Tuesday, July 9, 2002 For
More Information Contact:
Janet Firshein, 301-652-1558 or
Jon Gardner, Health Affairs, 301-656-7401, ext. 230
NEW
FEDERAL STUDY SHOWS SHARP INCREASES IN PRESCRIPTION RATES ACROSS
ALL AGES AND IN NEARLY ALL SPECIALTIES; AT CURRENT RATE DRUG
SPENDING WOULD DOUBLE IN NEXT FIVE YEARS
Increased
Prescribing Linked To More Older Patients, More Multiple Conditions,
New Drug Choices, Medical Payment And Delivery Systems, And
Direct Marketing To Consumers
Washington,
D.C. – At a time when Congress is struggling to create
a viable prescription drug benefit and consumers are increasingly
worried about drug costs, a new study shows that physicians
are prescribing medications to their patients at a far greater
rate than they did just two decades ago. In fact, the prescription
rate rose 34 percent between 1985 and 1999, from 109 to 146
prescriptions per 100 visits, according to a federal study released
today in the journal Health Affairs.
The increase
in drug mentions (including prescription drugs, over-the-counter
preparations and immunizations) cuts across all age groups and
all physician specialties except general surgeons, cardiologists,
and dermatologists. The study reveals that the largest increase
was found for psychiatrists, whose drug mention rate jumped
from 82 to 178 drugs per 100 visits. This is largely attributable
to an increased use of antidepressants - at least eight new
antidepressant drugs have been introduced since 1987.
"The
study data show that there are a number of reasons why prescription
rates are soaring," said study author Catharine Burt of
the Centers for Disease Control and Prevention. According to
the study, if the current drug increase rate continues, drug
spending will likely double in the next five years, despite
patent expirations for many popular brand name drugs.
Increases
in patient age and number of medical conditions by patients
seeking care account for about two-thirds of the observed increases
in drug prescribing practices. The study data show that from
1985 to 1999, the proportion of visits by patients who were
45 years of age or older increased by one quarter and visits
by patients with at least three diagnoses more than doubled.
Changes
in drug coverage, drug research and development, faster Food
and Drug Administration approval, and increased drug marketing
to physicians and consumers are additionally cited as likely
contributors to increased use of medications in ambulatory care.
The study also shows that physicians were 43 percent more likely
to prescribe multiple drugs per patient visit in 1999 than in
1985, after controlling for differences in patient and condition
mix in those two time periods.
The study
pulls data from the National Ambulatory Medical Care Survey
(NAMCS), which has collected patient encounter data periodically
since 1973, and annually since 1989. NAMCS is a sample survey
of 2,500 to 4,500 office-based physicians conducted by the CDC's
National Center for Health Statistics. For this study, Burt
analyzed 288,941 patient encounter records.
Increases
in medications prescribed were found for all major therapeutic
classes, except antimicrobial agents such as penicillins and
tretracycline. The prescription rate for this class of drugs
actually dropped 12 percent in the study period.
But six
areas accounted for 80 percent of the increase in the overall
drug mention rate: central nervous system drugs, hormones, respiratory
drugs, pain relief drugs, metabolic/nutrients, and cardiovascular-renal
drugs. Specifically, the top classes accounting for most of
the increase in the overall drug prescription rate at physician
office visits were:
• Antidepressants
• Hyperlipidemia drugs
• ACE inhibitors
• Antihistamines
• Calcium channel blockers
• Acid/peptic disorders
• Blood glucose regulators
• Vaccines
• Estrogens
For seniors,
the largest increase was found for hematologic agents with a
187 percent jump from 1985 to 1999 from 1.9 mentions to 5.5
mentions per 100 visits. The largest increase for patients ages
45-64, was 109 percent for metabolics, which includes lipid-lowering
drugs such as Lipitor. For children, the largest increase was
for central nervous system drugs, with the prescription rate
rising a whopping 327 percent between 1985 and 1999. According
to the study, one of the most frequently mentioned drugs at
children's visits in 1999 was Ritalin for treating attention
deficit hyperactivity disorder.
"Some
might assume that the likely driver of such an increase in prescriptions
is an aging population, but our study shows that only about
20 percent of the observed increases can be attributed to this,"
said Burt. "Other factors – more patients with multiple
conditions, new drugs for chronic conditions, increased health
insurance and prescription drug coverage, increased focus on
managed care including the use of treatment guidelines, and
direct-to-consumer advertising – appear to play a role."
New Drugs.
FDA approvals for new drugs have doubled since the early 1980s,
from an average of about 19 per year to 38 per year in the 1990s.
Also, the length of time for approval of new drugs has declined
from about 33 months in 1986 to 12 months in 1998. The newer
drugs offer doctors more choices in finding medications that
best meet the needs of patients, including those with the fewest
side effects.
Drug
Coverage and Managed Care. Payment sources for physician
office visits have changed tremendously since 1985. The NAMCS
data show that in 1985, 35 percent of visits were paid for by
the patient, in contrast to only 5 percent in 1999. The share
of visits paid for by Medicare rose 40 percent and by private
insurance or HMO coverage, almost 200 percent. At the same time,
the percentage of insured workers with drug coverage rose from
91 percent in 1988 to 99 percent in 1999. In addition, more
than half of all Medicare recipients now have some kind of drug
coverage from supplemental plans.
Managed
care has also likely led to increased use of treatment guidelines,
many of which include medication use. For example, treatment
guidelines for hypertension include multiple drug regimens in
many cases. The same is true for an increased emphasis on pain
relief medications.
Direct-to-Consumer
Advertising (DTC). Direct mass-media marketing, approved
since 1997, is linked to a sharp rise in the number of prescriptions
written and overall spending on prescription drugs. The study
cites research that shows that doctors wrote 34 percent more
prescriptions in 1999 than in 1998 for the 25 direct-to-consumer
promoted drugs that contributed most to overall drug spending.
They wrote only 5 percent more prescriptions for all other prescription
drugs. For example, Pfizer increased DTC advertising for Lipitor
six fold between 1998 and 1999 and saw prescriptions increase
by 50 percent.
Health Affairs,
published by Project HOPE, is a bimonthly multidisciplinary
journal devoted to publishing the leading edge in health policy
thought and research. Copies of the July/August 2002 issue will
be provided free to interested members of the press. Address
inquiries to Jon Gardner at Health Affairs, 301-656-7401, ext.
230, or via email, press@healthaffairs.org.
Selected articles from the July/August issue are available free
on the journal's Web site, www.healthaffairs.org.
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©2002
Project HOPE–The People-to-People Health Foundation, Inc.
