GENENTECH's ACTIVASE IS BEING USED IN 69% OF MEDICARE

GENENTECH's ACTIVASE IS BEING USED IN 69% OF MEDICARE cases in which a thrombolytic agent is used, according to a recent survey prepared for an HHS advisory group. Conducted for HHS by Project HOPE, the survey is based on data from 93 PPS hospital pharmacies on the availability, use, costs and charges for thrombolytic agents, including TPA, streptokinase and urokinase. Results of the survey were reported by the staff of the Prospective Payment Assessment Commission at a Dec. 13 commission session. The Medicare usage mirrors Genentech's estimates on TPA's general market share. The firm has estimated its share of the thrombolytic market at 65%. The ProPAC survey also found that 27% of myocardial infarction cases treated with a thrombolytic received streptokinase while 4% received urokinase. Staffers cautioned that the sample size, which includes about 200 patients, is too small to draw broad conclusions about drug utilization. The staff did not report how many MI patients receive a thrombolytic drug. "Eighty-six percent of the responding hospitals reported using the thrombolytic agents," ProPAC staffer Amy Kossoff told the commission. "TPA is being used throughout PPS hospitals and appears to be used more frequently than streptokinase, although the total number of cases at this point is quite small." The survey found that the average acquisition cost of TPA is $2,060, compared to $115 for streptokinase. "But there is quite a bit of variability in charges," Kossoff noted. Hospitals on average charge $2,950 for TPA, but 23 facilities charge less than $2,800 per dose and 15 charge more than $4,000. The average charge for streptokinase is $380. Twenty-three hospitals charge less than $200 and 17 charge more than $400. Kossoff said the survey results should help allay commission concerns that the costs of the drug would prevent its wide availability. "This has not proven to be the case," she said. "Both TPA and streptokinase...have diffused widely." ProPAC Executive Director Donald Young commented that TPA has spread "very, very" rapidly. "Very few other drugs have diffused as rapidly as this one has diffused," he noted. Commenting that payment policies have not been a decisive factor, Young attributed the drug's quick diffusion to publicity in both the general and medical press and to physician acceptance of the therapy. ."For some reason, physicians [decided] to adopt this one very early, whereas for many technologies, they are very slow to adopt," he remarked. ProPAC staffers intend to continue to analyze whether there are payment problems for thrombolytic agents in any specific DRGs.