Maximum Benefit Or Social Responsibility???

That is the question that our friend, “A Country Doctor,” poses in this important post. Picture a situation, a very real situation as it turns out, where the premium brand name pharmaceutical product is priced at $13 per day, and is b.i.d. The generic of a product in the same treatment area goes out the door for a whopping $.65 per day, and is once a day therapy. Which to prescribe?

What makes this seeming no brainer a little more interesting is that the premium product has a 20% greater reduction of cardiovascular risks than does the generic. BUT. On an absolute basis the risk numbers are cardiovascular events of 10% and 12% respectively. Confused yet?

Here’s the doctor’s question. Should he prescribe the more expensive, less convenient medication to obtain the maximum theoretical benefit or should he prescribe the far less expensive, more convenient product and ignore the difference in efficacy?

Bottom Line. The doctor wisely uses the term “stewardship” to describe the appropriate basis for making this decision. Read his discussion of the different things that stewardship could mean in this case and ponder what you would do if you were the prescribing decision maker in this situation. 

Thought question. How much do the efficacy and cost ratios need to change in order for you to make the opposite decision?

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