“ Some days it all adds up and what you got is enough. Some days are better than others,” sang U2 in their 1993 release. Like the song, the medical industry may mutter the same message. While some weeks are laced with recalls, new risks and high costs, others are filled with innovative research and treatments.
This week, the results of the AVERROES trial, which looked at the clinical benefits of apixaban in afib patients, are published and show that its use can reduce stroke and systemic embolism by nearly half.
The trial was stopped early because patients who received the drug performed so well. In fact, the researchers noted that apixaban could replace aspirin altogether to prevent stroke in AF patients.
However, additional research this week presented at the American Stroke Association's International Stroke Conference (ISC) showed that medication costs may be too high for patients to afford. Researchers from the University of Michigan, Ann Arbor, found that 11 percent of all stroke survivors reported nonadherence to medications.
Cost-related nonadherence was highest in stroke survivors aged 45 to 54, Part D Medicare beneficiaries and the uninsured. More interventions that provide insurance or help with medication costs are needed for these stroke survivors, because the costs of prescriptions are currently unaffordable and in turn may decrease a patient’s health.
In other pharmaceutical news, a substudy of the JUPITER trial found that rosuvastatin (Crestor, AstraZeneca) for patients who have a Framingham risk score of 10 percent or greater and JUPITER-eligible patients was cost effective.
However, an accompanying editorial thought differently. Mark A. Hlatky, MD, said that an estimated six to 12 million patients may receive statin treatment due to the JUPITER results, which could incur costs of $50 billion to $95 billion to extend Crestor treatment to all JUPITER-eligible patients.
In terms of treating specific patient populations, other news featured in JACC found that women benefit from cardiac resynchronization therapy with defibrillator (CRT-D) when compared with men. In fact, the researchers reported that HF was reduced by 50 percent for women compared with men when CRT-D was used, 70 percent versus 35 percent.
“Some days are dry, some days are leaky. Some days come clean, other days are sneaky. Some days take less, but most days take more,” sang the band. While some patient populations benefit heavily from this new research, what does the future hold for those others who may not? Some days we must count our losses and move on to find success; however, a better focus needs to be reducing the costs of medications for those who can afford them, but may benefit most.
On these topics or others please feel free to contact me.