bringing evidence-based medicine to consumers alliance for health reform january 12, 2005 gail...

Bringing Evidence-Based Medicine to Consumers

Alliance for Health Reform

January 12, 2005

Gail Shearer

Director, Health Policy Analysis

Washington Office

Consumers Union

“Consumer Driven” Health Care?• Is it defined contribution health care in reality?• Adverse segmentation of the health insurance

marketplace• Evidence-based medicine should be foundation

for universal coverage, comprehensive drug benefits, and improvements in the marketplace as it saves money and rationalizes delivery of care

Section 1013: Medicare Modernization Act• Bipartisan effort• Appeals to those who want to provide financial

relief• Appeals to those who want to curb federal

spending and deficit• AHRQ priorities: constructive first step• Section 1013 calls for findings that are “easily

understood” by the public and available both online and in print

MISSION:

• Information on prescription drugs for consumers and doctors

• Increase access to and affordability of needed medicines

• Relieve financial burden caused by high drug prices – consumers and businesses

METHODS: (1) Drug Effectiveness Review Project

• Pioneering work under leadership of former Oregon Governor John Kitzhaber

• Partnership (DERP) now includes 12 states and two non-profit organizations

• Systematic reviews by AHRQ’s Evidence-Based Practice Centers

• Process: transparent, unbiased, rigorous, highly regarded

METHODS: (2) Medical Input and Prices

• Input from medical consultant• Data on average national retail price paid by

cash-paying consumer• CU team reviews effectiveness and cost• Input from CU’s medical advisor, health editorial

team, statistician, 2-3 outside medical peer reviewers for each category

METHODS: (3) Identifying CR Best Buy Drugs

CU team reviews the effectiveness and cost data, and selects one or more drugs that:

• Are in the top tier of effectiveness• Have a safety record as good as others in the

category• Have an average price substantially lower than

the most costly drug in the category

CR BEST BUY DRUGS: Cholesterol–Lowering Drugs/Statins

For moderate cholesterol reduction:

• Generic lovastatin

Substantial cholesterol reduction:

• Atorvastatin (Lipitor)

POSSIBLE ANNUAL SAVINGS: 3 Categories

• Statins $1,300 (cholesterol)

• Proton Pump Inhibitors: $1,740 (acid reflux and ulcers)

• NSAIDs $2,200 (arthritis and pain)

Just the beginning …

• Continue to draw on DERP reports

• One per month

• Next up: anti-depressants (SSRIs), high blood pressure and heart disease (ACE Inhibitors and Beta Blockers)