Drug assessment: The first inhaled form of insulin available on the market here has been found to be cost effective in the treatment of diabetes.
Following an assessment by the National Centre for Pharmoeconomics (NCPE), Exubera, which is inhaled by patients with diabetes three times a day at mealtimes, has been recommended as a cost-effective treatment for medical card patients.
Dr Michael Barry, clinical director of NCPE, and Dr Mairin Ryan subjected the new medication to a health technology assessment - a measure of cost effectiveness which summarises the medical, social, economic and ethical issues related to the use of a new drug.
When prescribed under the medical card (GMS) scheme, they estimated Exubera's cost effectiveness at €44,526 per quality adjusted life years (QALY), just under the threshold for cost effectiveness of €45,000. A QALY represents the number of years of life gained by the patient and the quality of those years.
However, Dr Barry, a consultant in clinical pharmacology at St James's Hospital, Dublin, said Exubera was not cost effective when prescribed under the long-term illness (LTI) scheme. "Some 37 per cent of potential Exubera patients will receive the drug under the LTI scheme where payments to pharmacists include a 50 per cent mark-up fee. This mark-up renders Exubera not cost effective under the LTI scheme as the cost effectiveness values were over €65,000/ QALY."
Exubera is more expensive than the standard injectable form of insulin. It costs €1,100-€1,900 per patient per year. However, it is equally effective as injectable insulin and is associated with greater patient preference.
While the NCPE has estimated that almost 60,000 patients could be eligible for Exubera, it is not suitable for people with severe asthma or chronic obstructive airways disease. The new drug is also contraindicated in smokers and in children under 18 years.
Diabetes, which affects 210,000 adults in Ireland, causes sugar levels in the blood to rise above normal. It is due to a lack of the hormone insulin.
Left untreated, the disease causes damage to the cardiovascular system, the eyes and the kidneys.
Noting that the National Institute for Clinical Excellence in Britain had ruled against Exubera on the grounds of cost effectiveness, Dr Barry said: "Ours is the first pharmaceconomic evaluation of Exubera in Europe to demonstrate the cost effectiveness of this innovative product."
• A copy of the assessment is available at www.ncpe.ie