Biotechnology Healthcare - July/August 2008 - (Page 27)

COMPARATIVE EFFECTIVENESS RESEARCH What Path Do We Take? BY LOLA BUTCHER Contributing Editor The emergence of biologic therapies and geneticbased response makes it ever harder for physicians and payers to determine the best choices for a patient. Deciding when to bring up cost considerations only makes the problem more complicated. large clinical trial has yet evaluated bevacizumab’s effectiveness and safety in treating macular degeneration, and the best dosing schedule is unknown. For that matter, physicians wonder whether the dosing schedule for ranibizumab might be modified without compromising effectiveness. And one more thing: The cost of off-label bevacizumab is less than $100 per treatment, while ranibizumab costs $2,000. Either treatment requires multiple doses, so the price differential between the two agents rings in at nearly $27,000 a year. In a case like this, how does a physician, a payer — or a patient — decide the best course of action? By guessing. That’s the American way in healthcare today. Without definitive information about which therapy works best, medical decision making boils down to physician hunches and patient preferences, leading to huge variations in treatment for identical medical situations. The best evidence of this: per capita Medicare spending in some U.S. regions is nearly double that seen in other areas (Figure). So it is not surprising that most people seem to agree on one point: The United States needs to follow the lead of many other developed countries to establish a system for establishing reliable information about the comparative effectiveness of treatments. W hen it comes to treating age-related wet macular degeneration, the leading cause of severe vision loss in people over age 65, ophthalmologists like two biologics— ranibizumab (Lucentis) and bevacizumab (Avastin). Only one of these agents, ranibizumab, is approved by the U.S. Food and Drug Administration as a macular degeneration therapy, although many physicians believe bevacizumab, which is approved for the treatment of colorectal and lung cancer, may work just as well. No Per capita Medicare spending, by hospital referral region, 2003 Numbers in parentheses indicate number of regions $7,200–$11,600 (74) $6,800–<$7,200 (45) Not populated $6,300–<$6,800 (55) $5,800–<$6,300 (60) $4,500–<$5,800 (72) Source: The Dartmouth Atlas of Health Care, ©2007 The Trustees of Dartmouth College JULY/AUGUST 2008 · BIOTECHNOLOGY HEALTHCARE 27

Table of Contents Feed for the Digital Edition of Biotechnology Healthcare - July/August 2008

Biotechnology Healthcare - July/August 2008 Openers Contents Editorial/David B. Nash, MD, MBA Drug Track Health Plan Confidential Rheumatoid Arthritis A Decade of Trial, Error, False Starts, and Hope What Path Will Comparative Effectiveness Research Take? RA Therapies in Development: A New Generation of Relief Assessing the Full Impact of RA on Employers and Payers Stem Cells: Health Insurance You Can Bank On Specialty Pharmacy Employer to Employer Personalized Medicine Trends Clinical Briefs

Biotechnology Healthcare - July/August 2008

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