The Cost Of Living

Tuesday 15 May 2012 17.39
The Cost Of Living

Eithne O'Brien blogs ahead of her report tonight on the cost to the State of life-saving drugs and who gets what:

Every day, more and more drugs are being brought to the market that offer great hope for patients; hope of a cure, hope of a longer, healthier life. But these drugs come at a cost. The price of drugs are going up but healthcare spending is going down, so how do we choose what drugs to pay for and what patients should have them? Last month, the issue came to the fore when a number of melanoma patients contacted RTÉ's Liveline to express concern that a new drug for advanced melanoma called Ipilimumab, or Ippi - as it is known, would not be made available to patients.

The decision about the cost-effectiveness of new drugs is made by the National Centre for Pharmacoeconomics and they recommend to the HSE whether these new drugs should be made available or not. Up until recently, a drug that extended the value of life by a year at a cost of €30,000-€45,000 was considered good value for money but, in a bid to reduce costs, a figure of €20,000 is also being presented to the HSE . When the NCPE looked at Ipilimumab, they decided that at a cost of €85,000 per patient and an average survival rate of an extra 3 months, it was not good value for money.

But oncologists like Prof John Crown say that this is a crude measurement as a drug like Ippi can have a spectacular effect on a small number of patients and so the cost is worth it, if it means a major prolongation of some patients lives. Martin Mc Mahon is one of those patients and he is hoping that Ippi will give him that chance of life that he needs. When he heard that Ippi was not available to him he contacted the Liveline programme and pleaded his case. The result saw an extensive media campaign and Ippi was approved for use for melanoma patients.
But health economists like Prof. Charles Normand believe that decisions like these will mean that other patients will lose out as there is only so much money to go around. This year the HSE want to cut €112 million from their drugs budget, so hard choices must be made.

Doctors like Prof Orla Hardiman are also concerned that even when drugs are deemed good value for money by the NCPE, the HSE (who have the final say) are not making drugs available to patients because of funding problems. One example of this is the MS drug Gilenya. Thirty year old Karen O’Shea has had MS for five years, but the drug she was on was causing her terrible side effects. Her doctor recommended Gilenya but she can’t get it. She is now without any medication for her condition.

So with less resources to go around how can we make choices that are fair to everybody? Prof Hardiman argues that we need a transparent system rather than a system that sees the most tragic diseases with the greatest advocates get an unfair proportion of the funding. Prof. Crown argues that diseases like Cancer should not face the same harsh economics assessments as other medical costs. As the HSE comes under more pressure to manage diminishing resources, tough choices will be made and patients could get caught in the crossfire.
Eithne O'Brien
Prime Time, RTÉ 1, 21:35