Opportunities for Cost Reduction of Medical Care: Part 3

Monte Malach; William J. Baumol

Disclosures

J Community Health. 2012;37(4):888-896. 

In This Article

Pharmaceuticals

In addition to the therapeutic benefits of statins for the treatment of coronary artery disease, such drugs reportedly result in a 14% reduction in mortality from all causes,[66] as well as reversing the progression of coronary artery atherosclerosis.[67] Statins reduce the incidence of cholesterol stones in the gall bladder.[68] This is extremely cost effective and offers an opportunity for preventive medical therapy.

As previously reported, red wine and red grapes have sirtuins 1, 3, and 4 in the drug Resveratrol®, which has demonstrated significant anti-inflammatory and antioxidant effects in humans and improved longevity in laboratory animals.[69] This is a remarkable, cost-saving medication that helps to reduce the occurrence of cardiovascular disease, with its attendant high costs.

The use of colchicine (Colcrys®) to treat gout has been become significantly more expensive—increasing from $0.04 cents per tablet to more than $5 per tablet and thereby raising the cost to more than $30 per month. This is because its manufacturing has been restricted to one pharmaceutical company.[70]

Many antipsychotic medications have been found to have serious, even dangerous, consequences for elderly patients and, thus, increase the cost of care.[71] Less aggressive medication prescription is advisable and much less costly.

The new anticoagulant Ticagrelor® has received FDA approval for use with a low dose of aspirin (less than 100 mg daily) to prevent thromboembolic disease, reduce major bleeding, and lower death rates. However, there can be increased non-procedure-related bleeding from Clopidogrel®[72] (see also the discussion of new anticoagulants in the Cardiovascular Disease section).

Cleansing nostrils with mupirocin 2% ointment applied twice daily and a daily body bath with chlorhexidine gluconate soap within 24 h of hospital admission resulted in a lower incidence of hospital-associated staphylococcus aureus infections in 918 patients admitted to three university hospitals and two general hospitals in the Netherlands.[73]

The Wall Street Journal[74] reported that there has been a surge of mistakes in scientific studies. According to Thomsen/Reuters Health Agency, there were 339 retraction notices for scientific studies published in 2010. This included studies relating to the combination of Angiotensin Converting Enzyme (ACE) and Angiotensin Receptor Blocker (ARB) drugs for hypertension—a combination that is now considered to be contra-indicated. This also includes the link of the measles vaccine to autism that was previously published in The Lancet, which has raised allegations of fraud and/or incompetence. These mistakes waste millions of dollars and are an incalculable risk to patients.

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