One patient's drugs cost HSE €193,000

The HSE paid out more than €193,000 in drug costs for one individual patient last year, a new internal report on expenditure on statutory drug and allowance schemes reveals. It also shows that in 2005 the HSE spent more than €100,000 on drugs for each of its five most expensive patients.

The report forecasts that expenditure on statutory schemes, which include the well-known drug payment scheme which reimburses the cost of medicines above a €85 monthly threshold, is set to over-run the budget by €168 million this year.

It says that under the high-tech medicine scheme very expensive drugs are being prescribed for patients - one month's supply of Tracleer, a drug for treating respiratory illness, costs €2,986. It is understood that the patient who cost more than €193,000 was being administered Tracleer, among other drugs.

The report says that spending on the various statutory drug and allowance schemes has been increasing at significant rates in recent years and this represents "a growing underlying problem" for the HSE. The report says that budgets allocated to fund these schemes are not keeping pace with the growth in expenditure.

It identifies the main schemes driving this expenditure growth as the drug payment scheme, the long-term illness scheme, the high-tech medicine scheme, the domiciliary care allowance and the hardship medicine scheme.

The report says the volume and types of drugs being prescribed by doctors are the main factors in driving up spending levels rather than pharmaceutical price inflation.

It says the total spending last year on these statutory drug/allowance schemes was €785 million - an over-run of €114 on the approved budget. The report says statins (cholesterol-reducing drugs) have emerged "as the most expensive trend in drug schemes in recent years".

"They account for €35 million of the top 10 drug expenditures in the drug payment scheme/long-term illness scheme for 2006 and €87 million of drug expenditure on the medical card for the same period.

"Growth in prescribing for diabetes is another major trend with a 234 per cent increase in prescription volumes for insulin aspart and a 167 per cent increase in volume for insulin glargine when 2003 is compared with 2006. This is undoubtedly related to the twin epidemics of obesity and diabetes in Ireland."

The report says the growing use of insulin products is likely to continue for some time because of the continued increase in obesity levels. "The increase in diabetes type 2 would lag behind the increase in obesity," it says.

The report says that another factor to note is the changing clinical practice whereby doctors are now transferring patients from oral anti-diabetic medicines to insulin at an earlier stage. It also says diagnostic products such as equipment for checking blood sugar levels are now the highest expenditure items in the long-term illness scheme, costing almost €12 million last year.

The report says arthritis is the most expensive condition under high-tech medicines, costing €23 million in 2005, while multiple sclerosis is the second most expensive costing €14.3 million in 2005.

The HSE said it had established a number of review groups to examine spending in a number of areas covered by these demand-led statutory schemes. It also said it was working to reduce the cost of drugs supplied and that its new agreement with the pharmaceutical industry would see the price of patent-expired products fall by 35 per cent.