My comparative effectiveness story

Whoever must pay for care, we need a lot of data on which to base sound decisions.

It occurred to me after filing this morning's piece on comparative effectiveness  I had personal experience to bring to the party.

As some here may know I'm an incipient heart patient. My dad had a heart attack in his 40s, I'm in my 50s. So I treat myself aggressively.

Statins were not available in dad's middle age, but my cholesterol was over 300 when I first got it checked. ACE inhibitors were not around in the 1960s either. I take these hypertension drugs as well.

The result is I have a normal cholesterol count of 170, a healthy portion of that is the "good" stuff, and I know not only when my systolic blood pressure is up but what to do about it.

I also have bills he didn't face. Regular, monthly bills. Maintenance costs.  While we are lucky to have the "good" insurance I am cheap by nature.

Thus my effort to lower costs.

My doctor prescribed Lipitor, an anti-cholesterol statin that cost me $30/month and my insurer much more. I had her switch me to simvastatin, a generic with a lower co-pay and lower total cost. I have higher lipids as a result, but not much higher.

To raise my good cholesterol the doctor suggested Niaspan, a time-released niacin also available by prescription, with a $30/month co-pay. After a talk with my pharmacist I switched to an over-the-counter niacin. I'm able to take more and my costs are about $7/month. The insurer pays nothing.

When my physician noted a high resting pressure, she started fiddling with her approach. She added a diuretic. I learned, while researching this blog, that calcium channel blockers have a better track record, when used with ACE inhibitors, so she switched me.

That last switch saved no money, but it was based on a study called Accelerate that was a sort of comparative effectiveness study, in that it compared two regimens with a lot of people so its results might be relied upon.

That's what reformers like Brian Klepper and David Kibbe would have us do. The difference is they want us to collect a lot more data, so the results are more reliable. And they don't object to having cost-effectiveness -- the criterion I've been using in my personal life -- as a goal. They also want those results in the doctor's hand when she makes decisions.

I would also like to know whether the choices I made were the right ones. I would love to have data backing my choices. If my insurance carrier had sufficient data they could save money with sound science as well.

There are losers here. In any market savings by buyers are losses to sellers. Lipitor lost me (for now), and they would lose more if data allowed insurers to make the switch en masse. Niaspan lost, and would lose more if data showed my switch made sense.

Should we be choosing Lipitor over simvastatin based on slick TV ads? Does our search for cures suffer if Niaspan loses its monopoly rents to health supplements, and if data indicates this is a fair swap?

These are the important questions of comparative effectiveness. Communism, socialism, or Obamafascism don't enter into it.

Whoever must pay for care, we need a lot of data on which to base sound decisions. Comparative effectiveness collects the data, analyzes it, and then makes recommendations to those who must pay the bills.

But given the stakes don't expect drug and device makers to stop stoking the fears. Lower profits might mean less for research into cutting-edge cures and solutions for more dread conditions. That is a debate worth having, but it's not the debate we are having.