Famprya – a casualty of the inequity in Health Spending?

[Speaking in the Seanad during Statements on Availability of Certain Medication]

The Minister is very familiar with the whole concept of health economics. I do not believe for one second that medicine can be practised in an economic vacuum. I understand that every decision made about a patient has an opportunity cost for another patient who may benefit from a treatment which is denied them because the money was spent on the first patient. It is a question of prioritising and common sense.

On the efficacy of the drug in question, there seems to be a suggestion that because a majority of patients do not benefit from it, it does not work. That would be an extraordinarily high bar to set for any treatment for heart disease, stroke, diabetes, high blood pressure or cancer. In all of these conditions, there is an improvement in outcome when a treatment is given. It may not apply to every patient; it may apply incrementally to some more than it does to others.

The data published by the European Medicines Agency, EMA, the independent agency which is the European equivalent of the US Food and Drug Administration, showed that in two large randomised trials, the percentage of patients who benefitted from Fampyra rose from 8% in the control group to 45% in the treatment group and, in the second study, from 9% to 43%. In oncology, we would be cracking open the champagne if we saw differences that large. I suppose we all look for small victories in our different areas.

For a variety of reasons, the drug has been generally available to MS sufferers. That availability is now compromised and the State is not picking up the tab. We know some benefit from it while others do not. Can I suggest that we do something novel and mould-breaking with this matter, something which is being looked at in other areas, particularly in cancer treatment, namely adaptive reimbursement? This involves essentially those who have benefited from the drug getting the €3,000 per annum for it. I do not want the Minister to take this personally but, several years ago, we had a debate in a different context where it was pointed out that the salary of the public relations adviser for the then Minister for Health would have paid for the drug for 50 patients for a year.

When it comes to prioritising spending on health care, some items are analysed on the basis of cost per year of lives saved, cost per quality-adjusted life year, incremental cost-effectiveness ratio and so forth. This is the argot used routinely in health economics. It is awfully easy to apply it selectively to drugs and not to other matters in the care of patients. Should we not apply the same criteria to whether a public relations department is necessary, whether a management consultant is required or how many of the 11% extra grade 8 officials who were appointed between last year and this year are justified? How many years of life are saved from appointing those extra folk? Their jobs are probably very necessary and I am sure they work hard, but these are the same types of criteria. There should be an even playing field across the different areas of health spending for this.

With regard to quoting British figures, one of my patients, who shall remain nameless, tweeted today to announce it was his seventh cancer-versary. It is the seventh year since he was diagnosed with an incurable kidney cancer. This man has been kept alive for the last seven years through a variety of treatments, not one of which is available in the United Kingdom’s National Health Service. We should not necessarily lower the bar so low as to look at how the British approve drugs for different common diseases. They are the worst in the world. It is widely recognised. The Karolinska study carried out several years ago showed that they have the worst outcomes, certainly in cancer, and these were closely correlated with poor access to cancer drugs. If one speaks to nephrologists, cardiologists, blood pressure experts or experts in any area, they will say that, in general, once one accesses the system into diagnosis, British outcomes tend to be not that great, especially if high tech interventions or medications are necessary.

In the case of this drug, it is not a humane decision to deny it to people who are already benefitting from it. I am not saying the Minister is inhumane, but the decision to take it from people who have had the drug is inhumane. Second, it is bad medicine. It is something that works in a group of people who have had the ultimate biological test. They took it and some got better and some got worse. Those who got better should continue to have access to it. Also, it is bad economics. People who are more immobile and more dependent are people who will cost more money in the long term.

Finally, I did rounds in St. Vincent’s University Hospital this morning and I had to visit the emergency department. The Minister should know that all 35 of the bays or cubicles were occupied. There were 40 additional patients in the unit. There was a total of 75 people in the emergency department today, 40 of whom were not in designated places but in various corridors. It was an appalling scene.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: