Wednesday, November 28, 2012

Pharmaceutical Cost-Effectiveness and Diet

I saw an interesting short piece in the Washington Post discussing the discovery that the number of drugs with important interactions with grapefruit has increased substantially since an initial report on the matter 20 years ago and particularly since 2008.

I will refer interested readers to the article for the details, but the short description of the issue is that grapefruit (but not all citrus fruit and not regular oranges) contain a chemical that interacts with some pharmaceutical products and substantially increases the bioavailability of the product.  In this case, more is not necessarily better.  In fact, more can be toxic, particularly to the kidneys.

This raises an interesting question that was probably not considered when any cost-effectiveness analysis related to the drugs is conducted.  Essentially, how does the cost-effectiveness change when you have this type of potential interaction.  It is not a typical drug-drug interaction.  It is not an adverse event due solely to the drug.  It is an event that is purely avoidable by properly reading the packaging or listening to a physician or pharmacist and then following up on what a person has been told.  Sounds simple enough.

I suppose if people were constantly have drug-grapefruit interactions, it would make the news and we would all become aware.  It is probably in the category of "things that sound scary but really are pretty rare" even though an article without additional information about the incidence of such events may make it sound very scary.

If this were a big issue, it would not seem too hard to provide better education at a fairly low cost and prevent events. If it is not a big issue, then while the increasing number of drugs that have this characteristic is interesting but probably not worth more than the short article that I saw.  I'd be intrigued to know more--such as whether anyone has personal knowledge of this issue for themselves or someone they know.

It does point to a larger issue of how we might evaluate the economic importance of better counseling about the interaction between drugs and diet more generally.  

1 comment:

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