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Which drugs should health plans cover?

eding. But that claim was not consistently demonstrated in randomized comparisons. The most recent evidence now finds that Cox-2 inhibitors probably do not reduce intestinal side effects and probably do increase risk of heart problems.

"Fortunately, many health care organizations had weighed the true scientific evidence of the potential risks and benefits of these drugs and decided years ago not to include them in their formularies," said Mora. "The principles we present can help organizations make these kinds of sound decisions in the interest of patient safety."

2. Give more weight to real health outcomes than changes in risk factors.

Comparisons should give more credit to medications that are actually proven to result in less illness and fewer deaths, rather than simply changing risk factors. For example, many long-term medications, such as cholesterol or blood pressure drugs, are prescribed to reduce future risk of disease. While newer blood pressure drugs have been shown to reduce blood pressure, older and more affordable drugs are probably more effective for actually preventing heart disease, explained Simon.

3. Look at the full range of alternatives rather than those selected by industry when considering claims for advantages of new treatments.

Studies needed for new drug approval often compare a placebo with a current standard treatment. But sometimes there are many standard treatments available, and the manufacturer of a new drug may not always choose the most informative comparison. Psaty and his colleagues have developed a method called "network meta-analysis" that can be used to make valid comparisons across several treatments that are studied separately. This can be "especially important when the comparisons most interesting to clinicians and policy-makers differ from those that are most interesting or advantageous to research sponsors," the authors write.

4. Understand that variation in effects across in
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Contact: Joan DeClaire
declaire.j@ghc.org
206-287-2653
Group Health Cooperative Center for Health Studies
28-Oct-2005


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