Cleveland, OH—
While some defenders of higher drug prices have argued that the greater expense has little effect on usage, Cleveland Clinic researchers found otherwise.

In a research letter published in the New England Journal of Medicine, they report that the use of two cardiac medications—nitroprusside and isoproterenol—decreased by one-half and one-third, respectively, between 2012 and 2015, following major price increases.

During that time period, nitroprusside prices increased from $27.46 to $880.88, while isoproterenol prices shot up from $26.20 to $1,790.11. Study authors point out that because the medications are used only in inpatient settings, with no external patient demand and no direct-to-consumer advertising, it was possible to objectively examine the effect of the price increases on physician prescribing behavior.

To do that, the researchers analyzed utilization data for nitroprusside and isoproterenol in 47 hospitals between 2012 and 2015, while also obtaining information about nitroglycerin and dobutamine—two intravenous cardiovascular drugs with relatively unchanged pricing—for use as controls.

Results indicate that, during the study period, the number of patients treated with nitroprusside fell 53% and the number treated with isoproterenol dropped 35%. Usage of nitroglycerin increased 118%, while the number of patients treated with dobutamine went up 7%.

“In public testimony, it had been stated that these price increases would not decrease patient access or utilization of these two critical drugs, both of which have been used for decades in patient care,” said lead author Umesh Khot, MD, vice chairman of Cardiovascular Medicine at Cleveland Clinic.  “However, our research shows that these price hikes are not benign. Further research will determine if there has been any effect on patient outcomes, but it’s clear that utilization has been impacted.”

Background information in the letter notes that nitroprusside, which lowers blood pressure, is used in the treatment of critical hypertension and congestive heart failure, as well as to keep blood pressure low during surgery. Isoproterenol is used primarily for treating bradycardia and heart block and often is employed during electrophysiology procedures and specific cardiothoracic surgery cases to increase heart rate or contractility.

“These are medications that physicians are very familiar with, and for which there are no direct alternatives. As a result, hospitals have had to reevaluate use of these drugs and potentially bring in other therapies,” explained co-author Michael Militello, PharmD. “Understanding how physicians, pharmacists and health systems have addressed their use of these medications is an important area of further study.”

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