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Friday, August 24, 2007

The High Cost of Asthma Medications in the United States

In my personal opinion, the high cost of asthma therapy in the United States (over $100 per month for each controller inhaler) is due to the greed of the big drug companies, and the costs will only get higher during the next two years. Inhalers are a ten billion dollar a year market worldwide, and growing rapidly. The profit is very, very high, even considering the inflated R&D; expenses. During the past 7 years, pharmaceutical companies have successfully lobbied the FDA and Congress to ban any generic asthma inhalers (controller or reliever).

The problem with health plans fully covering every asthma inhaler is that it would provide no incentive for the manufacturers and distributors to control (lower) prices. The inhaler manufacturers run almost all of the research on asthma inhalers, so the new ones are only compared to placebo inhalers, and no head-to-head comparisons are done (for efficacy or for side-effect rates). It’s amazing that the FDA allows such placebo-controlled studies of me-too drugs (or reformulations with new inhaler devices).

It is highly likely that all of the ICS medications (generics included) – after controlling for the dose delivered to the lungs – have roughly the same efficacy and side-effects for more than 80% of those with asthma. However, it seems as though nobody cares enough about consumers and poor folks to conduct such a study to disprove such a hypothesis.

The only non-industry people in the United States who could run such a study are

  1. the Lung Division of the NIH-NHLBI and
  2. the American Lung Association’s Asthma Clinical Research Network (ALA-ACRC).

However, the majority of the staff and investigators of these programs have been “feeding at the trough,” so I don’t think you will see such studies funded by them anytime soon – unless a new asthma/COPD patient advocacy group starts talking to the press.

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Posted by: Paul Enright MD at 2:35 pm


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