The W2O Value and Access Communications team is (re)launching its “Redeeming Value” podcast with an emphasis on bringing the voices of those driving the conversation to your earbuds. This month, we dipped our toe into the audio waters, speaking with Jason Buxbaum, the first author on this month’s critical Health Affairs paper and a Harvard health policy PhD candidate. Buxbaum, along with Harvard’s David Cutler and Michael Chernew and Michigan’s Mark Fendrick, sought to connect public health, pharmaceutical, and other medical interventions with life expectancy gains between 1990 and 2015.
We’ve detailed these Health Affairs findings before—public health was the largest contributor to longer life in the United States, but pharmaceuticals had nearly triple the impact of other medical care—but this month’s conversation looked ahead to what those findings might mean for the discussion around drug prices and what might drive the next leaps in life expectancy.
You can listen along here via iTunes, and it should be showing up on your favorite podcast platforms. If you don’t see it, please let us know.
Among the podcast highlights (edited for brevity and clarity):
Brian Reid: So what were some of the surprises there?
Jason Buxbaum: I was taken aback to see that small share of just 13% for hospital care, for non-drug physician services, given that that is where the bulk of our national health care expenditures go. I think one important caveat to point out here is that our outcome of interest was life expectancy improvement. It wasn’t quality of life improvement, it wasn’t disability reduction. That said, my speculation here would be that, if anything, that might have biased us downward on the pharma number.
Brian Reid: One of the bolded texts in the paper itself said, “If we could translate knowledge from existing public health wins to areas with less success, longevity gains could be very large.” At the broadest level, what lessons do we learn? How do we apply those?
Jason Buxbaum: I think one reflection that comes to mind for me is just that we’ve found that reductions in tobacco smoking from 1990 to 2015 has been huge across a number of conditions: ischemic heart disease, lung cancer. There were some serious dollars behind anti-smoking work. I’m wondering: to what extent are we learning lessons, are we harvesting lessons from the anti-tobacco efforts? But I think that there’s a lot of inspiration that ought to be taken from the anti-tobacco work. Not to say that every campaign needs tons and tons of money behind them, but if we were to spend some small share of the money that we put into R&D and pharma development and some small share of the money that we spend every year on physician and hospital services, on, you know, public health R&D, I wonder what could be possible.
Brian Reid: I’m curious: the places where we did see success—HIV, cardiovascular disease—is there reason to think that those are just kind of one-off anomalies, we happened to look at the right quarter-century of data? Or is there a sense that this is something that can also be replicated?
Jason Buxbaum: [In] our paper, the horizon we were looking at ended in 2015, and this was too early to pick up effects from the direct-acting antiretrovirals and hep C. So I can tell you with confidence that there were breakthroughs at least somewhat analogous to the antiretrovirals with HIV that we picked up in our paper. … There continued to be miracle breakthroughs after the horizon of our paper. … I don’t know why one would believe that we’ve ceased discovery. Especially if you broaden your scope beyond thinking of longevity as all that matters, there’s so much around disability reduction, thinking in particular around mental health, around improving quality of life. There’s so much more to be done. And I hope this is not the end of the story and I don’t know why we would think that it is.
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