Health advisers urge speedier approvals

Annette King

The system for approving new health technology needs to be rationalised and sped up, say advisers to Health Minister Annette King.

The National Health Committee's report, published last night, did not cover drug-funder Pharmac, because that agency already had explicit decision-making processes, said committee spokesman Geoff Fougere.

But one of the issues that emerged during research for the report was unequal access across the country to "drug-eluting stents", used in heart-artery treatment.

Small mesh metal stents are used to keep previously narrowed heart arteries fully open. They are inserted at the groin through an artery using a narrow tube and expanded in a heart artery by a tiny balloon, which is then removed.

Healing tissue can re-grow into the coil, re-narrowing the artery. This can be avoided by using a stent coated in a medicine to inhibit it.

Plain stents cost $600 to $800; the drug-eluting ones about $3000.

Arteries re-narrow in about 30 per cent of plain-stent recipients, compared with about 5 per cent of those given the medicine-coated ones.

An Auckland City Hospital interventional cardiologist, Dr Mark Webster, said patients' access to drug-eluting stents varied nationwide. Public hospitals were funded only for the plain stents and had to pay for the medicine-coated ones from savings in other areas.

He knew of some hospitals where their use sometimes stopped because money for them ran out.

"It's a very bad system. It's been a frustrating time trying to achieve any national policy. We've been pushing very hard for that for a very long time."

In Australia, 40 per cent of patients having the stent procedure, called angioplasty, were given a medicine-coated one, compared with an estimated 15 to 20 per cent here, Dr Webster said.

The evidence that they reduced the number of patients needing to have repeat angioplasty was solid.

Mr Fougere said the decision-making about the introduction of drug-eluting stents lacked uniformity round the country.

It was symptomatic of procedures that needed to change.

When one district health board decided to introduce a treatment, pressure immediately built on the rest to follow suit, he said.

Ms King said finite health dollars must be spent as effectively as possible and decisions needed to be based on the best evidence available.

They must not be based on "someone's pet project, and certainly not on guesswork, presumption, or the political flavour of the moment".