Central  South  Dakota  Medical News
The Clinical View
  by P.E. Hoffsten, M.D.
17 September 20036 NOVEMBER 03

TREATMENT STATISTICS – 1:  HOW EFFECTIVE ARE YOUR MEDICATIONS?

     When I was in the 4th grade in 1948, there wasn’t any television.  But we did have radio and on Friday nights they had a crime show called the FBI and another one called the Lone Ranger.  These took up an hour from 6:30 to 7:30 pm.  There was an advertisement at the beginning for one minute and an advertisement after 15 minutes for one minute and another one at the end of the show for about one minute.  So in listening to two ½ hour shows, one got 54 minutes of program and six minutes of advertisement.  Now when you watch television, you get 40 minutes of show and 20 minutes of advertisements.  The advertisements are for everything from musical recordings, to cars, to beer, and now, more and more to prescription medications with direct-to-consumer advertising. The advertisements are glossy, higher, deeper, louder, flashier and clearly designed to get you to go buy the product.  But never was the homage, “Let the buyer beware!” more applicable then in today’s world.  Scare tactics regarding diseases are balanced by media scare tactics regarding the side effects of medications.  I don’t think either one is directed to the benefit of the patient consumer.

     In this column I want to provide an illustration of how advertisers are using statistics and what you can do to keep perspective on what is useful for your health and what is not.

     Several years ago a scientific study was undertaken to see if reduction of a person’s blood cholesterol would decrease the rate of heart attacks.  It had clearly been shown that a high blood cholesterol was a risk factor for having a heart attack.  What wasn’t shown yet was whether lowering the blood cholesterol would really change the rate of people having heart attacks or not.  This was an important question to the drug company that was making the medication to lower the blood cholesterol.  So they went to a country where there was a very high rate of heart attacks.  It was seen in Finland that the heart attack rate in the study group of men was 120 heart attacks per 1,000 men in 5.4 years.  The drug company set up a study where a large group of these men were given the blood cholesterol-lowering drug and another large group of similar men were given an inert pill with no drug effect.  After 5.4 years of using the medication the heart attack rate had dropped from 120 heart attacks per 1,000 men to only 80 heart attacks per 1,000 men in the drug treated group.  Thus 40 men were prevented from having a heart attack for every 1,000 men who used the medication.  These statistics allow calculation of the “number needed to treat”.  Note that for 1,000 men treated, 40 heart attacks were prevented or stated another way, 1 heart attack was prevented for every 25 men who were treated.

     Now the drug company grabbed these numbers and said that they provided a 33% decrease in the rate of heart attack in men that were treated with the medication.  The drug company would provide TV advertisements with a picture of a man clutching his chest having a heart attack and then say you too should go buy this drug so you don’t have to have a heart attack.  Emotional effect can be quite impactful.  But is the drug really a good deal?  Let’s look at the economics.  First, realize that not all of the men in the treated group were prevented from getting a heart attack.  There was still some risk there.  Second of all, recognize that not all of the men in the untreated group had a heart attack.  Eighty-eight percent of the men in the untreated group did not have a heart attack in the 5.4 years of observation.

     So is the use of this drug really worthwhile from an economic standpoint?  If one figures that the cost of the medication is $64.00 per month on today’s market and 25 men have to take this drug for 5.4 years to prevent one heart attack, the divided expense for the 25 men is $96,000.00.  That is what it costs just for the drug so that one of those 25 men doesn’t have a heart attack.  Note that that isn’t what it costs each individual, but that is what it costs the 25 people who took the drug to prevent one heart attack.  If you divide that $96,000.00 twenty-five ways, it costs each person $3,840.00 or about $770.00 per year.  One could sort of look upon this as a form of term life insurance.

     If one then calculates the cost to society of all of the medical bills for the 40 extra heart attacks in the untreated group, it turns out that the savings would be $3,872.00 per person making the cost to society slightly in favor of using the drug.  This calculation places no value on the lives saved from the heart attacks that were prevented.  Thereby it would appear that use of the cholesterol-lowering drug was very substantially favored from both the economic and an overall health benefit.

     The important number to remember in comparing one drug to anther is the “number needed to treat to prevent one event (heart attack)”.  In next week’s column, I will present another calculation showing how a different drug used in a different population of people could claim an equal percent reduction in the heart attack rate but result in an industrial expense for each individual heart attack prevented.