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Use of nitroprusside, isoproterenol declined after price spike
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As the prices for two medications for the treatment of life-threatening CV conditions increased, utilization of both decreased, according to a correspondence published in The New England Journal of Medicine.
“There have been some claims that with the price increases, there should not be any impact on prescribing behavior, but our results were the exact opposite,” Umesh N. Khot, MD, vice chairman of the Robert and Suzanne Tomsich department of cardiovascular medicine and a staff cardiologist at the Sydell and Arnold Miller Family Heart and Vascular Institute at Cleveland Clinic, said in an interview with Cardiology Today. “We found a dramatic reduction in the utilization of both these drugs after these price increases.”
Researchers analyzed the utilization of two medications within 47 hospitals between 2012 and 2015. During that time, the price of nitroprusside increased by a factor of 30 (from $27.46 per 50 mg in 2012 to $880.88 per 50 mg in 2015) and isoproterenol increased by a factor of nearly 70 (from $26.20 per mg in 2012 to $1,790.11 per mg in 2015).
“When [these drugs] were originally priced back in 2012, they were quite inexpensive, and so nobody was really paying much attention to their price because their prices were rather low,” Khot said in an interview.
Data on dobutamine and nitroglycerin were also reviewed, as prices of those did not fluctuate during that time.
The prevalence of patients treated with nitroprusside decreased by 53%, whereas isoproterenol use decreased by 35%. The utilization of medication per 1,000 inpatients per hospital decreased by 40% for isoproterenol and 46% for nitroprusside (P < .001 for both).
The number of patients treated with nitroglycerin and dobutamine increased by 118% and 7%, respectively. The number treated per 1,000 inpatients per hospital increased for nitroglycerin (89%; P < .001) and slightly rose for dobutamine (4%; P = .74).
The difference in use between nitroprusside and nitroglycerin increased over time, as did the difference in use between isoproterenol and dobutamine (P < .001 for both comparisons).
“We now know that physicians are changing their behavior in terms of prescribing practices, but what is the clinical impact of these changes to patients ... if they are, for example, restricting access or using some other drug,” Khot told Cardiology Today. “Has this made any impact on patient care, or have they found other options that are equivalent or similar? These are important questions that needed be answered in the future.” – by Darlene Dobkowski
For more information:
Umesh N. Khot, MD, can be reached at khotu@ccf.org.
Disclosures: Khot reports receiving personal fees from AstraZeneca. Please see the study for all other authors’ relevant financial disclosures.
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