Remdesivir, the pharmacy budget buster

I saw the discussion below in one of the pharmacy forums. Fact check true on this one.

Gilead would have everyone believe that remdesivir is a magic bullet for COVID-19 infection. Not true. Helpful? Useful tool? Maybe.

Remdesivir, while potentially beneficial, has limitations. For one, it should only be used on hospitalized patients that have falling oxygen saturation and chest infiltrates. Second, while it has been shown to potentially shorten the course of the disease, it has not been shown to reduce mortality.(1)

On the flipside, the drug is relatively expensive, has been overused, and contrary to data showing that it may shorten the course of the disease, may inadvertently lengthen hospital stays.

Based on the “Solidarity” trial, a WHO guideline committee went as far as to recommend against the use of remdesivir.(2)

“The Solidarity Trial published interim results on 15 October 2020. It found that all 4 treatments evaluated (remdesivir, hydroxychloroquine, lopinavir/ritonavir and interferon) had little or no effect on overall mortality, initiation of ventilation and duration of hospital stay in hospitalized patients… So far, only corticosteroids have been proven effective against severe and critical COVID-19. [see RECOVERY trial (3)]… The researchers determined the evidence quality to be low for remdesivir in regard to improving time to clinical improvement, hospitalization duration and mechanical ventilation duration.”

However, you won’t find physicians touting this particular WHO recommendation. Why not? Simply put, it doesn’t fit the narrative put forward by Gilead and the media. Nor does the WHO recommendation give practitioners access to this new therapeutic toy. A combination of marketing and fear has led to remdesivir rapidly evolving into “best practice”. It is basically spreading through hospitals unchecked.

But Jerry, no hospital could have predicted the pandemic and therefor the cost of remdesivir. True. However, if remdesivir truly cut hospital stays by a couple of days and reduced time on mechanical ventilation, the cost of the drug would be a wash. I have not seen any large-scale data to support this notion. As of today, hospitals have spent millions upon millions of dollars on remdesivir. Not to mention that there are reports of providers prolonging patient stays to complete remdesivir treatment courses even when patients have met criteria for discharge. Such practice spits in the face of common sense.

But Jerry, even if it saves one life it will have been worth it. Ah yes, the battle cry of people who want something done, regardless of the consequences. Such sentiment seems reasonable on the surface, but quickly fades with analysis and thought. A philosophical debate for another time. Suffice it to say that real life doesn’t work that way.  

Overall, the unfettered use of remdesivir, combined with failure of healthcare to provide clear, concise, science-based use criteria, has created a budget pitfall that will take years to climb out of, if at all. It’s this type of fiscal irresponsibility that makes the U.S. healthcare system so special.

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  1. Healio.com. 2021. Remdesivir shortens time to improvement, but has no significant mortality effect. [online] Available at: <https://www.healio.com/news/primary-care/20210331/remdesivir-shortens-time-to-improvement-but-has-no-significant-mortality-effect> [Accessed 29 April 2021].
  2. Who.int. 2021. “Solidarity” clinical trial for COVID-19 treatments. [online] Available at: <https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov/solidarity-clinical-trial-for-covid-19-treatments> [Accessed 30 April 2021].
  3. New England Journal of Medicine, 2021. Dexamethasone in Hospitalized Patients with Covid-19. 384(8), pp.693-704.

New drug education

Medicine And Technology: “We have seen so many new drugs and even new classes of drugs emerge over the last ten years. How do most physicians learn about new drugs? Many (certainly not all) community practitioners would say they learn what they need to know from the drug reps. Others indicate continuing medical education or CME activities as their main source of information regarding new drugs. Back in the “old days,” docs would also attend many promotional/marketing dinners and social functions to learn about new medications. Those days are ending as PhRMA code regulations get stricter. So what is the most effective way for physicians to learn about new drugs? They are so busy and easily overwhelmed by their workload that many have a difficult time keeping up with the latest science, the latest medical news, or even urgent FDA alerts and warnings.” – Any healthcare practitioner should be leery of using “drug-reps” or marketing dinners to educate themselves about new drug therapy. Remember, drug-reps are in it for the sales. In most cases they are not even healthcare professionals; pharmacist, nurse, physician. There are few truly unique breakthroughs in drug therapy each year and even fewer turn out to live up to expectations. Several years may be necessary to properly evaluate a medication’s place in therapy. I never understood the bandwagon approach to medication therapy, it’s irresponsible. Information on new drug therapy should come from primary literature or other reputable sources, such as the Pharmacist Letter, the Medical Letter, or from practice guidelines developed by professional organizations like the Infectious Disease Society of America (IDSA) and the American College of Chest Physicians (ACCP). Heck, this would be a good place to start reducing the cost of healthcare as many new “me too” medications with no proven benefit are often significantly more costly than their evidence-based counterpart. Why isn’t anyone talking about that?