Benefits and Costs of Newer Drugs: An Update

We update and extend our previous study of the effect of drug age -- years since FDA approval -- on total medical expenditure, in several respects. The estimates indicate that, in the entire population, a reduction in the age of drugs utilized reduces non-drug expenditure 7.2 times as much as it increases drug expenditure. In the Medicare population, a reduction in the age of drugs utilized reduces non-drug expenditure by all payers 8.3 times as much as it increases drug expenditure; it reduces Medicare non-drug expenditure 6.0 times as much as it increases drug expenditure. About two-thirds of the non-drug Medicare cost reduction is due to reduced hospital costs. The remaining third is approximately evenly divided between reduced Medicare home health care cost and reduced Medicare office-visit cost. We also found that the mean age of drugs used by Medicare enrollees with private Rx insurance is about 9% lower than the mean age of drugs used by Medicare enrollees without either private or public Rx insurance.

Response to Baker and Fugh-Berman's Critique of my Paper, "Why has Longevity Increased more in some States than in others?"

Dean Baker and Adriane Fugh-Berman have published a critique of a study I performed in 2007, entitled “Why has longevity increased more in some states than in others?” One of the conclusions I drew from that study was that medical innovation accounts for a substantial portion of recent increases in U.S. life expectancy. Baker and Fugh-Berman claim that my study was subject to a number of major methodological flaws. Many of their claims pertain to the role of infant mortality; the definition of drug vintage; the issue of age adjustment; and the appropriateness of controlling for AIDS, obesity, and smoking in the analysis of longevity. In this article, I make the case that their claims about my study are largely incorrect. I show that infant mortality was not an important determinant of the growth in U.S. life expectancy during the period that I studied, and that my estimates are completely insensitive to the inclusion or exclusion of infant mortality. Controlling for the age distribution of the population also has essentially no effect on the longevity equation estimates. I argue that my definition of drug vintage, based on the initial FDA approval year of a drug’s active ingredient, is quite reasonable, and it is consistent with the FDA’s evaluation of the therapeutic potential of new drugs. I argue that controlling for AIDS, obesity, and smoking in longevity analysis is entirely appropriate and consistent with the epidemiological literature. Baker and Fugh-Berman express deep skepticism about my study’s conclusion that medical innovation has played a very important role in recent U.S. longevity growth, but they offer no explanation of why life expectancy increased by almost a year during 2000-2006, a period of increasing poverty and obesity and declining health insurance coverage.

The Benefits and Costs of Newer Drugs: Evidence from the 1996 Medical Expenditure Panel Survey

The nation's spending for prescription drugs has grown dramatically in recent years. Previous studies have shown that the replacement of older drugs by newer, more expensive, drugs is the single most important reason for this increase, but they did not measure how much of the difference between new and old drug prices reflects changes in quality as better, newer drugs replace older, less effective medications. In this paper we analyze data from the 1996 Medical Expenditure Panel Survey (MEPS) to provide evidence about the effect of drug age on mortality, morbidity, and total medical expenditure, controlling for sex, age, education, race, income, insurance status, who paid for the drug, the condition for which the drug was prescribed, how long the person has had the condition, and the number of medical conditions reported by the person. The results provide strong support for the hypothesis that the replacement of older by newer drugs results in reductions in mortality, morbidity, and total medical expenditure. People consuming new drugs were significantly less likely to experience work-loss days and to die by the end of the survey than people consuming older drugs. The estimates indicate that reductions in drug age tend to reduce all types of non-drug medical expenditure, although the reduction in inpatient expenditure is by far the largest. Reducing the age of the drug results in a substantial net reduction in the total cost of treating the condition. Allowing people to use only generic drugs would increase total treatment costs, not reduce them, and would lead to worse outcomes.

The Contribution of Pharmaceutical Innovation to Longevity Growth in Germany and France

I investigate the contribution of pharmaceutical innovation to recent longevity growth in Germany and France. First, I examine the effect of the vintage of prescription drugs (and other variables) on the life expectancy and age-adjusted mortality rates of residents of Germany, using longitudinal, annual, state-level data during the period 2000-2007. The estimates imply that almost half of the 1.7-year increase in German life expectancy during the period 2000-2007 was due to the replacement of older drugs by newer drugs. Next, I examine the effect of the vintage of chemotherapy treatments on age-adjusted cancer mortality rates of residents of France, using longitudinal, annual, cancer-site-level data during the period 2002-2006. The estimates imply that chemotherapy innovation accounted for at least one-sixth of the decline in French cancer mortality rates, and may have accounted for as much as half of the decline.

The Benefits and Costs of Newer Drugs: Evidence from the 1996 Medical Expenditure Panel Survey

The nation's spending for prescription drugs has grown dramatically in recent years. Previous studies have shown that the replacement of older drugs by newer, more expensive, drugs is the single most important reason for this increase, but they did not measure how much of the difference between new and old drug prices reflects changes in quality as better, newer drugs replace older, less effective medications. In this paper we analyzed prescribed medicine event-level data (linked to person- and condition-level data) from the 1996 Medical Expenditure Panel Survey (MEPS) to provide evidence about the effect of drug age on mortality morbidity, and total medical expenditure, controlling for a number of characteristics of the individual and the event. (Previous researchers have hypothesized that differences in treatment patterns across individuals and areas may occur because of physicians' uncertainty and ignorance over the best medical practice.) The MEPS data enable us to control for many important attributes of the individual, condition, and prescription that influence outcomes and non-drug expenditures and that may be correlated with drug age. These include sex, age, education, race, income, insurance status, who paid for the drug, the condition for which the drug was prescribed, how long the person has had the condition, and the number of medical conditions reported by the person. Indeed, the fact that many individuals in the sample have both multiple medical conditions and multiple prescriptions means that we can control for all individual characteristics both observed and unobserved by including individual effects'. The results provide strong support for the hypothesis that the replacement of older by newer drugs results in reductions in mortality morbidity, and total medical expenditure. Although the mortality rate in this sample is quite low making it difficult to detect any...

The Effect of Drug Vintage on Survival: Micro Evidence from Puerto Rico's Medicaid Program

Using micro data on virtually all of the drugs and diseases of over 500,000 people enrolled in Puerto Rico's Medicaid program, we examine the impact of the vintage (original FDA approval year) of drugs used to treat a patient on the patient's 3-year probability of survival, controlling for demographic characteristics (age, sex, and region), utilization of medical services, and the nature and complexity of illness. We find that people using newer drugs during January-June 2000 were less likely to die by the end of 2002, conditional on the covariates. The estimated mortality rates are strictly declining with respect to drug vintage. For pre-1970 drugs, the estimated mortality rate is 4.4%. The mortality rates for 1970s, 1980s, and 1990s drugs are 3.6%, 3.0%, and 2.5%, respectively. The actual mortality rate is about 16% (3.7% vs. 4.4%) lower than it would have been if all of the drugs utilized in 2000 had been pre-1970 drugs. Estimates for subgroups of people with specific diseases display the same general pattern.

"Industrial De-Diversification and Its Consequences for Productivity"

Due in large part to intense takeover activity during the 1980s, the extent of American firms' industrial diversification declined significantly during the second half of the decade. The mean number of industries in which firms operated declined 14 percent, and the fraction of single-industry firms increased 54 percent. Firms that were "born" during the period were much less diversified than those that "died", and "continuing" firms reduced the number of industries in which they operated. Using plant-level Census Bureau data, we show that productivity is inversely related to the degree of diversification: holding constant the number of the parent firm's plants, the greater the number of industries in which the parent operates, the lower the productivity of its plants. Hence de-diversification is one of the means by which recent takeovers have contributed to U.S. productivity growth. We also find that the effectiveness of regulations governing disclosure by companies of financial information for their industry segments was low when they were introduced in the 1970s and has been declining ever since.

The Effect of Pharmaceutical Innovation on the Functional Limitations of Elderly Americans Evidence from the 2004 National Nursing Home Survey

I examine the effect of pharmaceutical innovation on the functional status of nursing home residents using cross-sectional, patient-level data from the 2004 National Nursing Home Survey. This was the first public-use survey of nursing homes that contains detailed information about medication use, and it contains better data on functional status than previous surveys. Residents using newer medications and a higher proportion of priority-review medications were more able to perform all five activities of daily living (ADLs), controlling for age, sex, race, marital status, veteran status, where the resident lived prior to admission, primary diagnosis at the time of admission, up to 16 diagnoses at the time of the interview, sources of payment, and facility fixed effects. The ability of nursing home residents to perform activities of daily living is positively related to the number of “new” (post-1990) medications they consume, but unrelated to the number of old medications they consume. If 2004 nursing home residents had used only old medications, the fraction of residents with all five ADL dependencies would have been 58%, instead of 50%. During the period 1990-2004, pharmaceutical innovation reduced the functional limitations of nursing home residents by between 1.2% and 2.1% per year.