Healthy Skepticism Library item: 1667

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Mansfield P, Evans A.
Costs are important but it's medicines that save lives
Australian Financial Review 2002 Feb 2

Full text:

The Government thinks the impotency drug should not be subsidised. Peter Mansfield, a GP and director of HealthySkepticism.org, agrees on grounds of potential cost blowout. The chief executive of the Australian Pharmaceutical Manufacturers’ Association, Alan Evans, says it should be subsidised for the sake of equity.

Peter Mansfield

Australia must just say no to subsidising drugs such as Viagra. We need a wake-up call to the reality that the out-of-control exponential growth in expenditure on drugs in recent years is not sustainable. In the US, large employers such as General Motors are awake to the three key issues. First, drug costs are the fastest growing threat to their profits. Second, the cost growth is largely driven by waste on expensive new drugs when older alternatives would be better or equal but cheaper. Third, wasteful drug use is largely driven by promotion that often misleads doctors and costs 20 to 35 per cent of the wholesale price of drugs.

General Motors is awake because they pay for their workers’ health care directly. In Australia, we also pay heavily but don’t know it because we pay indirectly via taxation. Here also millions are wasted on new drugs for blood pressure, asthma and arthritis that are inferior to older alternatives. If you buy a new computer it will be better than an old one but that rule does not apply to drugs because subsidies, patent protection and misleading promotion distort the market.

Sure, doctors like me want subsidised Viagra for our patients.

But we want subsidised everything for our patients. Lack of exercise is a major cause of impotence so why not subsidise walking shoes? We want the taxpayer to be Norman Lindsay’s Magic Pudding so we can take all we want and have it replenished by magic. The reality is that if we waste money on treatments that are less cost-effective, then we are stealing resources from treatments that would do more good.

Focusing on individual patients makes it difficult to see the big picture link between waste on expensive drugs and the suffering from lack of timely access to other parts of the health-care system.

I have met the widow of a man who died after his first dose of Viagra because of an interaction with another drug he was taking for heart pain. Severe reactions are rare but may increase as men continue taking Viagra as they get older. However, for defined groups of patients men with spinal cord injuries the benefits are well worth the risks and costs.

As with other drugs, the problem is that outside the defined groups are many people for whom the benefit is not enough to justify the cost to the taxpayer. My loyalty to the individual patient sitting with me makes it very difficult to resist the temptation to give my customer what he wants regardless of greater harm to the community. The experts have guessed that this moral hazard could cause spending on Viagra to blow out to $100 million annually.

The Government has good reason to worry about cost blow outs since the new drug for arthritis, Celebrex, soared beyond expectations to cost taxpayers $161 million last year.

The underlying cause of these problems is the fact that our system rewards drug companies for maximising sales regardless of the impact on health care.

This gives drug companies little choice but to oversell their drugs or be taken over by more aggressive competitors.

The best solution is contracts calculated from the number of Australians who really need the drug plus incentives for the drug companies to reward honest promotion that ensures that the drug is provided for those who need it and not to those who don’t.

Until we have a better system we have to say no to subsidising drugs such as Viagra.

Alan Evans

Opposition to the recommended listing of Viagra on the Pharmaceutical Benefits Scheme raises a number of critical health-care issues that affect more than those who suffer erectile dysfunction.

At stake is our national medicines policy, access to the best and latest medicines and quality of life for all Australians.

Policy makers and advocates who choose to focus their attention simply on the cost of the PBS and one product have the potential to adversely affect the health care of many Australians without sustaining any real savings to overall health care expenditure.

The use of prescription medicines produces significant savings elsewhere in the health budget by reducing the need to access more expensive health-care treatments involving surgery, hospitalisation and aged care.

Medicines save lives, relieve pain, prevent and cure disease and help people avoid disability.

There are those that say that the growth in the cost of the PBS is unacceptable, yet the majority of that growth has been for medicines to treat diseases in the Government’s national health priority areas, which affect millions of Australians.

The patients who will benefit from treatment with Viagra will be those who suffer from a disease or illness identified as a national health priority: including cancer, cardiovascular disease and diabetes.

The decision by the Pharmaceutical Benefits Advisory Committee to recommend a medicine for listing on the PBS, and this includes Viagra, means they consider the medicine is cost effective. And the PBAC tends to be conservative in its assessment of cost effectiveness.

Reports about the cost to the PBS for the listing of Viagra have been highly inaccurate. As the listing would be for men from nine strictly defined groups and repeat prescriptions would be limited, the resulting costs would be less than 0.5 per cent of PBS outlays over three years or about $20 million.

If a decision is made solely on the basis of comparing the treatment of one disease against another then we will be back to the 1940s where only a limited number of people had limited access to a very limited range of medicines unless you were rich.

Australia has the seventh-lowest spend on prescription medicines amongst the OECD nations with manufacturer prices for medicines in Australia much lower than prices in the US, Canada, France and Britain.

Over the next decade the PBS will face many challenges, particularly with the ageing of Australia’s population and the increasing availability of effective medicines. The prescription medicines industry is committed to the PBS and working with government, as it continues to make a significant contribution to Australia’s national medicines policy aimed at ensuring that all Australians have timely access to high quality medicines.

If, however, the focus about access to medicines remains on price and the cost of the PBS, Australia will follow the disastrous path of New Zealand. There, access to medicines for patients is neither fair nor equitable: nor do they have access to the latest and best medicines. Patients with cancer are being treated with 20-year-old medicines and only 160 sufferers with MS can get treatment.

A review of the PBS is needed. We must either change the thinking or, if we stay with the present system, the public needs to better understand the process.

If Australians want and need subsidised medicines and they want the latest and the best, then the user-pays system needs to change or the Government will have to provide more funds so Australians can continue to enjoy high quality health care.