A recent study found that patients benefit as much from aspirin post-surgery as they do from costly and painful injectables. Both prevent blood clots in patients who have severely fractured a bone, but most hospitals continue to treat patients with the costly injectables. Researchers make the case that prescribing the injectables has serious health equity consequences in a Stat News op-ed and question provider behavior.
Patients are burdened with far lower costs for aspirin than the low-molecular weight heparin injectables. And, it’s easier for them to take a pill than to get an injection. However, hospitals and physicians appear not to consider health equity issues or simple cost-effectiveness, for that matter, when they treat patients.
The goal post bone-fracture surgery is to prevent clots, which keep blood from flowing in the lungs and can cause deadly embolisms. And, again, two aspirins a day work just as well as the painful injections into patients’ stomach wall twice a day for three or four weeks post surgery, even for high-risk patients. Moreover, six days of injections cost at least $70 and as much as $300, while the bottle of aspirin costs a few dollars.
Health insurers will generally pay for the injectable drug even though the less costly aspirin alternative is just as good. But, the injectable drug drives up patients’ out-of-pocket costs and members’ premiums. Moreover, people prescribed the injectable after their surgery post bone fracture often don’t take it, making it more likely that they will have a blood clot.
Physicians do not appear to consider that lower-income people, in particular, often do not have the means–financial or social–to comply with the injectable regimen. Only about 15 percent of physicians prescribe aspirin directly after surgery to treat a bone fracture. Only about half of physicians prescribe aspirin to patients after they are discharged.
At many hospitals, policies have not changed notwithstanding the results of the clinical study showing aspirin’s efficacy. It appears that the hospitals would benefit financially if they used aspirin and stopped using the injectables.
The insurers should have a role to play. After all, the insurers claim that they offer “value.” Why aren’t they insisting that aspirin is the most cost-effective treatment and refusing to cover the injectable drug post bone-fracture surgery? Are they somehow benefiting financially from patients taking the injectables?
Here’s more from Just Care:
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