RX : DOCTORS PRESSURED TO USE CHEAPER HEART DRUGS.

Byline: Nathan Horwitz Medical Tribune News Service

Doctors are faced with growing pressures from managed care and other health-care forces to reduce costs by limiting the use of new, expensive drugs for hypertension and other heart ailments.

But cardiologists stress that cheaper, older medications actually may increase costs in the long run, because they are not as effective as newer drugs and result in more hospitalizations.

Noting how managed health-care groups, hospitals and lawmakers try to influence practitioners to reduce medical expenses, Dr. Michael A. Weber, professor and chairman of medicine at Brookdale University Hospital and Medical Center in Brooklyn, N.Y., said: ``It is easy to compute costs; it's hard to establish benefits. We know that effective therapy saves money by saving lives, reducing clinical events, laboratory costs, physician visits and the need for hospitalization.''

Comparable savings cannot be achieved simply by reducing the use of newer drugs arbitrarily on the basis of costs, he and other experts stressed in interviews.

Weber acknowledged that the national bill for health care is high and growing, but ``the issue at bottom is not really cost. I believe there is enough money in the health-care system. Cost is a surrogate concept. What the word really describes in this context is how health-care officers and businessmen are transferring patient care into the bottom line, into profitability for their organizations.''

The pressures on the profession to reduce expenses, he declared, ``are compelling physicians to practice a form of medicine that is governed by the financial needs of businessmen who have no responsibility for the care of patients.''

And despite the cost of new drugs, ``they are the oxygen of our intellectual growth,'' he added. ``Of course they have to be fully tested and appropriately used. But I will not tolerate anyone who denies me access to a drug if I think it's best for an individual patient.''

Dr. Norman Kaplan, a professor of medicine at the University of Texas Southwestern Medical Center in Dallas, noted that ``all of us are now being pressured by managed-care operators to cut down on the use of the newer drugs. At the same time, we know there is very little data to support the view that the older drugs are better in the long run than some of the newer formulations.''

He cited a recent study in which investigators reviewed the total costs of Medicaid in South Carolina for one year, comparing an older form of an anti-hypertensive agent with a newer, once-a-day drug. ``They accumulated data on over 2,000 subjects who received either the more expensive once-a-day formulation or the less costly, generic form,'' Kaplan reported. ``The total drug cost was obviously less for the older drug formulation, but the cost of physician visits was greater, and the cost of hospitalization was considerably greater.''

Daniel E. Hilleman, professor and chairman of pharmacy practice at Creighton University in Omaha, Neb., described a preliminary study at his center comparing newer, more expensive drugs in combination against treatment with an older type of medication known as a calcium-channel blocker in 102 patients with mild to moderate hypertension.

``Overall, 42 percent of the patients while on the calcium-channel blocker reported side effects,'' he said, while 10 percent to 21 percent suffered side effects after switching to the newer drugs.

For the group overall, Hilleman concluded, the switch to the newer combinations represented a savings of approximately $11,000, with an anticipated saving in subsequent years of $16,000.