Rationing and delays lead to unnecessary deaths
| “In terms of statin availability and use PHARMAC’s delays in making available appropriate medications has probably caused more unnecessary death and major morbidity to New Zealanders than any other of their policies,” Drs Chris Ellis and Andrew Hamer said in the February edition of the New Zealand Medical Journal. |
They were commenting on an analysis of data from the follow-up LIPID [Long-term Intervention with Pravastatin in Ischaemic Disease trial] (Stewart et al; NZMJ 121:1269 pp 11-23)
“The findings are dramatic: there is a 35 percent greater chance of a New Zealander dying of CVS [cardiovascular disease] in the median follow-up period of 7.8 years, compared to an Australian.”
The authors argue the delays in making statins available to New Zealanders are significant.
“The benefits of such medications, |
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which are generally well proven in robust clinical trials, are large, but have often not been readily available to New Zealanders.”
For instance, in the late 1990s most New Zealand patients with heart disease simply could not access life-saving medicines such as statins because of delays in funding by PHARMAC.
While there is a general awareness of the need to ration expensive medicines, Ellis and Hamer question the amount of funds allocated to the pharmaceutical budget.
“From 1993 to 2007 there was only a 35 percent increase in funding for PHARMAC. However the compound inflation rate over these 14 years was 33 percent, the population grew by 17 percent, and hence per person in New Zealand, there was a 15 percent decrease in drug funding over these 14 years for every man, woman and child.”
They echoed RMI concerns when they stated that New Zealand currently spends less than half the amount Australia spends on pharmaceuticals per capita, citing OECD Health Data as their source.
Dr Pippa MacKay, the chair of the RMI said this research is deeply disturbing and reinforces many of the arguments made by a number of submitters to the development of the medicines strategy announced prior to Christmas.
“Words, such as ‘caused more unnecessary death and major morbidity’ when used in such a respected journal are a dire warning to those involved in the setting of the budget for the pharmaceutical schedule. Let’s hope the principles of the new medicines strategy which clearly says that New Zealanders should have access to the medicines they need are heeded in this context, and that a realistic budget is set later this year.
“Research, such as that Ellis and Hamer discuss shows that access to modern medicines can save not only lives, but also money,” Dr MacKay noted.
Cardiovascular health in New Zealand: areas of concern and targets for improvement in 2008 and beyond. Chris J Ellis and Andrew W Hamer in NZMJ 15 February 2008, Vol 121 No 1269; ISSN 1175 8716 |
Decreased investment reflected in declining health outcomes
An association between decreasing cardiovascular and respiratory drug investment and declining cardiovascular and respiratory health in New Zealand has been suggested in a study published in the Canadian Journal of Cardiology last year.
The objective of the research was to compare health care indexes and health care use information from Canada, Australia and New Zealand.
The 2006 OECD health data were used to compare health and health cares indexes between 1994 and 2002 to 2004, and the principle focus of the evaluation was cardiovascular and respiratory disorders.
Between 1997 and 2004 New Zealand expenditure on drugs for respiratory disease declined by a third, while it increased by 31 percent in Australia and 86 percent in Canada over the same period the report says.
Sales of cardiovascular drugs also decreased in New Zealand from 1998 -2004, while they sharply increased in Canada and Australia.
The authors noted that during the study period New Zealand experienced increased numbers of hospitalisations, with longer average length of stay, for cardiovascular and respiratory disease indicating a decline in health in both these areas. Further, while medicines costs have been contained in New Zealand it is likely that these costs have been shifted onto the hospital system.
By comparison, the average length of hospital stay for cardiovascular and respiratory disease not only declined in Canada and Australia but the number of hospitalisations also either decreased or remained unchanged.
The authors concluded “whether New Zealand’s drug cost-containment system is directly related to the negative impact on health or one of many contributing factors is debatable, but the disparities in cardiovascular mortality and the use of services for cardiovascular disorders among New Zealand and the other two countries, where cost-containment is not so restrictive, is remarkable”.
For a copy of the report click here.
“Lessons for a national pharmaceuticals strategy in Canada from Australia and New Zealand,” Jacques Le Lorier MD PhD FRCPC and Nigel Rawson PhD, in the Canadian Journal of Cardiology, Vol 23, no 9, July 2007 |
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Suggestions that saving money on medicines means funds can be spent in other areas, such as education, are superficial and misleading, the RMI chief executive, Ken Shirley, said.
It is certainly true that New Zealand’s meagre investment in innovative medicines reduced the drug bill but many contend that this frugality results in a negative outcome to both the economy and society.
“The two pieces of research cited in this edition of RMI Line show that the New Zealand government is failing its people with its extremely restrictive medicines procurement regime.”
The RMI suggests that both PHARMAC and the DHBs should strongly support the case for a larger pharmaceutical investment to help save lives, reduce hospital costs and allow many New Zealanders to enjoy a better quality of life.
New Zealand’s per capita public expenditure on medicines is significantly less than Australia’s and the OECD average
(Health at a glance 2007: OECD Indicators).
“As the government’s procurement agency PHARMAC should be promoting more investment in cost-effective and life-saving medicines rather than positioning itself as the champion of a cost- cutting culture which results in the avoidable deaths of too many New Zealanders.
“On a positive note the RMI welcomes the opportunities presented by the government’s medicines action plan to redress the existing deficiencies in pharmaceutical investment,” he commented. |
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