Report: Dips in doc visits, drug spending bode ill for healthcare costs

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Drops in patient office visits, non-emergency room hospital admissions and older patients’ use of retail drugs contributed to a decline in the overall per capita utilization of medicine in 2011, according to a report by the IMS Institute for Healthcare Informatics. But emergency room admissions rose, all trends that point to higher costs for the healthcare system in the future.

The report, “The Use of Medicines in the U.S.: Review of 2011,” looked at five topics in healthcare and medicine: utilization, patient payment, spending, usage and spending in major therapy areas (including cholesterol medicines) and transformations in disease management.

“This retrospective analysis, in which we examine key issues and trends impacting consumption of and spending on medicines, provides new perspective and important background to informing critical decisions currently under consideration by all who have a stake in the U.S. healthcare system,” wrote Michael Kleinrock, the institute’s director of research development.

The study found that office visits declined 4.7 percent in 2011, down from the 4.1 percent dip recorded in 2010. Non-emergency room admissions edged down 0.1 percent in 2011 compared with an increase of 1.9 percent in 2010. Emergency room admissions climbed 7.4 percent in 2011, up from a 2.3 percent rise in 2010, which the authors attributed to the continuing high levels of unemployed and therefore uninsured patients.  

“The lowest-cost medical interventions are patients’ visits to doctors’ offices, which continued to decline in 2011,” according to the report. “Non-emergency admissions generally have a lower cost for the health system and payors, so this trend is likely to contribute to rising health system costs.”

They noted that retail per capita volume usage declined. Retail prescription usage dropped in 41 states, with 10 states incurring drops of 3 percent or more. Use of medicines per person declined by 1.1 percent; the drop for people 65 years old or older was steeper, at 3.1 percent. “Not only were rates of usage for chronic medicines declining, there were important variations across the country and by patients’ age, which suggests a concerning trend in the nation’s use of healthcare services,” the authors noted.

Insured patients spent $49 billion in 2011 for out-of-pocket expenses for prescription drugs, which was $1.8 billion less than in 2010. The report said a decline in co-pays for seniors participating in Medicare Part D fueled some of that drop.

Total spending on medicines equaled $320 billion, approximately $50 billion more than in 2010 and $125 billion more than 2002. Spending on new brands rose more than $12 billion in 2011, while spending on generics increased by $5.6 billion.

Five therapy areas accounted for approximatey a third of total spending, with oncologic medicines leading the list followed by respiratory agents, lipid regulators, diabetes medicines and antipsychotics. Spending in lipid regulators rose by $1.4 billion in 2011 for a total of $20.1 billion. The report estimated that almost 20 million Americans regularly took a cholesterol medicine, with more than 3 million being prescribed atorvastatin.

“Dispensed prescriptions for lipid regulators exceeded 260 million in 2011, with 63 percent filled with a generic; this is expected to rise to over 75 percent following the Lipitor (Pfizer) patent expiry,” according to the report. Lipitor went off patent in November 2011.

The report identified several therapies that became available in 2011 as treatments for cancer, multiple sclerosis, hepatitis C and cardiovascular disease. It listed dabigatran (Pradaxa, Boehringer Ingelheim) and rivaroxaban (Xarelto, Janssen Research & Development) for stroke prevention in patients with atrial fibrillation among the breakthroughs.

“Major transformations in treatment options for diseases affecting a few thousand to several million patients became available during 2011,” the authors wrote, referring to 34 new therapies launched in 2011. “They were not only the most in number in a decade, but represented important clinical advances, rarely seen in combination in the last 10 years.”

IMS Institute for Healthcare Informatics reported that its study was developed by the institute with no funding from government or industry.