Heart patients feel Pharmac cuts

By MARTIN JOHNSTON health reporter

About 2800 people suffered side-effects from having to change their blood-pressure pills after Pharmac did a controversial price-cutting deal with a drug supplier.

The 1998 deal was attacked by some doctors who believed it put their patients at risk. It restricted the maximum subsidy to just two brands of Ace (angiotensin converting enzyme) inhibitors.

But Professor Murray Tilyard, of the Dunedin Medical School, said yesterday that the change, which was about rationing healthcare, was worthwhile as it was saving $150 million over five years and had very little clinical effect on average.

About 76,000 blood-pressure patients changed their Ace inhibitor medication, and 58,000 of them visited their doctor for a follow-up consultation, at which some made further changes to their medication.

Average blood-pressure levels were virtually the same in the "before" and "after" groups, he said, although some individuals would have done worse or better than the mean.

About 2800 patients reported suffering "adverse events," which was relatively few, said Professor Tilyard, who headed Pharmac-funded research into the effects of the change.

The findings were made public yesterday at the College of General Practitioners' conference.

When asked if severe side-effects in any patients had been linked to the change, Professor Tilyard said: "We were notified of one possible hospitalisation but that was all."

His researchers had been told of 13 deaths among patients who had switched medication, but none was related to it.

Cancer caused four of the deaths, vehicle accidents two, a burst blood vessel one, heart attacks three and strokes three.

The oldest patient among the reported deaths was 95.

Medical Association chairwoman Dr Pippa MacKay questioned the study, saying its research data was unreliable.

The information was obtained from patients when they went to a doctor to be assessed for a change in medication. The Government subsidised two visits.

Dr MacKay said doctors had objected to the way the change was handled.

"I suspect, anecdotally, doctors weren't all that careful about the numbers taken down [for the research]."

She said the policy change by Pharmac was a huge, uncontrolled clinical trial.

Pharmac general manager Wayne McNee said the money saved from the change allowed more spending in other health areas, such as widening access to drugs to lower cholesterol.

Greenlane Hospital cardiologist Dr Mark Webster said last night that medical debate over whether all Ace inhibitors were as good as each other was unresolved.