When Newer Isn't Better

I am going to write today about information that was presented at a recent American Diabetes Association conference.

Several research studies, clinical studies, have been conducted on the newer diabetes medications popularly known as Avandia and Actos. They are made by different companies and compete for market share. Of course they were studied for effectiveness and side effects prior to market and during FDA hearings some clinicians voiced concern about the risk of heart attacks and heart failure but the drugs made it to market none the less. They have for some time been noted as do not use drugs by the consumer group Public Citizen.

http://www.citizen.org/

I am not writing so much about that today as I am the concept of comparative or effectiveness research. You have heard me mention this before and I am a proponent of it.

This week a study that compared these medications to insulin, and procedures to unclog arteries in diabetics to use of medications for the same purpose was released by the NIH.
In both cases, the more expensive options did NOT provide better results.

The diabetes drugs Avandia and Actos are meant to help the body use the insulin better, there by eliminating the need for insulin injections. They also prevent the blood sugar from becoming too low. We have to look at this further though. Controlling the blood sugar is a step taken to prevent a more fatal outcome, i.e. a heart attack. If the heart attack still occurs at the same frequency then nothing was gained at an increased cost.

The same goes with angioplasty and by pass surgery. If the rate of death, heart attack or stroke is the same or even higher than occurs with a less invasive less expensive treatment ( generic heart drugs, like beta blockers) then the procedure (over 10,000$) is not cost effective.

I believe that this is important and I believe that our health plans have a right to this research and a right to refuse to cover this. I know we all think that newer and costlier techniques are better but that just isn't always the case. If benefits managers are not allowed to make informed decisions on coverage, all of our insurance costs will increase.

Additionally, new risk factors for the two diabetes medications were noted.

I wasn't able to find a report of the actual research, it may not be in print yet, but here is a link to the WSJ article which triggered this blog entry.

http://online.wsj.com/article/SB124441644145192397.html

Much of diabetes can be prevented as it is often associated with weight and what one eats.