Cost assessments: Tighter control on reimbursing the cost of medicines to patients is inevitable, a leading expert in the area has warned.
Such moves may mean patients having to pay for high cost drugs.
At present, audits to assess whether drugs provide value for money to the taxpayer are not mandatory. These assessments will target high cost medicines and those that have a large budgetary impact, according to Dr Michael Barry, an expert in pharmaco-economics,
Dr Barry, who is clinical director of the National Centre for Pharmoeconomics (NCPE) at St James's Hospital and a senior lecturer and consultant in clinical pharmacology at Trinity College Dublin, said health technology assessment, which included an analysis of the value for money of new therapies, was emerging as standard practice across Europe.
"Some countries look for the results of health technology assessment [ HTA] before they will reimburse the cost of the product to the patients. My view of HTA is that it is inevitable it will come here."
Covering drugs and medical devices, HTA is defined as a systematic transparent process to summarise information on the medical, social, economic and ethical issues related to the use of a new or established health technology.
In Britain, where value-for- money assessments are carried out by the National Institute for Clinical Excellence (NICE), controversial decisions have been made to restrict payment for new treatments for breast cancer and Alzheimer's disease.
But in Finland, Norway and the Netherlands pharmoeconomic evidence is mandatory before national authorities reimburse drug costs, Dr Barry said.
"It is about taxpayers' money - it is not about who will get the drug but about who will pay for it," he added.
"This is about opportunity cost. If you spend money in one area, it will not be available to spend elsewhere."
Asked how he thought doctors might react to possible cost restrictions to their prescribing, Dr Barry acknowledged practitioners would have reservations. "In the past, doctors looked at safety and efficacy when prescribing but now they must also consider cost-effectiveness. It is more difficult and a challenge."
Meanwhile, the results of new research by the NCPE show that cholesterol-lowering statin drugs are cost-effective in the prevention of coronary heart disease in people with no history of cardiac problems.
Dr Barry and Dr Valerie Walshe carried out a cost-effectiveness analysis where the cost of statins were measured in terms of life years gained for treatment (Cost/LYG).
When tested in a patient population with a 15 per cent 10-year risk of developing coronary heart disease, atorvastin (Lipitor) was found to be the most cost-effective statin. The range of cost-effectiveness for statins prescribed under the medical card (GMS) scheme varied between €17,900 per LYG and €33,800 per LYG. Researchers calculated the cost-effectiveness threshold for the Republic at €36,000 per LYG.
"It is interesting to note that the cholesterol-lowering statins are less cost-effective under the drug payment scheme [ DPS], influenced in part by the 50 per cent mark-up to the pharmacist," Dr Barry said.