Does High Return Call for Greater Investment?

Over the past decades, advances in medical technology — from medications to devices — have had a profound impact on how patients receive care and manage disease. From cardiac bypass surgery for those with chest pain to more accurate diagnostic tests for cancer to insulin pumps for diabetics and curative medications for hepatitis C, these treatments have visibly increased the quality of life and outcomes for patients.

Although these examples represent important individual innovations in surgery, diagnostic testing, devices and drugs, which of these types of medical care has provided the greatest overall contribution to improvements in patient outcomes during the past several decades? This question has relevance as concerns grow about how much we spend on health care, with calls to better allocate our health care dollars.

New research helps us understand which interventions led to the greatest patient benefit over time, which could help us in making informed resource decisions today and in the future.

The research asked physicians — a group well-versed in which medical advances move the needle for patients — about what advances, excluding public health interventions, have changed treatment practices in their areas of expertise. According to the research, published in the Journal of Managed Care and Specialty Pharmacy, new biopharmaceuticals have driven innovation over the past 25 years, reshaping our treatment of diseases in profound ways.

The research was based on a survey of more than 130 U.S.-based physicians, asking what they considered to be the greatest contributor to improved health outcomes and quality of life since 1990. Physicians surveyed said the majority — 56 percent — of improvements in health outcomes were driven by pharmaceutical and biopharmaceutical innovations. Diagnostics (20 percent) were viewed as the next significant innovation, followed by surgical procedures and techniques (14 percent) or medical devices (11 percent).

This survey gave us a clearer understanding of which health care services deserve the most investment. Pharmaceuticals, which have made up roughly 10-15 percent of our overall health dollars for decades, have driven the majority of medical innovation and improved outcomes for patients when looking at the system overall, suggesting the dollars allocated to them were — and continue to be — a sound investment.

Perhaps the most vivid example is the impact of pharmaceutical innovation on patients with HIV. Since peaking in 1995, death rates from HIV/AIDS have fallen nearly 85 percent, due largely to antiretroviral treatment. By the end of 2015, the Centers for Disease Control and Prevention reported that an estimated 1.1 million adults were living with HIV in the United States, indicating that a disease once considered a death sentence has emerged into a chronic condition.

Within the past decade, we’ve also seen the development of a hepatitis C drug that can, for the first time, cure nearly all patients. We’re also seeing promising new treatments on the horizon with advancements like gene therapies. It’s no wonder why the physicians surveyed attributed a majority of improved health outcomes to pharmaceuticals: The benefits are hard to ignore.

Pharmaceuticals comprise only a small piece of the national health spending pie, but the return on this spending is notable — in surveys and in the improved outcomes and quality of life of patients with access to these treatments. Based on the survey, physicians seem to agree. While physicians recognize the importance that diagnostics and surgeries have in the treatment of certain conditions, they also recognize the enormous impact that a medicine can have in managing chronic conditions.

Could it be then that we as a society are underinvesting in the most valuable facet of health technology? What aspects of health care do we want to incentivize as a society in this new age of innovation: new construction or new cures? Where is the return — on human life as much as on investment — the greatest?

While attacks against the pharmaceutical industry wage and the industry raises questions about providing value, it is critical to evaluate which sectors of health spending are providing the most value for the dollars spent. Judging from the perspective of the nation’s physicians, it’s medicines driving that value — and if that’s where we are seeing the most impact on health outcomes, then perhaps that’s where we should spend our resources.


Robert W. Dubois, MD, Ph.D., is executive vice president and chief science officer of the National Pharmaceutical Council.

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