Baseline Drug Metrics in Healthcare

BaselineTo understand today’s healthcare, we will measure what metrics make its foundation. This involves looking at improvement percentages, including tradeoffs, of highly successful drugs in the marketplace.

The following will display data about percentages of “betterment”, such that substance which achieve competitive percentages should be considered by a fair government as medicine.

The COPERNICUS study concluded carvedilol is beneficial. The placebo group showed  marked improvement by16.1%, and the carvedilol group showed 21.1%. Moreover, the study found the carvedilol group only showed marked worsening 0.3% of the time, and the placebo group 1.7% of the time.

Thus, in the COPERNICUS study, the baseline is:

  • 5% higher chance of improvement
  • 1.4% less chance of worsening.

SPARCL researchers concluded in a 5-year atorvastatin study the drug is beneficial, based on:

  • Risk reduction of major cardiovascular event by 3.5%
  • Similar mortality rate (216 atorvastatin; 211 placebo)
  • Slight increase in mortality rate for causes other than stroke (154 atorvastatin; 136 placebo)
  • Small increase in the incidence of hemorrhagic stroke

OBERON researchers concluded during a 26-week trial that esomeprazole is beneficial based on:

  • Risk reduction of peptic ulcer by 5.9%
  • Increase in serious adverse events other than death by 0.9%
  • A slightly higher rate of death (4 esomeprazole; 1 placebo)

Researchers publishing in Arthritis & Rheumatism concluded infliximab is beneficial in treating rheumatoid arthritis (RA) based on:

  • 10.3% increased chance of Improvement in physical function versus MTX–placebo
  • 3% increased chance of pneumonia
  • 2.9% increased chance of serious infection
  • Slight increased risk of myocardial infarction, asthma, tuberculosis

Methotrexate (MTX) was introduced for the treatment of rheumatoid arthritis without any clear understanding of its mechanism of action (Cronstein 2005), but has become a staple treatment for RA, which explains the need for “MTX–placebo” comparison.

PRIMA researchers concluded Rituximab is beneficial based on:

  • 45% reduction in lymphoma progression-free survival
  • No significant difference in overall survival
  • 46% increased risk of adverse health events, such as infection

JUPITER researchers concluded Rosuvastatin is beneficial based on:

  • 19% reduced risk of death from any cause
  • Slight increase in rate of diabetes

Trastuzumab research funded by F Hoffmann-La Roche shows benefit based on:

  •  4-year overall survival of 89.3%, versus 87.7% (placebo)
  • A 2% increase in congestive heart failure

The metrics of these drugs can be used as a foundation of comparison to other treatments. The “tradeoff” percentages of what health must be “given up” to achieve the drug”s stated benefit should also be considered against competitive treatments.

Citations:

Packer M, et al “Effect of carvedilol on the morbidity of patients with severe chronic heart failure: results of the carvedilol prospective randomized cumulative survival (COPERNICUS) study.” Circulation. 2002 Oct 22;106(17):2194-9. Article link

Amarenco P, et al “High-Dose Atorvastatin after Stroke or Transient Ischemic Attack” N Engl J Med. 2006 Aug 10;355(6):549-59. doi: 10.1056/NEJMoa061894

Scheiman JM, et al “Prevention of peptic ulcers with esomeprazole in patients at risk of ulcer development treated with low-dose acetylsalicylic acid: a randomised, controlled trial (OBERON)” Heart. 2011 May;97(10):797-802. doi: 10.1136/hrt.2010.217547

Cronstein B “Low-Dose Methotrexate: A Mainstay in the Treatment of Rheumatoid Arthritis” Pharmacological Reviews June 2005 vol. 57 no. 2 163-172 doi: 10.1124/pr.57.2.3.

St. Clair, E. W. et al “Combination of infliximab and methotrexate therapy for early rheumatoid arthritis: A randomized, controlled trial” Arthritis & Rheumatism 50: 3432–3443. doi: 10.1002/art.20568

Salles G, et alRituximab maintenance for 2 years in patients with high tumour burden follicular lymphoma responding to rituximab plus chemotherapy (PRIMA): a phase 3, randomised controlled trial” Lancet. 2011 Jan 1;377(9759):42-51. doi: 10.1016/S0140-6736(10)62175-7

Ridker P, et al “Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein” N Engl J Med 2008; 359:2195-2207 November 20, 2008 doi: 10.1056/NEJMoa0807646

Gianni,L, et al “Treatment with trastuzumab for 1 year after adjuvant chemotherapy in patients with HER2-positive early breast cancer: a 4-year follow-up of a randomised controlled trial” Lancet Oncol 2011; 12: 236–44 doi:10.1016/S1470-2045(11)70033-X