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Use of Cardiac Drugs Decreased After Prices Skyrocketed

August 10, 2017

A recent research letter in the New England Journal of Medicine found that use of nitroprusside and isoproterenol, two generic cardiovascular generics crucial to critical care delivery, decrease significantly after their prices increased substantially.

According to the letter, drugmaker Valeant increased the price of nitroprusside by 30 times, from $27.46 in 2012 and $880.88 in 2015. Likewise, Valeant increased the price of isoproterenol from $26.20 in 2012 and $1790.11 in 2015.

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“It has been claimed in public testimony that these dramatic price in- creases would not decrease utilization of or patients’ access to these two drugs,” Umesh N Khot, MD, of the department of cardiovascular medicine at the Cleveland Clinic, and colleagues wrote. “In our study, we identified large decreases in the utilization of nitroprusside and isoproterenol in response to very large price increases, changes that were not seen in the use of similar intra- venous cardiovascular drugs with stable prices.”

The researchers studied nitroprusside and isoproterenol utilization at 47 hospitals between 2012 and 2015. They then compared their findings to data on two similar intravenous cardiovascular drugs that did not have abnormal price increases over the same period.

The researchers found that use of nitroprusside decreased by 53%, while use of isoproterenol decreased by 35%. Furthermore, the number of patients treated with nitroprusside and isoproterenol per 1000 inpatients decreased by 46% and 40%, respectively (P < .001).

Additionally, the researchers found that use of the comparative drugs, nitroglycerin and dobutamine, increased by 118% and 7%, respectively.

“Clearly, physicians have decreased their rate of prescribing the drugs even though in the hospital setting both they and patients are typically insulated from the cost increases,” DR Knot and colleagues concluded. “These findings refute the claim that price increases do not reduce patients’ access to these medications. Decreasing demand also indicates a correcting market response to increased prices that may be a valuable restraining force to pharmaceutical price increases.”

—David Costill

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