The chief medical expert tasked with advising the Health Service Executive on the cost-benefit of key medicines has questioned the effectiveness of a new cystic fibrosis drug which has been described by some Irish people with CF as life-changing.
Professor Michael Barry, who heads up the National Centre for Pharmacoeconomics (NCPE), said there was "no doubt" that Orkambi worked for some users.
However, while he said that while 50% of users did well in a trial of the drug carried out by its manufacturer, Vertex Pharmaceuticals, the results of a post-use breathing test was close to the cut-off point in terms of its efficacy.
A course of the drug for one year costs €160,000 per patient.
The NCPE is waiting for Vertex to submit a file outlining a case for the State to reimburse the cost of the drug.
Speaking on RTÉ's This Week, Prof Barry he said that the HSE had a good history of making drugs available and he was confident that it would be made available for people who would benefit.
He said one of the challenges facing the HSE was the issue of what other services might be impacted if the HSE committed to providing certain drugs, including Orkambi, to users.
The "whole issue is opportunity cost", he said.
Prof Barry said that additional spending in the HSE's service plan on cancer, mental health and general practice all came to €90m, which he said was around the same as covering the cost of the Orkambi drug for all CF sufferers.
This "crystallises the challenge" in any assessment of Orkambi or other similar medicines, he said.
He also said that prescribing practices in hospitals could be better and there was a need to be more cost conscious in prescribing medicines which were the most expensive, when there was a cheaper alternative available.
He said it was not about over-prescribing but about the quality of prescribing.
