Use of Common Heart Drugs Dropped After Price Increases, Cleveland Clinic Study Finds

Findings disprove the notion that rising prices do not reduce patient access and utilization of certain medications

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 August 10th 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 analyze the impact, researchers analyzed utilization 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 percent and with isoproterenol fell 35 percent. In comparison, the number of patients treated with nitroglycerin increased 118 percent and those treated with dobutamine increased 7 percent.

“In public testimony, it had been stated that these price increases would not decrease patient access or utilization of these two critical drugs, both of which have been used for decades in patient care,” said Umesh Khot, M.D., 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,” said Michael Militello, PharmD. “Understanding how physicians, pharmacists and health systems have addressed their use of these medications is an important area of further study.”

About Cleveland Clinic

Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. U.S. News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey. Among Cleveland Clinic’s 51,000 employees are more than 3,500 full-time salaried physicians and researchers and 14,000 nurses, representing 140 medical specialties and subspecialties. Cleveland Clinic’s health system includes a 165-acre main campus near downtown Cleveland, 10 regional hospitals, more than 150 northern Ohio outpatient locations – including 18 full-service family health centers and three health and wellness centers – and locations in Weston, Fla.; Las Vegas, Nev.; Toronto, Canada; Abu Dhabi, UAE; and London, England. In 2016, there were 7.1 million outpatient visits, 161,674 hospital admissions and 207,610 surgical cases throughout Cleveland Clinic’s health system. Patients came for treatment from every state and 185 countries. Visit us at clevelandclinic.org. Follow us at twitter.com/ClevelandClinic. News and resources available at newsroom.clevelandclinic.org.

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