A major change occurred a few years ago in the economics of drugs: we have entered an era of expensive drug therapy. The turning point was probably situated at the very beginning of the 80s. Since then, in almost every area of the medicine, new drugs have been marketed with large price gaps compared to old existing drugs:
- in hypertension: ACE inhibitors and calcium inhibitors vs. diuretics and beta-blockers,
- in hypercholesterolemia: «statins» versus fibrates,
- in depression: SSRI vs. tricyclics,
- in infectious disease: cephalosporines, quinolones, fluoroquinolones vs. penicillins,
- in gastric ulcer: PP inhibitors versus anti-H2,
- in oncology: anti-5 HT3 vs. anti-emetics like metoclopramide,
- in BPH: alpha-blockers and finasteride vs. plant extracts.
The price differences between these new products and the other drugs are generally large, even if their magnitude varies from one country to another depending on price regulation schemes. The differences are generally larger in countries where prices are directly fixed by government. In France for instance, the simvastatin was launched at an average daily cost of about 10 F. (US$1.80) against less than 2 F. ($0.40) for the most widely sold fibrate in the same indication. The fluoxetine was about three time more expensive than the average daily cost of tricyclics. Anti-HT3 are about 20 times more expensive than metoclopramide.
But prices are also high compared to what they used to be in free prices countries: in the USA, the drug price index lagged inflation until the late 70s and began to raise much faster than inflation in the 80s.
Prices for new drugs can reach amounts hardly imaginable a few years ago. The annual treatment cost of pentamidine for opportunistic infectious diseases in AIDS is over US$1,200 a year. The annual cost of the erithropoïetin treatment in end stage renal disease amounts between US$4,000 and 8,000. The treatment with a Human Growth Factor like protopin can cost up to US$30,000 a year.