A new comparison of two classes of heart drugs reveals that millions of dollars in savings could be realized if the health-care system restricted use of the more costly option.
In fact, the research published Monday in the Canadian Medical Association Journal shows that restricted access to angiotensin-receptor blockers could have saved more than $77 million in 2006, the year for which prescription costs were analyzed for these drugs and the cheaper angiotensin-converting enzyme inhibitors.
“ARBs have great alternatives — they’re called ACE inhibitors. They’re cheaper, there’s absolutely no evidence that ACE inhibitors are less effective, and from a public health standpoint, there’s no advantage of using ARBs,” said Dr. Stephane Rinfret, a cardiologist at Quebec Heart and Lung Institute, and a member of the Canadian Cardiovascular Outcomes Research Team.
Even though the picture has changed since 2006, with some drugs coming off patent, Rinfret still projects savings around $20 million a year.
Use of the angiotensin-receptor blockers rose by more than 4,000 per cent from 1996 to 2006. Over the same period, overall costs of cardiovascular drugs in Canada increased by more than 200 per cent, prompting the research team to look at the issue.
Dr. Derek So, a staff cardiologist at the University of Ottawa Heart Institute and one of Rinfret’s co-authors, says both classes of drugs are used for patients with high blood pressure or congestive heart failure.
If restrictions were placed on ARBs, then drug benefit plans would need to acknowledge the need for some patients to switch, he said.
“There would have to be, sort of, policies to say that if patients are intolerant of the ACE inhibitor for reason X or reason Y, then they could be put on an ARB. For sure there would be cost savings that would be realized in that scenario as well.”
Rinfret said most of the angiotensin-receptor inhibitors are about 20 to 30 per cent more expensive than ACE inhibitors for a 30-day treatment.