Suchergebnisse

There were no innovations in chemotherapy for myeloma patients during the period 1977-1997, but there have been several important innovations since 1997. We investigate the impact of recent chemotherapy innovation on the longevity of myeloma patients using both time-series U.S. data and longitudinal data on 26 countries. In the US, the average annual rate of increase of life expectancy of myeloma patients at time of diagnosis was over five times as large during 1997-2005 as it had been during 1975-1997. We estimate that almost two-thirds (0.99 years) of the 1997-2005 increase in life expectancy was due to the increase in the number of chemotherapy regimens now preferred by specialists, and that the cost per U.S. life-year gained from post-1997 chemotherapy innovation did not exceed $45,551. We also investigate the impact of chemotherapy innovation on the myeloma mortality rate using longitudinal country-level data on 26 countries during the period 2005-2009. Countries that had larger increases in the number of chemotherapy regimens had larger subsequent declines in myeloma mortality rates, controlling for other factors. The estimates imply that chemotherapy innovation reduced the age-adjusted myeloma cancer mortality rate by about 3.1% during the period 2005-2009.

"The NBER Bulletin on Aging and Health provides summaries of publications like this. You can sign up to receive the NBER Bulletin on Aging and Health by email. We investigate the effect of therapeutic procedure innovation in general on the longevity of all hospital patients, i.e. patients with a variety of medical conditions. The analysis is based on data on over one million discharges from public and private hospitals in Western Australia (WA) during the period 2000-2007. We can measure survival for a period as long as 8 years after admission, and we know the date each procedure was added to the Medicare Benefits Schedule.Estimates based on patient-level data indicate that therapeutic procedure innovation increased the life expectancy of WA hospital patients by almost 3 months between 2000 and 2007, controlling for the patient's age, sex, Diagnosis Related Group (DRG, over 600 categories), Aboriginal status, marital status, insurance coverage (whether or not the patient had private insurance), postcode (over 400 postcodes), year of hospital admission, and number of procedures performed.. Estimates based on longitudinal DRG-level data also indicate that therapeutic procedure innovation increased the life expectancy of WA hospital patients, but the implied increase may be smaller-about 2 months. In either case, therapeutic procedure innovation in WA hospitals appears to have been remarkably cost-effective, because it increased the cost of medical procedures by a negligible amount"--National Bureau of Economic Research web site

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.

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?ʺ 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.

"We examine the impact of pharmaceutical innovation on the longevity of Australians during the period 1995-2003. Due to the government's Pharmaceutical Benefits Scheme, Australia has much better data on drug utilization than most other countries. We find that mean age at death increased more for diseases with larger increases in mean drug vintage. The estimates indicate that increasing the mean vintage of drugs by 5 years would increase mean age at death by almost 11 months. The estimates also indicate that using newer drugs reduced the number of years of potential life lost before the ages of 65 and 70 (but not before age 75). During the period 1995-2003, mean age at death increased by about 2.0 years, from 74.4 to 76.4. The estimates imply that, in the absence of any increase in drug vintage, mean age at death would have increased by only 0.7 years. The increase in drug vintage accounts for about 65% of the total increase in mean age at death. We obtain a rough estimate of the cost per life-year gained from using newer drugs. Under our assumptions, using newer drugs (increasing drug vintage) increased life expectancy by 1.23 years and increased lifetime drug expenditure by $12,976; the cost per life-year gained from using newer drugs is $10,585. An estimate made by other investigators of the value of a statistical Australian life-year ($70,618) is 6.7 times as large as our estimate of the cost per life-year gained from using newer drugs. We discuss several reasons why our estimate of the cost per life-year gained from using newer drugs could be too high or too low"--National Bureau of Economic Research web site

"This study examines the effect of changes in the vintage distribution of cardiovascular system drugs on hospitalization and mortality due to cardiovascular disease using longitudinal country-level data. The vintage of a drug is the first year in which it was marketed anywhere in the world. We use annual data on the utilization of over 1100 cardiovascular drugs (active ingredients) in 20 OECD countries during the period 1995-2003. Countries with larger increases in the share of cardiovascular drug doses that contained post-1990 or post-1995 ingredients had smaller increases in the cardiovascular disease hospital discharge rate, controlling for the quantity of cardiovascular medications consumed per person, the use of other medical innovations (CT scanners & MRI units), potential risk factors (average consumption of calories, tobacco, and alcohol), and demographic variables (population size & age structure, income, and educational attainment). The estimates also indicate that use of newer cardiovascular drugs has reduced average length of stay and the age-adjusted cardiovascular mortality rate, but not the number of potential years of life lost due to cardiovascular disease before age 70 per 100,000 population. The estimates indicate that if drug vintage had not increased during 1995-2004, hospitalization and mortality would have been higher in 2004. We estimate that per capita expenditure on cardiovascular hospital stays would have been 70% ($89) higher in 2004 had drug vintage not increased during 1995-2004. Per capita expenditure on cardiovascular drugs would have been lower in 2004 had drug vintage not increased during 1995-2004. But our estimate of the increase in expenditure on cardiovascular hospital stays is about 3.7 times as large as our estimate of the reduction in per capita expenditure for cardiovascular drugs that would have occurred ($24)"--National Bureau of Economic Research web site