Healthy Skepticism Library item: 2180
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
Picard A.
Policy critic likes Rock's prescription
Globe and Mail 2001 Aug 15
Abstract:
Doctor backs adding cost-effectiveness as basis for approving new drugs; firms balk
Full text:
QUEBEC — One of the most persistent critics of Canada’s drug industry says the idea of making cost-effectiveness a basis for approving drugs — as the federal Health Minister proposed this week — is long overdue.
Joel Lexchin, an emergency-room physician at Toronto Western Hospital, said such a system would save money, improve safety and make it easier for doctors to prescribe medication.
“To get a new drug on the market today, all you need to do is show that it’s better than a placebo. As a result, there’s a lot of clutter. The idea of approving drugs based on medical need would be sound and a great improvement,” Dr. Lexchin said in an interview.
Pharmaceutical manufacturers, not surprisingly, are less keen about the plan. Murray Elston, president of Rx &D Canada, said he worries that an additional review will create new barriers to access and treatment. He also took issue with Health Minister Allan Rock’s implication that dubious drugs are routinely entering the marketplace and driving up costs.
“The minister is wrong to suggest that new drugs would not stand up to a fair economic analysis,” Mr. Elston said. “He is also wrong to suggest that lots of drugs have marginal benefits. If you’re that one person in 10 whose life is improved, you don’t consider an innovation to be marginal.”
Mr. Elston said that, instead of looking for ways to limit access to drugs, Mr. Rock should be promoting their efficient use to maximize health and savings.
On Monday, Mr. Rock said governments have to take a “good, hard look at the cost-effectiveness of drugs we are approving,” particularly as drug budgets soar.
Health Canada approves drugs based strictly on their technical merits. This means approval is also given to numerous drugs with similar effects produced by competing companies, and new drugs that offer marginal benefits compared to an existing one but often cost substantially more. Once drugs are approved federally, provinces must decide whether to place them on formularies (lists of preapproved drugs). Only B.C. and Ontario require that manufacturers submit pharmaco-economic studies to demonstrate cost-effectiveness.
Mr. Rock is proposing a committee consisting of consumers, clinicians, health economists and ethicists that systematically reviews new drugs to determine if they are more beneficial and more cost-effective than existing products.
Dr. Lexchin said most new drugs would fail that simple test, and cited research from La Revue Prescrire, a Paris-based medical journal that examined the 2,200 pharmaceutical products approved in France between 1981 and 2000.
It found that only 70 of the drugs were major therapeutic advances, while 350 others were considered an improvement over existing drugs. But the balance were found to be no better, or less safe.
“The vast majority of new drugs do not contribute anything to the therapeutic armamentarium,” Dr. Lexchin said. “They are designed to generate market share and do absolutely nothing but harm from a health-spending perspective.”
He said new drugs are invariably more expensive, and give physicians an unnecessarily large number of choices. Further, because they have not been used extensively, new drugs tend to be less safe, Dr. Lexchin said.
The proposal to alter the drug-approval process to consider cost-effectiveness will be formally discussed at a meeting of health ministers next month in St. John’s.
Spending on prescription drugs has soared almost fivefold in Canada over the past 15 years, according to the Canadian Institute for Health Information. Canadians spend more on prescription drugs, $12.4-billion a year, than they do on physician services, $11.7-billion
