Has pharmaceutical innovation reduced the average cost of U.S. health care episodes?
International Journal of Health Economics and Management - Trang 1-31 - 2023
Tóm tắt
A number of authors have argued that technological innovation has increased U.S. health care spending. We investigate the impact that pharmaceutical innovation had on the average cost of U.S. health care episodes during the period 2000–2014, using data from the Bureau of Economic Analysis’ Health Care Satellite Account and other sources. We analyze the relationship across approximately 200 diseases between the growth in the number of drugs that have been approved to treat the disease and the subsequent growth in the mean amount spent per episode of care, controlling for the growth in the number of episodes and other factors. Our estimates indicate that mean episode cost is not significantly related to the number of drugs ever approved 0–4 years before, but it is significantly inversely related to the number of drugs ever approved 5–20 years before. This delay is consistent with the fact (which we document) that utilization of a drug is relatively low during the first few years after it was approved, and that some drugs may have to be consumed for several years to have their maximum impact on treatment cost. Our estimates of the effect of pharmaceutical innovation on the average cost of health care episodes are quite insensitive to the weights used and to whether we control for 3 covariates. Our most conservative estimates imply that the drugs approved during 1986–1999 reduced mean episode cost by 4.7%, and that the drugs approved during 1996–2009 reduced mean episode cost by 2.1%. If drug approvals did not affect the number of episodes, the drugs approved during 1986–1999 would have reduced 2014 medical expenditure by about $93 billion. However, drug approvals may have affected the number, as well as the average cost, of episodes. We also estimate models of hospital utilization. The number of hospital days is significantly inversely related to the number of drugs ever approved 10–19 years before, controlling for the number of disease episodes. Our estimates imply that the drugs approved during 1984–1997 reduced the number of hospital days by 10.5%. The hospital cost reduction was larger than expenditure on the drugs.
Tài liệu tham khảo
Agency for Healthcare Research and Quality. (2023a). Clinical classifications software.
Agency for Healthcare Research and Quality. (2023b). Healthcare cost and utilization project (HCUPnet).
Alston, M., Dieguez, G., & Tomicki, S. (2018). A primer on prescription drug rebates: Insights into why rebates are a target for reducing prices. In: Milliman white paper. 21 May.
Baker, L., Birnbaum, H., Geppert, J., Mishol, D., & Moyneur, E. (2003). The relationship between technology availability and health care spending. Health Affairs, 22, 3–537.
Blankart, K. E., & Lichtenberg, F. R. (2022). The effects of off-label drug use on disability and medical expenditure. In: NBER working paper 30440. http://www.nber.org/papers/w30440
Bureau of Economic Analysis. (2023a). Health care.
Bureau of Economic Analysis. (2023b). Health care satellite account, more detailed blended data.
Bureau of Economic Analysis. (2023c). Health care satellite account, blended account, 2000–2020.
Cahan, E. M., Kocher, B., & Bohn, R. (2020). Why isn’t innovation helping reduce health care costs? Health Affairs Forefront, June 4.
Centers for Medicare and Medicaid Services. (2021). 2014 Part D rebate summary for all brand name drugs.
Centers for Medicare and Medicaid Services. (2023). National health expenditures by type of service and source of funds, CY 1960–2021.
Centre National Hospitalier d'Information sur le Médicament. (2023). Thériaque.
Congressional Budget Office. (2012). Offsetting effects of prescription drug use on Medicare’s spending for medical services, November 29.
Dorsey, E. R., de Roulet, J., Thompson, J. P., et al. (2010). Financial anatomy of biomedical research, 2003–2008. Journal of the American Medical Association, 303(2), 137–143.
Douguet, D. (2018). Data sets representative of the Structures and experimental properties of FDA-approved Drugs. ACS Medicinal Chemistry Letters, 9(3), 204–209.
Duflos, G., & Lichtenberg, F. R. (2012). Does competition stimulate drug utilization? The impact of changes in market structure on US drug prices, marketing and utilization. International Review of Law and Economics, 32(1), 95–109.
Dunn, A., Rittmueller, L., & Whitmire, B. (2015). Introducing the new health care satellite account, Bureau of economic analysis, January.
Dunn, A., Liebman, E. B., Shapiro, A. (2014). Developing a framework for decomposing medical care expenditure growth: Exploring issues of representativeness. In: D. W. Jorgenson, J. Steven Landefeld, and P. Schreyer (Eds.), Measuring economic sustainability and progress (pp. 545–574). Chicago: University of Chicago Press, for the National Bureau of Economic Research.
Dunn, A., Whitmire, B., Batch, A., Fernando, L., & Rittmueller, L. (2018). High spending growth rates for key diseases in 2000–14 Were driven by technology and demographic factors. Health Affairs, 37(6), 915–924.
Food and Drug Administration. (2023a). Drugs@FDA data files.
Food and Drug Administration. (2023b). Compilation of CDER NME and new biologic approvals 1985–2022.
Institut de Pharmacologie Moleculaire et Cellulaire. (2023). Cheminformatic tools and databases for pharmacology.
Lat, I., Micek, S., Janzen, J., Cohen, H., Olsen, K., & Haas, C. (2011). Off-label medication use in adult critical care patients. Journal of Critical Care, 26(1), 89–94. https://doi.org/10.1016/j.jcrc.2010.06.012
Lichtenberg, F. R. (2014). The impact of pharmaceutical innovation on disability days and the use of medical services in the United States, 1997–2010. Journal of Human Capital, 8(4), 432–480.
Lichtenberg, F. R. (2018). The impact of new drug launches on hospitalization in 2015 for 67 medical conditions in 15 OECD countries: A two-way fixed-effects analysis. Forum for Health Economics and Policy, 21(2).
Lichtenberg, F. R. (2021). Are drug prices subject to creative destruction? Evidence from the U.S., 1997–2017. Health Economics, 30(8), 1910–1932.
Lichtenberg, F. R. (2022a). The effects of dynamic and static competition on prescription drug prices in Denmark, 1997–2017. Journal of Evolutionary Economics, 32, 1155–1173.
Lichtenberg, F. R. (2022). The effect of pharmaceutical innovation on longevity: Evidence from the U.S. and 26 high-income countries. Economics and Human Biology, 46, 101124.
McKibbin, R. J. (2020). The effect of RCTs on demand for off-label cancer drugs. In SSRN scholarly paper ID 3574623. Rochester, NY: Social Science Research Network. https://doi.org/10.2139/ssrn.3574623
Radley, D. C., Finkelstein, S. N., & Stafford, R. S. (2006). Off-label prescribing among office-based physicians. Archives of Internal Medicine, 166(9), 1021–1026. https://doi.org/10.1001/archinte.166.9.1021
Research America. (2019). U.S. Investments in medical and health research and development 2013–2018.
Robinson, J. C., & Smith, M. D. (2008). Cost-reducing innovation in health care. Health Affairs, 27(5), 1353–1356.
Roebuck, M. C., Dougherty, J. S., Kaestner, R., & Miller, L. M. (2015). Increased use of prescription drugs reduces medical costs in Medicaid populations. Health Affairs, 34(9), 1586–1593.
Zhang, Y., Donohue, J. M., Lave, J. R., O’Donnell, G., & Newhouse, J. P. (2009). The effect of Medicare Part D on drug and medical spending. New England Journal of Medicine, 361(1), 52–61.