Healthcare rationing

 

The decision of the National Centre for Pharmacoeconomics (NCPE) to recommend the Health Service Executive does not approve the use of two new cancer drugs on cost effectiveness grounds may prove controversial.

Following a formal assessment process the NCPE has advised that crizotinib, used to treat lung cancer, and pertuzuma, a new treatment for breast cancer, should be subject to further scrutiny before being made available to Irish patients. Both drugs work best in a subgroup of patients with these tumours: crizotinab does not impact on overall survival of patients with one type of lung cancer but does improve their quality of life; and pertuzuma has been shown to improve survival, albeit in a group of breast cancer patients for whom effective treatments already exist.

Health Technology Assessment (HTA), the process under which the NCPE evaluates new treatments, works by summarising information on the medical, social, economic and ethical issues related to the new drug. HTA aims to identify what will deliver the best health gain for the population within the constraints of a fixed healthcare budget.

Our national healthcare budget is under enormous strain, with service reductions now obvious across all sectors. We are moving from a period of cost -containment to one of effective healthcare rationing. Defined as the controlled distribution of scarce resources, rationing is not a new concept in healthcare. But there has been little debate about its implications.

Until we have that debate, there is a need to ensure that rationing does not occur in a haphazard fashion, with the result that factors such as a person’s age or where they live become the determining considerations in whether they receive a particular treatment or not. Whatever about the nuances and merits of particular cases, the rigorous assessments carried out by the NCPE are both transparent and objective. As such they represent a logical basis for making difficult decisions about the cost effectiveness of novel medical treatments.

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