on policymakers to consider the implications.
 
There is tremendous pressure to lower drug prices, and while every dollar spent on health care deserves to be scrutinized, it’s important not to lose sight of the magnitude of what’s received when money is spent on medication. The Health Affairs study – mirroring our work – found that heart disease accounted for most of the improvement in survival, with pharmaceuticals providing most of the benefit in that condition.

In cancer, the authors found a benefit linked to drugs, bringing additional heft to work from the National Cancer Incidence published last month in the New England Journal of Medicine that suggests that treatments are having population-level impacts in cancer, too.

Of course, the benefits are not evenly distributed; the impact in heart disease is undeniable, and not every condition has a similar impact on overall life expectancy. Understanding where interventions – whether they’re diagnostic, pharmaceutical, hospital care or otherwise – bring high-value care (and where they don’t) is of critical importance, and it’s the driving force behind our Going Below The Surface effort to dig deeper on the true root causes of health spending.

The topic has special resonance now, as we work to beat back the menace of COVID-19. The historical data suggests that the way out of this crisis will be some part public health and some part pharmaceutical intervention, with lesser contributions from hospital techniques or technology. That lines up well with the emerging reality in dealing with the pandemic, and it suggests that the investments that the drug industry is making today will pay dividends tomorrow. Any time we measure costs, we need to simultaneously examine benefits. This latest article is another demonstration that medications provide a great “bang for the buck.”