Tuesday, August 01, 2006


The New England Journal of Medicine last week had two articles about the use of nitric oxide in premature babies. Nitric oxide is a drug that we have known for years is very helpful in some full term babies with respiratory failure. Over the past several years there have been studies investigating whether it is also helpful in premature babies, with so far mixed results. The articles published in the NEJM last week seem to support its use in premies, with one study showing improvement in the incidence and severity of bronchopulmonary dysplasia, the chronic lung disease that premies get, and the other showing fewer complications like intracranial hemorrhage in the nitric oxide treated babies. An accompaning editorial acknowledges the promise of nitric oxide for premature neonates, but wisely, in my opinion, recommends that it be studied further before it is used routinely for them. (Nota bene: We're talking about nitric oxide, not nitrous oxide, a gas used for anesthesia.)

I'm not sure what's going to happen with nitric oxide in premies. I suspect that eventually it will be shown to be beneficial in at least some subset of premies. But the thing that gets me about nitric oxide is its cost. It starts at $3,ooo dollars per day, with a maximum charge of $12,000 over 30 days. Even in NICU's, used to stratospheric charges, that's a significant chunk of change. If nitric oxide babies go home earlier than others then some of that cost can be recouped, but still....$3000 per day?

I have mixed feelings about drug companies these days. They fund and make possible some very large and good studies, such as the ones that studied artificial surfactant, studies that may not have been done otherwise. But they charge outrageous prices for new drugs, as well as do dirty tricks to keep patents from expiring, and run misleading ads and the like. I know they need to regain some of the costs involved in drug development, and I know the companies' executives primarily answer to the stockholders, but profits in the hundreds of millions of dollars when some people can't afford drugs - and when HIV drugs are out of reach for some in developing countries because of their cost - is well, um, well, scandalous.

This is a big subject, and I am hardly the first to complain about it, so I'll stop here. But doesn't it bug you, too?

P.S. I wish I could say it's good to be back from vacation, but frankly, I'd rather still be lying on a sunny beach.


Anonymous Anonymous said...

I agree with you 100% about the ridiculous costs of medications today. As the parent of 2 former preemies, I've experienced this first hand. Both of my children needed Synagis shots (which Neonatal Doc will no doubt know a lot about) to protect them against RSV in their first 2 winters. One shot a month, for approx. 6 months, at a cost of around $2500 per month.

I'm sorry, but these drug companies have to know that they have us over a barrel here......our children's lungs are compromised and RSV could be deadly, and thankfully now there's a medication to keep the illness from being so serious. BUT, if we want it, we have to go into serious debt to do so. How can you say "no, I don't think I'll get that life-saving medication for my child!"? If this is the only medication of its kind, then they have to know that we'd pay almost any amount in order to get it.

My pediatrician told us about an organization that specifically helps pay for Synagis for preemies. I called them, and guess what? Because my husband and I both work, and we do have health insurance, we didn't qualify for this. Consequently, we're still carrying a balance at the pedi's office.

Sorry to vent, but you bring up some excellent points. Thanks for starting the discussion.

10:59 PM  
Blogger PaedsRN said...

I guess I'm lucky in that I get to see nitric used where it shows clear benefit, in term or near-term babies with pulmonary hypertension. And I don't have to think about the cost if I don't want to... just turn the regulator tap. Too convenient?

Hey, did you do something to your RSS feed? Your atom.xml's broken.

6:39 AM  
Blogger Surgeon in my dreams said...

The cost of medications hits home for me because of hubbys illness'. We make too much money (snort-snort)to qualify for any of the drug companies help programs but we make way less than enough to pay for what he is supposed to take every day.

On another note Neonatal Doc, would you read the post I have on my site about Daniel's Law? I would love to know your opinion about the situation with this newborn.

8:24 AM  
Blogger Dream Mom said...

Sometimes I am just floored by the cost of some items and prescription drugs are at the top of my list. I see the drug charges for Dear Son and I see older people struggling to pay for their meds at the pharmacy and I think to myself that there has to be a better way. I can't imagine $3000 dollars a day.

It's difficult too to find lower prices for prescription drugs; true, you can find lower prices on the internet, but can you trust them? Are you getting what you pay for? It's so difficult.

I know there is one other charge that bugs me on the hospital bills-it's the charge for air transport. Typically it runs around $6,000 or $7000 dollars for a 30 mile one way trip. I am not saying I don't appreciate the option and certainly it's necessary, but it's still a lot of dollars.

By the way, it's good to have you back. Hopefully, you had a nice vacation.

9:11 AM  
Blogger That Girl said...

Im glad youre back even though you should have more weeks of sun and sand!

I have excellent insurance thankfully, so I havent had to worry about it personally but if course I watch documentries about malaria, HIV, & TB in other countries and it makes me want to hurt people.

Corporations are all out of control. They pretend they have "no choice" but to maximize profits at the expense of human decency but it is untrue.

Too many things are "third party" so that no one can point to a responsible party while those in charge bleat about "personal responsibility" ad nauseum.

9:20 AM  
Blogger Flea said...

Welcome back,

Hope you used sunscreen.

What ever happened to CPAP and prevention of BPD? Did the guys at Columbia ever publish that data? If so, and it was favorable, how does it compare to NO?



10:56 AM  
Blogger neonataldoc said...

Thanks to all for the well wishes and comments. Synagis bugs me a little bit. There's one study - funded by Synagis's maker - showing its benefit, but it wasn't a huge benefit. It's extremely expensive for the modest benefit it offers.

I know air transport is very expensive, too, but I don't know what it really costs to keep a helicopter in service. It's probably a lot of money.

Flea, I use sunscreen like crazy. The CPAP and BPD thing is a big issue, too much for a comment. Maybe I'll blog about it someday, if I can figure out how to fit it into 4 or 5 paragraphs.

8:58 PM  
Blogger NeoNurseChic said...

Fill me in on the CPAP and BPD thing because I'm naive... Personally, I detest CPAP...I really do. It is uncomfortable and half the time the babies seem to brady, desat, and become a mess simply from the pain of the freaking system. However, we are currently switching to a new system, and I'm told that it has been "liked" by the babies thus far. And then there's their poor stomachs on such high flow. They seem to blow up like a balloon and then have horrid feeding intolerances while on CPAP. And yes, we insert OG tubes, but still....the belly gets distended and full of air - sometimes dangerously so. I have been quite uncomfortable with the bellies of more than a few teeny ones on the CPAP. And I miss vapotherm anyways because at least they could learn to PO feed while we used this. As long as they demand the flow of a CPAP system, their feeding skills end up being very delayed. And now that we're using high flow nasal cannula instead, you can't go as high on the flow without requiring CPAP.

I guess I don't really need to be filled in on the CPAP and BPD prevention thing since I do already know that Columbia doesn't intubate the tiny ones and sticks them right on CPAP...if that's the correct interpretation I got of that whole thing! We intubate but extubate within 48 hours if possible to CPAP, even though most of them seem to fail and end up on conventional vents and oscillators. What can ya do?

Vitamin A to prevent BPD - what say you?

9:58 PM  
Anonymous Anonymous said...

Another parent who shelled out too much money for Synagis for my twin daughters in '03-04. I always thought we paid more 'cause Flumist didn't market as well as hoped for. I saved a couple boxes for their baby books...
Our out of pocket expense for Synagis while baies were still hospitalized = $0 If we had taken them to hospital clinic monthly = 30% Our ped (out of network) = 20% A visiting nurse to administer the shots = 10%. Crazy expensive system.

2:15 PM  
Anonymous Daniel Haszard said...

Eli Lilly is a big drug company that puts profits over patients.
Daniel Haszard Bangor Maine zyprexa caused my diabetes http://www.zyprexa-victims.com

3:36 PM  
Anonymous Kim said...

I'm glad you clarified nitric vs. nitrous...I read too fast and my jaw dropped for a minute! LOL!

9:25 PM  
Blogger Mommy Alvarez said...

My 30 weeker developed pulmonary hypertension and was given the NO when all else failed. That stuff saved her life. The NO was their last option because they said she was too tiny for ecmo. She weighed a little under 3lbs.

6:21 PM  

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