Take some drugs out of GMS, report to suggest

IF CERTAIN products which don't have a strong evidence base for their effectiveness were taken out of the State's medical card scheme then the cervical cancer vaccine could be provided and there would still be money left over, a conference heard yesterday.

Dr Michael Barry, chairman of the group appointed by Minister for Health Mary Harney, to examine ways of making savings on drugs prescribed by GPs under the medical card scheme, told delegates attending a conference on medicines and health technology assessments at Croke Park that one couldn't keep adding to the list of drugs which were free or reimbursable without taking others out of the scheme when funds were limited.

"You can't keep adding to the GMS, you cannot keep adding product after product without taking something away, particularly when you have a finite budget," he said.

He added that there were certain products that did not work very well such as clinical nutritional products now covered by the GMS but if products that didn't work well were taken out of the scheme and replaced by things like the HPV vaccine, you could still have "change in your pocket".

Dr Barry said that in 2007 the State spent €1.74 billion on prescription medicines under the community drugs schemes, a five-fold increase on 1997.

He added that more than €45 million a year was going on clinical nutritional supplements which had a "poor" evidence base. "The question is should we be doing that? Should we be spending elsewhere?" he said.

"We can't keep adding technologies without at least questioning are all the technologies we're funding value for money. If they're not value for money then we shouldn't be funding them," he added.

Dr Barry's group is due to report to Ms Harney on how drugs savings can be made by next Monday.

Meanwhile, Dr Barry said in relation to reimbursement of medicines, there were two questions. One was, was it value for money and, if yes, the second was can we afford it.

Regarding Ms Harney's decision not to proceed with the cervical cancer vaccination programme even though HIQA, of which Dr Barry is a board member, found it would be cost effective, he said it was "the right of the minister of the day" to make that decision. "Our role is to provide the information, it's not to make the decision," he said.

Asked if he felt more decisions on the provision of health technologies found by HIQA to be cost effective would be deferred because the State couldn't afford them, he said: "It's possible . . . it's a real issue".

Meanwhile, Prof Peter Littlejohns, the clinical and public health director of the National Institute for Clinical Excellence (Nice) in the UK, said the economic downturn would make it more difficult for governments to sanction expensive new drugs and treatments.

He said the approach among many governments during good times had been to increase the health budget to fund new treatments, but such an approach could not work in the present economic climate.

Nice was set up in 1999 by the British government to measure the cost-effectiveness of new drugs and treatments. It has been praised and criticised in the UK in equal measure, but its work has been widely scrutinised in Ireland and other countries as governments face constant challenges about the funding of new treatments.

Prof Littlejohns and Dr Barry were addressing yesterday's conference organised by the Irish Platform for Patients' Organisations, Science and Industry (IPPOSI) to examine the way forward for health technology assessments (HTA).

This article appears in the print edition of the Irish Times