Dialogue: Pharmac's main concern is to get value for money

Claims that new drug treatments delay the progression of dementia have yet to be backed by scientific evidence, writes Pharmac chief executive WAYNE McNEE.

Dementia is indeed a terrible disease. Pharmac, the Government's drug-buying agency, understands the pain and suffering of people afflicted with the disease and their carers.

But despite Pamela Melding's enthusiasm for new drug treatments in a Dialogue article, the drugs available do not provide the magic bullets to take away that pain.

Pharmac has reviewed these drugs extensively. Our independent medical advisory committee concluded that the medical evidence for these drugs was not strong enough to show there were real benefits for patients.

John Hedley, the chairman of the committee, says the benefits are just not significant enough to warrant a taxpayer subsidy.

Hard scientific data shows a lack of evidence that the drugs give substantial benefit to people with dementia.

These drugs are expensive. About 30,000 New Zealanders suffer from dementia and the drug costs $2000 a year. That does not add up to $6 million, as Pamela Melding says. It is $60 million, and that is a lot of money to spend on a drug that has, at best, a limited benefit.

Claims from individual patients that the drug has worked for them are not enough on which to base our decisions. What we need is scientific evidence which to date we have not seen. That said, Pharmac is more than happy to review any new evidence that comes to light.

It is true there is research looking at the benefits of these drugs. But the problem with them is the lack of long-term studies. The duration of the benefits from them rely on studies carried over just six and 12 months. This makes it difficult to know with any certainty the real benefits - for patients, caregivers and funders - beyond the first 12 months of treatment.

This information is vital to forming a view on the true cost to New Zealand of funding this treatment.

Contrast this with studies looking at the benefits of cholesterol-lowering statins drugs which ran over five years. It shows that Pamela Melding's disparagement of statins is a red herring.

There is strong evidence that they are, indeed, cost-effective, and it has been our goal to get them prescribed for all those people who need them.

Pharmac is charged with looking at the widest health issues. After all, it would not be sensible for us to worry only about funding drugs if that put pressure on other parts of the health sector. But so far we have not seen any evidence that would convince us that wider use of treatments for Alzheimers would save us money in residential care.

In an ideal world we would probably fund drugs in the hope that they might have benefits. However, with a limited budget we just do not have this sort of luxury.

Pharmac understands individual patient groups want their particular drugs to be a priority for funding. But we have to consider the health needs of all New Zealanders.

It is also important to realise that the drug budget is limited and there is an obligation to make sure taxpayer money is spent wisely.

Pharmac has developed a fair and robust system to ensure that every drug put up for subsidy is treated in exactly the same way. We are not swayed by arguments that the old or the young, or cancer patients or Aids patients or asthma patients or any other groups should have more money spent on them.

What we need to see is research that shows that the drug in question offers a cost-effective treatment compared with other health funding options.

Last month, New Zealand suffered an onslaught of overseas experts who were paid to come here to convince us that we must subsidise these treatments for Alzheimers disease. There will be others coming, too, no doubt to talk about other treatments, and we just cannot give in to such campaigns.

Obviously drug companies want their products subsidised because it is worth a lot of money to them. Lobby groups often feel that the sufferers of their disease have a right to taxpayer money.

Through all of that, Pharmac will continue to do its job, to get the very last cent of value out of the pharmaceutical budget.