The effect of new medication dispatches on life span: proof from longitudinal, illness level information from 52 nations.


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The effect of new medication dispatches on life span: proof from longitudinal, ailment level information from 52 nations, 1982-2001 Straight to the point R. Lichtenberg Columbia College and National Department of Monetary Examination United Countries Human Advancement File (unweighted) normal of three files:
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Slide 1

The effect of new medication dispatches on life span: proof from longitudinal, sickness level information from 52 nations, 1982-2001 Frank R. Lichtenberg Columbia University and National Bureau of Economic Research

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United Nations Human Development Index (unweighted) normal of three files: a file of per capita GDP a future list a training list

Slide 3

U.S. monetary development, 20 th C. Nordhaus: “to a first close estimation, the financial estimation of expansions in life span over the twentieth century speaks the truth as huge as the estimation of measured development in non-wellbeing merchandise and services”

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Life hope during childbirth, world, 1950-2000

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Life hope during childbirth, by area Unlike GDP, life span is joining

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Sources of life span increment? enhanced nature of, and access to, restorative consideration different components

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Conventional astuteness “the observational proof shows [that] the general commitment of therapeutic consideration to wellbeing is fairly humble at the edge …education, way of life, the earth, and salary [are] the significant contributing factors” (Santerre and Neun (2000, p. 69)). “ increment in future [has] been a great deal more affected by monetary advancement than changes in medicinal consideration …the most essential therapeutic advances are being realized by upgrades in data innovation, not pills and scalpels” (Getzen (1997, p. 330)).

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Conventional insight “Research on the relationship between wellbeing status and medicinal care oftentimes has found that the minor commitment of restorative consideration to wellbeing status is somewhat little …any huge enhancements in wellbeing status will probably start from elements other than therapeutic care…Factors that focus the level of wellbeing incorporate wage and training, natural and way of life components, and genetics” (Henderson (1999, p.142)). “ The chronicled decreases in populace death rates were not because of restorative intercessions in light of the fact that viable medicinal mediations got to be accessible to populaces to a great extent after the mortality had declined. Rather, general wellbeing, enhanced environment, and enhanced sustenance most likely played generous roles” (Folland, Goodman, and Stano (2001, p. 118)).

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Paul Romer’s Model of Endogenous Technical Progress Y = (A L) 1- K  Y = yield A = the “stock of ideas” L = work used to create yield K = capital 0 <  < 1 The combined number of medications propelled (N_DRUG) is comparable to the load of thoughts.

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Health creation capacity AGE_DEATH ijt = b ln(N_DRUG ij,t-k ) + g X ijt + e ijt AGE_DEATH ijt = a measurement in view of the age circulation of passings from illness i in nation j in year t N_DRUG ij,t-k = the quantity of medications dispatched to treat malady i in nation j by year t-k X ijt = a vector of different variables (e.g. training, salary, sustenance, the earth, and “lifestyle”) influencing the age dispersion of passings from infection i in nation j in year t

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Specification unavoidable losses to increments to the supply of medications determine a k-year slack in the relationship to take into account slow dissemination of new medications to purchasers; we will gauge the model utilizing diverse accepted estimations of (k = 0, 1, 2,…).

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Controlling for “other factors” Hypothesize that a considerable lot of the “other factors” influencing the age circulation of passings from illness i in nation j in year t (e.g. per capita wage, general wellbeing use, and natural quality) are: invariant crosswise over illnesses inside of a nation and year invariant crosswise over nations inside of an ailment and year, or invariant crosswise over years inside of a nation and malady

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Controlling for “other factors” disintegrate X ijt as takes after: X ijt = a ’ it + d ’ jt +  ’ ij +  ’ ijt (2) where a ’ it = a settled impact for ailment i in year t d ’ jt = an altered impact for nation j in year t  ’ ij = an altered impact for sickness i in nation j

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Reduced structure AGE_DEATH ijt = b ln(N_DRUG ij,t-k ) + an it + d jt +  ij + u ijt Zero-slack comparison (k = 0), is assessed utilizing 4678 perceptions, included 496 country*year impacts, 189 disease*year impacts, and 502 country*disease impacts. The comparisons are evaluated by means of weighted minimum squares, utilizing the quantity of passings as a part of that illness nation year cell as the weight.

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IMS Health Drug Launches database Has followed new item presentations worldwide since 1982 In August 2001 the database contained more than 165,000 records of individual item presentations somewhere around 1982 and 2001 Allows estimation, for every nation and remedial region, of the aggregate number of fixings propelled, and the quantity of new substance elements dispatched

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Example: tenecteplase Launch date Country 6/00 USA 3/01 Finland 5/01 UK 9/01 Norway 10/01 Canada 10/01 South Africa 11/01 Ireland

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Drug dispatch likelihood profiles: U.S. versus Canada

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Censoring of medication dispatches IMS Health Drug Launches database has followed new item presentations worldwide since 1982 NCE dispatches are ensured to be beginning dispatches, however non-NCE dispatches may be either introductory dispatches or re-dispatches; we think they are dominatingly the recent.

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Censoring of medication dispatches AGE_DEATH ijt = b NCE ln(CUM_NCE ij,t-k ) + b NON ln(CUM_non-NCE ij,t-k ) + an it + d jt +  ij + u ijt CUM_NCE = the combined number of NCEs propelled CUM_non-NCE = the total number of non-NCEs dispatched Hypothesize that b NCE > b NON b NON could be negative?

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WHO Mortality database Provides information on the age dispersion of passings, by illness, nation, and year Use total life tables to interpret our evaluations of the effect of new medication dispatches on survival probabilities into assessments of the effect of new medication dispatches on future

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Relationship between future and likelihood of survival to age 65, U.S., 1900-2000

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Linkage of medication dispatches to ailments Drug dispatches archived in the IMS Health Drug Launches database are grouped by restorative class Deaths recorded in the WHO Mortality Database are arranged by reason (ailment), utilizing the International Classification of Diseases The abnormal state IMS drug characterization compares nearly to the abnormal state ICD ailment order, e.g. cardiovascular framework tranquilizes clearly relate to (are utilized to treat) sicknesses of the circulatory framework

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11 wide malady classifications

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Countries with most and least medication dispatches

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Findings Launches of New Chemical Entities (NCEs) have an in number positive effect on the likelihood of survival It takes no less than three years for new NCE dispatches to have their greatest effect on survival rates This is presumably because of the continuous dissemination of medications to customers taking after dispatch; information on pharmaceutical use are steady with this translation Launches of (more established) medications that are not NCEs—many of which may as of now have been on the market—do not expand life span

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Estimates of b NCE for distinctive slacks between supply of NCEs propelled and life span

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Estimates of b NCE and b consume at diverse slack qualities

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Contribution of NCE dispatches to life span build NCE dispatches seem to represent a critical part of the long-run increment in life span in the specimen all in all Between 1986 and 2000, normal future of the whole populace of test nations expanded by just about two (1.96) years. The evaluations infer that NCE dispatches represented 0.79 years (40%) of the 1986-2000 increment in life span. The normal yearly increment in future of the whole populace coming about because of NCE dispatches is .056 years, or 2.93 weeks.

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Contribution of NCE dispatches to increment in normal future of the populace since 1986

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Cost per life-year picked up from the dispatch of NCEs In 1997, normal per capita pharmaceutical consumption in OECD nations spoke the truth $250 The normal yearly increment in future of the whole populace coming about because of NCE dispatches is .056 years Hence pharmaceutical use per individual every year separated by the increment in life-years per individual every year inferable from NCE dispatches speaks the truth $4500 This is far lower than most gauges of the estimation of an existence year Moreover, since the numerator incorporates use on old medications and additionally on as of late propelled NCEs, it presumably horribly exaggerates the expense per life-year picked up from the dispatch of NCEs

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Micro confirmation from a Medicaid program

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Vintage of medications utilized Jan-June 2000 % affirmed after 1970 % endorsed after 1980 % sanction after 1990 Probability of death by end of 2002 Other attributes age sex area usage Jan-June 2000 no. of MD visits no. of Rx’s no. of healing center affirmations nature of person’s diseases 540,000 individuals 12.2 million cases

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Data All medicinal and drug store cases of Medicaid recipients amid the period January 1-June 30, 2000 Almost 800,000 individuals; 540,000 had drug store claims About 12.2 million cases List of all inhabitants who kicked the bucket amid the period 2000-2002.

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Mortality rate decays as medication vintage increments

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Actual versus speculative death rates

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Analysis by infection bunch

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