The large colchicine price increase in 2010 led to a decrease in its use. Hospital and health care visits for gout have increased since then.
Colchicine is an anti-inflammatory drug used to treat and prevent acute gout flares. These recent trends are consistent with poorer disease control, Zirui Song, MD, PhD, of Harvard Medical School in Boston, Massachusetts, and colleagues reported in JAMA Internal Medicine. Price increases in medications that have few or no substitutes could have adverse economic and clinical consequences, they warned.
The FDA discontinued lower-priced versions of colchicine in 2010 after it granted market exclusivity to Colcrys for 3 years. The mean price per prescription of colchicine increased from $11.25 in 2009 to $190.49 in 2011. Average out-of-pocket costs increased from $7.37 to $39.49. These costs remained high through 2019.
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From 2007-2010 to 2011-2019, mean colchicine use declined significantly by 9.6 pills per patients in adjusted analyses, while allopurinol use rose significantly by 33.1 pills per patient and oral corticosteroid use by 1.5 pills per patient, the investigators reported.
Emergency department visits for gout significantly increased by 40% over the decade or by 0.05 visits per patient. Rheumatology visits for gout likewise increased 11% or 0.02 visits per patient.
“These findings, Dr Song’s team wrote, “suggest that as gout flares became more expensive to treat, patients and clinicians may have been more aggressive in preventing such flares by increasing allopurinol use; that is, when the price of a treatment rises, prevention may receive more attention, which is beneficial.”
The data were based on a large cohort of patients with gout who had employer-sponsored insurance from 2007 through 2019.
The study was observational, so correlation does not imply causation. The investigators could not rule out secular trends such as changes in the economy and health care or account for gout severity.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Reference
Ly DP, Giuriato MA, Song Z. Changes in prescription drug and health care use over 9 years after the large drug price increase for colchicine.JAMA Intern Med. Published online May 8, 2023. doi:10.1001/jamainternmed.2023.0898
