Sir, – Drug reimbursement decisions must be made in the interests of all patients in Ireland. This important perspective was absent from a recent article in these pages (“There is a treatment and she’s not getting it’: Calls for HSE to fund drug for rare disease”, Health, March 31st).
The patient who shared her story in Tuesday’s article deserves sympathy and support. We would all, in her or her family’s situation, fight for access to every treatment out there.
However, the rationale for the drug assessment process in Ireland requires clarification. The HSE now spends approximately €3.2 billion on pharmaceuticals, representing around 13 per cent of the total healthcare budget.
Each euro spent on a new pharmaceutical is a euro that cannot be spent on other healthcare. Therefore, the HSE must determine whether the funding of a new drug will provide more health gain than the health that would have been gained from spending that money on other programmes of care.
Many understand “cost-effectiveness” to refer to a purely budgetary consideration, but cost-effectiveness is, in essence, all about health. It is an assessment of whether adopting a new medicine would represent a net benefit or net harm to population health given the healthcare that we must be sacrificing elsewhere in the system.
The drug in question (omaveloxolone, brand name Skyclarys) exhibited modest and highly uncertain health improvement compared to placebo in clinical trials.
Yet the company was seeking over €280,000 per patient per year. The NCPE assessment of the drug concluded there was a zero per cent chance of it being cost-effective. The only way to make such a drug net health enhancing is for the company to lower the price.
Health budget allocation decisions are unavoidable. It is right that we make them in a way that is consistent, equitable, evidence-based and for the benefit of all patients in Ireland. – Yours, etc,
DR RONAN MAHON,
Discipline of Economics,
University of Galway.