Innovation vs "Metoovation"

The British Medical Journal has just published a significant article about medicine costs. (Morgan SG et al. "Breakthough" drugs and growth in expenditure on prescription drugs in Canada. Br Med J 2005; 331: 815-816.)

Some have suggested that rising health care costs are in part attributable to new, innovative, effective treatments. Morgan et al used existing categorizations by the Canadian Patented Medicine Price Review Board to classify all new prescription drugs available in Canada since 1990.

These were classed as "breakthrough" - "the first drug to treat effectively a particular illness or which provides substantial improvement over existing drug products," to which Morgan and colleagues added later drugs added in the same chemical class; "me-too," other new drugs patented since 1990 that did not provide substantial improvements over existing drugs.

Breakthrough drugs accounted for 6% of expenditure and 1% of use in 1996, and 10% and 2% in 2003.

In contrast, me-too drugs accounted for 44% of use and 63% of expenditure by 2003.