According to the Canadian Institute for Health Information, Canadians spent $29.8 billion on drugs in 2008, an increase of $2.3 billion over the previous year.
The projected annual growth rate for prescribed drugs is 7.4 per cent. Spending on prescribed drugs increased on average by 11.2 per cent per year from 1997 to 2004. Over a longer period, 1985 to 2008, the percentage of health care spending on drugs almost doubled to 18 per cent of total expenditures.
Last year, every man, woman and child accounted for $897 in drug expenses, up 7.4 per cent over 2007.
Spending on drugs and on health care in general is growing at a rate far above inflation. And still we have plenty of complaints about our health care system.
I’ve argued for years that the cost of health care, despite our desire for a great system, will outstrip our ability to pay. Simple math shows the kind of increases we’ve seen year over year would, if left unchecked, eventually consume every tax dollar, and demand that governments collect ever more from us. Clearly, that’s not feasible.
The problem is we’ll have to say “no” at some point. Politicians have no will to do so, rightfully fearing a backlash from voters who don’t see the contradiction between demanding more spending and lower taxes.
The billions we spend on drugs, coupled with ongoing debates about the cost of those medications – you’ll probably recall the many stories about Americans crossing the border to have their prescriptions filled at comparatively less expensive Canadian pharmacies – begs the question, are we better off for it?
According to Dr. Mitchell Levine, the answer is yes. At least in most cases.
A professor in the department of clinical epidemiology and biostatistics at McMaster University, Levine is also director of the Centre for Evaluation of Medicines at St. Joseph’s Healthcare in Hamilton.
“In general, drugs provide some of the best value in terms of money spent on health care. You get a bigger bang for your buck with drugs,” he says.
That’s not a blanket statement, however. Nor did it mean we should stop constantly reviewing medicines and how we use them.
The issue is, are we getting good value for the money? It’s the same question that should be applied to all aspects of health care, not just drugs, he adds.
“There are therapies that may not be worth the money.”
While some people vilify drugs and the pharmaceutical companies, and others are happy to join the pop-a-pill bandwagon, Levine argues prescription medications are neither good nor bad in and of themselves. They must be evaluated in context.
Certainly modern drugs have been literal lifesavers for many Canadians. Medication also helps many live much happier lives by keeping ailments under control. That doesn’t mean, however, that we should blindly use drugs in every instance.
Doctors must evaluate each patient’s individual needs, he says. That’s just sound medical judgment.
When it comes to the wider issue of spending, cost-effectiveness is the mantra.
For instance, there are some very good drugs for treating acid reflux, but you wouldn’t use the drugs to treat a mild case of heartburn. Sure they’d be effective, but there are much cheaper alternatives.
When it comes to reviewing drugs, however, the primary thought is efficacy, not cost, he notes.
We’ve all seen stories about drugs that the government has removed from the list of what it will pay for, or about people who have been denied a certain drug because the government hasn’t added it to its coverage list. What goes on the list is usually determined by a panel of experts. Those people, says Levine, are looking at the overall impact of the drug, not specifically at the cost.
It’s easy, he notes, to point to the cost of medicine. Drugs are an easy thing to quantify when looking at how much we spend on health care. We know how many pills we dispense to how many people, and we can tell if the therapy was effective or not. The same is not true of other facets of health care, making drug costs something of a flashpoint in the debate over costs.
New drug therapies can be expensive. That is also true generally of new technologies in the medical field. There are always advances, but with costs already soaring, there may come a point where the technology is simply beyond our means. We’ll have to look at the return on our investment to see if it is worthwhile – a hard call to make.
“Maybe we have to say ‘no’ to some of these advances,” says Levine.
