Use of common heart drugs dropped after price increases, Cleveland Clinic study finds

10 August 2017

Following major price increases, the use of two cardiac medications -nitroprusside and isoproterenol - decreased by one-half and one-third between 2012 and 2015, according to a Cleveland Clinic study published in the 10 August issue of the New England Journal of Medicine as a 'letter to the editor'.

From 2012 to 2015, nitroprusside prices increased 30-fold from $27.46 to $880.88, while isoproterenol prices increased nearly 70-fold from $26.20 to $1,790.11.

These medications are used only in the hospital, with no external patient demand and no direct-to-consumer advertising. Therefore, researchers were able to objectively examine the effect of the price increases on physician prescribing behavior.

To analyse the impact, researchers analysed utilisation data for nitroprusside and isoproterenol in 47 hospitals between 2012 and 2015. They also obtained data for nitroglycerin and dobutamine - two intravenous cardiovascular drugs with stable pricing - for use as controls.

During this period, the number of patients treated with nitroprusside fell 53 per cent and with isoproterenol fell 35 per cent. In comparison, the number of patients treated with nitroglycerin increased 118 per cent and those treated with dobutamine increased 7 per cent.

"In public testimony, it had been stated that these price increases would not decrease patient access or utilisation of these two critical drugs, both of which have been used for decades in patient care," says Umesh Khot, MD, vice chairman of Cardiovascular Medicine at Cleveland Clinic and lead author of the study. "However, our research shows that these price hikes are not benign. Further research will determine if there has been any effect on patient outcomes, but it's clear that utilization has been impacted."

Nitroprusside lowers blood pressure and is used in the treatment of critical hypertension and congestive heart failure, as well as to keep blood pressure low during surgery. Isoproterenol is used primarily for treating bradycardia (low heart rate) and heart block. It's also used during electrophysiology procedures and specific cardiothoracic surgery cases to increase heart rate or contractility.

"These are medications that physicians are very familiar with, and for which there are no direct alternatives. As a result, hospitals have had to reevaluate use of these drugs and potentially bring in other therapies," says Michael Militello, PharmD. "Understanding how physicians, pharmacists and health systems have addressed their use of these medications is an important area of further study."

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