New cost rules may prevent patients accessing drugs

NEW DRUGS for the treatment of a range of illnesses are likely to become more difficult to obtain after the threshold used to measure their cost effectiveness was halved.

The National Centre for Pharmacoeconomics is charged with assessing drugs coming to the market for cost effectiveness and making recommendations to the Health Service Executive.

Up until recently, the centre judged drugs as good value for money if they cost €45,000 or less for every quality-adjusted life year – year of good health – delivered to a patient. This figure has now been cut to €20,000 after discussion with the executive, which has been seeking to reduce costs.

Controversial cancer drug Ipilimumab, used to treat malignant melanoma, was released for use last week following a public campaign by patients. It had been costed at €85,000 per patient.

This amounted to almost €150,000 per life year, which the centre for pharmacoeconomics said did not represent good value for money. It recommended the drug should not be released to market at that price. Following negotiation with drugs company Bristol-Myers Squibb, the price of the drug has been reduced.

Dr Michael Barry, clinical director of the centre, said the organisation had been using the €45,000 threshold per life year, but recently the €20,000 limit was being used. He said the centre’s recommendations go “toward the decision” on whether or not the drugs are released, but other factors are also taken into account by the HSE.

“It’s not all about the economic component; medical issues, social issues and ethical issues are considered,” he said. “We do the economics, but the HSE take the final decision including all four factors.”

Dr Tony Holohan, chief medical officer with the Department of Health, said people can still get many drugs that do not meet the thresholds.

These included drugs for rare diseases which had been released into the scheme despite being outside the pricing criteria. The HSE had also entered into cost-sharing arrangements with drugs companies where drugs were deemed too expensive, he said.

Three drugs have been deemed too costly by the centre since January this year. These include Rivaroxaban, a drug used to prevent stroke and embolism. It is an alternative to well-known medication Warfarin, and is more suitable for some patients.

Cabazitaxel, used to treat prostate cancer, was also not recommended because of price. And Dexamethasone Intravitreal Implant, which treats macular oedema, a condition of the eye, was also ruled too expensive. This drug was close to the €20,000 cost threshold and has been approved by the centre’s equivalent in Britain, the National Institute for Health and Clinical Excellence.