Public campaigns for drugs to treat conditions such as cancer are likely to be more common in the future, according to the head of the National Centre for Pharmacoeconomics.
The centre's Clinical Director, Dr Michael Barry, says that the cost of medical treatments is going up at a time when the Health Service Executive's budget for such drugs is diminishing.
Dr Barry said that the previous threshold for calculating what new medicines would qualify under community schemes was reassessed in 2009.
In 2009, expenditure reached over €5bn, a five-fold increase from 1999.
"We did have a threshold of €45,000 per quality adjusted life year," Dr Barry said.
"That was an assessment of whether an agent would be cost effective or not. If it was below that we would say yes, if it was above often we would say no.
"At that stage that threshold was higher than some other European countries, including Portugal and Spain.
"For our decision makers in the HSE it was reasonable to ask what the cost effectiveness be of a lower threshold.
"So from 2009 we have been providing information as to both thresholds really, €45,000 and €20,000."
Dr Barry said the controversy over access to expensive treatments, such as the recent campaign over access to Ipilimumab, a treatment for melanoma, are likely to re-occur.
He identified two treatments that are currently being assessed that may prove contentious, including one for prostate cancer and one for cystic fibrosis.
"I was at a meeting on Friday in relation to a new drug called Ivacaftor for cystic fibrosis. Now this will come with a price tag - there's no fixed price yet - but I think it would be above €300,000 per patient per year, and we suspect we would have 120 eligible patients at least. So you can work it out for yourself, but this will come with a very handsome price tag of €35m plus."
Dr Barry said that different mechanisms to achieve value for money need to be explored, including performance-based risk-sharing schemes.
The director said: ''Supposing we would say, for argument, that the HSE would pay for 50% of the drug; the industry would pay for 50%. If the patient didn't respond, the company would reimburse the HSE the 50%.
"We would be getting to a situation where we would pay for people who responded to the drug, and we wouldn't pay for people who didn't respond. I think probably that is the way we will go down for the really expensive drugs."
