Choosing Brand-Name Over Generic Statins Can Cost Billions

October 04, 2011

October 3, 2011 (Chicago, Illinois) — "Overuse" of a dozen different treatments or diagnostic tests ordered by US primary-care physicians, spanning a broad range of clinical conditions, costs the healthcare system an extra $6.74 billion annually, according to an analysis that singled out a certain statin prescribing practice as accounting for most of the excess cost [1].

Failing to prescribe a generic statin as opposed to an exclusively brand-name statin for a patient just starting lipid-lowering therapy made up 86% of the total extra costs, though it was only the third most common inappropriate activity on the list, according to the authors, led by Dr Minal S Kale (Mount Sinai School of Medicine, New York, NY).

The group's report was published online October 1, 2011 in the Archives of Internal Medicine to coincide with its presentation at the National Physicians Alliance (NPA) Annual Meeting in Washington, DC.

The most commonly performed inappropriate activity--ordering a complete blood count (CBC) at an adult patient's general medical examination--topped the list in terms of frequency but contributed less than 1% of total extra costs, Kale pointed out for heartwire . At the same time, expensive bone-density scans ordered for adult women younger than 65 years, considered inappropriate except in certain specific clinical situations like bone fracture or corticosteroid use, occurred only 1.4% of the time.

A lesson from the analysis, Kale told heartwire , is that "activities with small costs contributed substantially to the overall cost if they were frequent enough," as can activities that are seldom done inappropriately yet still are expensive, perhaps challenging some perceptions about the overall financial impact of specific treatment and diagnostic decisions.

The analysis looked at a dozen such primary-care activities that family practitioners, internists, and pediatricians responding to the 2009 National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) cited as commonly performed inappropriately. The authors determined the frequency of those activities performed in the absence of accepted indications based on Medicare data, and their retail "acquisition cost to consumers."

Prevalence and Cost of Selected "Inappropriate" Physician Activities

Inappropriate primary-care physician activity % of eligible visits including with inappropriate activity Direct annual cost ($)
CBC ordered or performed at adult general medical examination 56.0 32 679 628
Antibiotics prescribed for children

with pharyngitisa

40.9 116 365 312
Exclusively brand-name statin prescribed on starting lipid-lowering therapy 34.6 5 817 251 527
Bone-density scan for women aged 40-64 yearsb 1.4 527 433 773

a. Excluding patients with strep pharyngitis or fever

b. Excluding women with fractures, corticosteroid exposure, anorexia, vitamin-D deficiency, or tobacco use

That so much of the total extra cost is attributed to one practice, brand-name statin prescribing, doesn't suggest it will be necessarily easy to cut down on the inappropriate practice, according to Kale et al, as "numerous efforts have already been made by the US states (generic-substitution laws), payers (tiered formularies), and healthcare providers (generic drug detailing) to achieve this goal. In this light, our data suggest that considerably more work is needed to reduce the costs associated with brand-name statin use."

Kale pointed out that the analysis didn't look at why some inappropriate activities were so common and said "future research needs to examine the role of reimbursement, defensive medicine practices, lack of adherence to guidelines," or other potential factors that might account for it.

Kale and the other authors had no disclosures.

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