Relative importance of pharmaceuticals on health outcomes: 1990-2015 – Healthcare Economist

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Health outcomes have improved in the US over the last 25 years. Clearly public health initiatives (e.g., reduced smoking rates) is having an impact, but another key key question is, what is medical technologies are driving these gains? Is it new surgical techniques, better diagnostics, improved medical devices, or new pharmaceuticals? This answer is difficult to answer empirically, but a paper by Wamble et al. 2019 wanted to see what the experts thought. They examined 8 conditions with the largest historical mortality and morbidity impact in the US which include: ischemic heart disease; cancer of the trachea, bronchus, or lung; breast cancer; human immunodeficiency virus (HIV); cerebrovascular disease; chronic obstructive pulmonary disease (COPD); unipolar depression; and diabetes. Then they surveyed 138 physicians to determine which medical technology had the largest impact on health. Individuals responded based on their disease area of expertise.

Based on physicians responses, across all 8 diseases , pharmaceuticals had the largest impact on health. Across all 8 diseases 56% of the relative value came from pharmaceuticals.

…pharmaceuticals and biopharmaceuticals were perceived by the physicians to account for the greatest effect on mortality and morbidity across the 8 top conditions since 1990….physicians attributed 56% (95% confidence interval [CI] = 52.03%-59.84%) of patient outcomes gained to innovations in pharmaceuticals and biopharmaceuticals, followed by diagnostics at 20% (95% CI = 17.26%-22.13%). Surgical procedures and techniques and medical devices had a lesser effect on mortality and morbidity, accounting for 14% (95% CI = 11.19%-16.16%) and 11% (95% CI = 8.94%-12.45%) of outcomes gained, respectively.

While the research above is based on physician perceptions alone, empirical evidence from my my own research in oncology (see MacEwan et al. 2020) which shows how pharmaceuticals have had a major impact on oncology survival gains over the past 15 years.

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