Perceptions of Drug Cost Affects Perceived Benefits

Perceptions of drug costs may affect how much patients benefit from the drug, according to a study treating participants with a placebo. The results were published in the online issue of Neurology.

In the study “Placebo effect of medication cost in Parkinson disease: A randomized double-blind study” from Alberto J. Espay, MD, MSc, of the University of Cincinnati in Ohio and a fellow of the American Academy of Neurology, and colleagues studied 12 patients with moderate to severe Parkinson disease and motor fluctuations. The patients were randomized to a “cheap” or “expensive” placebo. After 4 hours, they were crossed over the alternate arm.

"Patients' expectations play an important role in the effectiveness of their treatments, and the placebo effect has been well documented, especially in people with Parkinson's disease," Dr Espay said in a statement. "We wanted to see if the people's perceptions of the cost of the drug they received would affect the placebo response."

The participants were told the shots they were receiving were 2 formulations of the same drug that were believed to be of similar effectiveness, but that one cost $100 per dose and the other cost $1500 per dose. They were told the purpose of the study was to prove the drugs were equally effective despite their different price tags.

Both placebos improved motor function, but the benefit was greater when patients were randomized first to the expensive placebo. While the effect of the expensive placebo was less than levodopa, the placebo did significantly improve motor function and decrease brain activation.

After the participants were told the true purpose of the study.

"Eight of the participants said they did have greater expectations of the ‘expensive’ drug and were amazed at the extent of the difference brought about by their expectations," Dr Espay said. "Interestingly, the other 4 participants said they had no expectation of greater benefits of the more expensive drug, and they also showed little overall changes."