Friday, November 16, 2007

Is Money Being Wasted on Syndrome's Treatment?

There's been a lot of criticism of the Consumer Reports (CR) Adwatch video segment that satirized the ubiquitous Requip TV ad (see this post to Pharma Marketing Blog). Requip is a GSK drug approved in 2005 for the treatment of "Restless Leg Sydrome" (RLS).

I have to agree with most of the critics who complained that the CR video was a sophomoric attempt at humor. However, CR reporter Jamie Hirsh did make one point that most critics have glossed over: 57% of sufferers get better with placebo compared to 73% on Requip.
NOTE: "Placebo" is a sugar pill. In many clinical trials of drugs, placebo happens to be a pretty effective alternative! But I digress...
Let me whip out my trusty Microsoft desktop calculator and do some math so that you don't have to.

Let's say that 3% of the US adult population suffers from RLS (the Requip website claims 10%, but I am using the 3% number because that's the number Jamie Hirsh cited and none of her critics -- including pro-DTC Bob Ehrlich of DTC Perspectives magazine -- quibbled with that estimate). This equates to about 7 million US adults.

Let's say 15% of these RLS sufferers are taking Requip. I got this figure from a GSK presentation made to Merrill Lynch analysts (here). That's 1 million people on Requip, give or take a few thousand.

I found an estimate of $500 million in US Requip sales for 2006. This comes to $500 per person treated per year. I assume all of this goes to the RLS sufferers and most of it is paid for by 3rd parties (insurers, gov't, employers), which eventually adds to all our healthcare financial burdens from taxes, higher co-pays, etc.

But what about the effectiveness of Requip vs. placebo?

If 57% (570,000) of the 1 million RLS sufferers would find relief with sugar pills vs. 73% (730,000) with Requip, that means only 160,000 people (730,000 - 570,000) actually benefited from Requip.

That's not a small number. But for our healthcare system to spend $500 million to benefit 160,000 people ($3125 per person per year) is ridiculous!
NOTE: You can also say that $285 million was wasted treating the 570,000 people who would have done as well taking a sugar pill.
BTW, how many of those 1 million people actually suffer from RLS versus how many are convinced they have it and, in turn, convinced their doctors to prescribe Requip?

If we were talking about a cancer treatment, it might be callous to do this kind of monetary analysis. You can't put a number on a human life -- although insurance companies do it all the time. I am sure, therefore, that someone besides me has done this analysis for Requip/RLS and other drug/syndrome pairings. if so, I'd like to know about it.


  1. Anonymous2:42 PM

    Here in the UK we have the National Institute for Health and Clinical Excellence whose job is to perform these calculations for drugs to be offered on the NHS. Occasionally they refuse to approve drugs on the grounds of insufficient benefit (such as Herceptin for certain classes of patient). When this happens the drug companies deploy telegenic and articulate patients on breakfast-time TV, to sway public opinion. I guess they have analogous strategies in countries where the decisions are made by insurance companies and not civil servants.

  2. If you read the NICE recommendations, you will see that they measure quality-adjusted life years. This kind of analysis is necessary for ALL drugs, not just those that fit indications that may seem trivial. The big question that you do not answer is how much "benefit" does Requip provide? For a cancer drug, it may be life or death. For this, the factor is probably very small and therefore tips the tables against the product.

    This article links to others that give more background.

  3. Anonymous6:49 PM

    People with Parkinsons also use Requip and in much larger doses than for RLS. I'm pretty sure you know that. Why did you leave that out of your equation?

  4. Yes, that should have been taken into consideration. But this was just a very rough estimate -- I am sure it doesn't affect the conclusion that hundreds of millions of dollars may be wasted on the treatment of RLS by Requip.

  5. David E. Williams of the Health Business Blog11:52 PM

    Restless Leg Syndrome is a serious problem for people suffering from it. The drug's effectiveness vs. placebo isn't unusual.

    Even if your $3125/person calculation is correct I don't think it's an unreasonable expense.

  6. Anonymous12:18 AM

    For your information: RLS begins in the mild form and for many, that is all they ever have. For most of us though, the disorder progresses as we grow older and many are physically unable to get up and walk or move around to relieve it a little. I have nightmares about being in that position because I am one of the severe sufferers. What you need to know is that the constant twitching and jerking in our muscles contributes to the actual pain that many of us experience. And it does not always stop with the legs. The arms and even the whole body can be effected. My particular case begins in the nerves of my lower back and travels down the sciatic nerves of both legs.....and up into the arms and upper body. It is a gnawing, grinding irritation of the nerves that can be compared to nothing else that I have ever felt. Ever hit your "crazybone"???? Sometimes I imagine it to be like a mild epileptic seizure that goes on for hours....a stinging of the nerves. Okay, so it won't kill you like cancer or heart disease, but all we want is a little respect for a little-understood neurological movement disorder. It can make you want to throw yourself on the floor and roll around and bang your head against the wall. Many swear they are ready to blow their brains out and I would not be surprised if someone did. All of this when you are so damned tired that you can barely stand up......night after night after night after night.......and please don't forget the days when everyone else can sit in a car for a nice ride or sit at their desks and work, or at a movie or concert or God forbid we should have to get on a plane! I really wish that Jamie Hirsh could walk for a week in my shaky shoes.......
    Connie, 70. MD
    RLS Support Group
    PS: By the way, Requip does nothing at all for me.

  7. I am sorry this is happening to you and Requip doesn't help. You are among the millions of RLS sufferers for which Requip is useless. Which is my point -- which, after hearing form many commenters, is this: RLS may be a real medical, but Requip is not an effective treatment and, as a society, we shouldn't be wasting our money on it. Where's the research into a real cure for this real condition?

  8. Gracie G2:08 PM

    One word: caffeine . I had this problem -- and can reproduce it at will by consuming caffeine three days in a row. I found out about the caffeine connection in a book about folk remedies. I read an article by someone recommending drugs to solve RLS. I wrote her and asked her why she never mentioned just quitting caffeine. She wrote me back that she knew of the connection between RLS and caffeine, but that most of her readers would prefer to take drugs. I don't think so. I think most people would prefer to know the truth and be able to make informed decisions.

  9. My mother and myself both suffer from RLS... we both started to be affected by this after a surgery.
    It is a life altering condition .. anyone who believes that this is in our heads should have to suffer from this condition.
    I have little patience for this type of individual.
    I can only hope that they may have the pleasure of having a so called "invisible" disease.

  10. Thanks for your kind remarks and good wishes.


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