Wiser Med Use Could Cut Health Costs   06/19 10:57

   TRENTON, N.J. (AP) -- If doctors and patients used prescription drugs more 
wisely, they could save the U.S. health care system at least $213 billion a 
year, by reducing medication overuse, underuse and other flaws in care that 
cause complications and longer, more-expensive treatments, researchers conclude.

   The new findings by the IMS Institute for Healthcare Informatics improve on 
numerous prior efforts to quantify the dollars wasted on health care.

   Numerous experts previously have estimated that tens of billions, perhaps 
hundreds of billions of dollars, could be better used each year to improve 
patient care and outcomes and to slow down spending by government health 
programs, insurers and consumers.

   The institute, part of data analysis and consulting firm IMS Health, used 
its proprietary data on prescriptions written by doctors _ many of which 
patients never fill _ plus other information to produce a current, more 
reliable estimate of avoidable costs solely related to medication use.

   IMS arrived at the $213 billion figure based on six categories in which 
doctors, patients or both could be making better use of medication, from 
getting a prompt diagnosis when new symptoms arise to taking medicines as 
directed by the doctor. Across the six categories, the researchers generally 
focused on spending on a handful of very common or very expensive diseases _ 
from high cholesterol and blood pressure to HIV and diabetes _ for which costs 
of care and complications are well documented.

   "There's even larger avoidable costs if we were to look at all disease 
areas" where patients aren't getting optimal care, Murray Aitken, the 
institute's executive director, told The Associated Press in an exclusive 
interview. "There's a big opportunity for improvement."

   The $213 billion equals nearly 8 percent of the more than $2.7 trillion the 
U.S. spent on health care last year. Those billions could pay for the health 
care of more than 24 million Americans currently uninsured, according to IMS.

   And Aitken said more-appropriate use of medication _ taking it exactly as 
prescribed, not taking antibiotics for viral illnesses, preventing medication 
errors and the like _ could prevent 6 million hospitalizations, 4 million trips 
to the emergency room and 78 million visits to doctors and other outpatient 
care providers each year.

   "Those are staggering numbers," Aitken said.

   The report, titled "Avoidable Costs in Healthcare," found the biggest area 
of waste is patients not taking medicines prescribed by their doctor, either at 
all or as directed. IMS estimates the cost of such "non-adherence" at about 
$105 billion a year.

   Reasons for the longstanding problem include patients fearing drug side 
effects, not understanding complications that can occur without treatment, 
having mental health issues and not being able to afford their medicines. Price 
has become less of a factor, though, as there are now relatively inexpensive 
generic versions of drugs for most diseases.

   "I think there's really good, solid evidence that if you adhere to 
medications, that keeps you out of the hospital," said M. Christopher Roebuck, 
president of health policy consultants Rx Economics LLC.

   Roebuck, who was not involved in the study, said it's well done. But he said 
the estimates of potential savings are "quite conservative" for medication 
non-adherence and treatment delays.

   Those delays are blamed for racking up about $39 billion a year in avoidable 
care costs _ due to patients putting off doctor visits and not getting 
medications they're prescribed, or doctors not promptly starting treatments 
proven to prevent expensive complications.

   "We've got a lot of people without insurance who are not routinely going to 
the doctor, and even some with insurance aren't," Aitken said.

   Other areas of waste noted in the report include:

   _ Prescribing antibiotics inappropriately, as for patients with the flu or 
another viral infection, costing about $35 billion annually. This can 
contribute to bacteria becoming resistant to antibiotics, resulting in more 
expensive treatment and even hospitalization with a future infection.

   _ Medication errors, costing about $20 billion annually. Those include 
sloppy handwriting leading to the wrong drug or dose being dispensed and 
doctors not checking to see that the patient is getting better, meaning they've 
been getting the right medicine. Those errors are on the decline due to more 
doctors using electronic prescriptions and other changes.

   _ Not using generic drugs when they are available, costing about $12 billion 
annually. That's a decreasing problem, as strategies of health plans and 
pharmacies encourage patients to choose generics by setting copayments for 
brand-name drugs a few times higher than for the generics. Without insurance, 
generics can cost 90 percent less than brand-name drugs. Today, when a generic 
is available, it's dispensed about 95 percent of the time.

   _ Multiple medication confusion, costing about $1.3 billion annually. For 
elderly patients taking five or more medicines, it's easy to mix up which pills 
should be taken when, and for those who are frail, those mistakes can cause 
serious harm. That problem likely will grow significantly with our aging 
population.

   The report will be shared with government, medical and policy groups and 
other stakeholders in the health system, Aitken said.

   The institute, whose clients include major drugmakers, noted that its report 
was prepared without funding from government or the pharmaceutical industry.   


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