NCPA - National Center for Policy Analysis


October 19, 2004

A Health Affairs study revealed that the elderly are often prescribed Cox-2 Inhibitor drugs, including Vioxx -- which reduce pain without harming the stomach -- not on the basis of clinical need, but on the basis of the amount of drug coverage they carry.

According to the study:

  • Among the 4,601 elderly Medicare patients, those with high risk of gastro-intestinal events (bleeding or ulcers) were more likely to be given an Cox-2 Inhibitor drug for arthritis.
  • However, the use of a Cox-2 Inhibitor drug also increase among patients with the most generous drug coverage (26 percent of patients with generous coverage compared to 13 percent with the least amount of coverage).
  • Furthermore, 25 percent of patients with generous drug coverage but only a moderate risk of GI events received a Cox-2 Inhibitor, while only 20 percent of patients with limited coverage but a substantial risk of GI events received a Cox-2 Inhibitor.

In other words, the amount of drug coverage a patient carried was positively associated with the use of expensive Cox-2 Inhibitors, resulting in some patients using them that were less likely to need them.

As a result, Merck, the manufacturer of Vioxx, discontinued its sales in order to "get it out of the hands of people who would have been just as well off with aspirin or Tylenol or Advil," says commentator Holman Jenkins, Jr. Unfortunately, the small number of patients whose rewards from Vioxx outweigh the risks lose out.

Source: Holman W. Jenkins, Jr., "Good Drug, Bad Customers," WSJ Opinion Journal, October 6, 2004; and Jalpa A. Doshi, Nicole Brandt and Bruce Stuart, "The Impact of Drug Coverage on Cox-2 Inhibitor Use in Medicare," Health Affairs web exclusive, February 18, 2004.

For Health Affairs study:


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