Balancing act: Drugs or surgery

An impending ‘‘tsunami of new drugs'' could financially cripple the Otago District Health Board if it does not develop processes to deal with requests for expensive new medications, chief medical officer Richard Bunton says.

A raft of new medications that were coming on to the market almost daily were not subsidised by the Government's drug-buying agency, Pharmac, Mr Bunton said.

Patients would want drugs that could potentially lengthen their lives or significantly add to their treatment, but the problem was they were ‘‘extraordinarily expensive''.

The cost of some drugs was huge and could go up to as much as $200,000 a year for one patient.

There would be an expectation the health board would pay for new drugs but, in reality, that might not be possible because of funding constraints, Mr Bunton said.

When the board was juggling budgets, spending money on an expensive drug that could give a patient an extra year of life had to be weighed up against doing an extra six heart operations, he said.

‘‘It is a balancing act that is extraordinarily hard to do.''

Constant advances in science and medicine were creating the overwhelming supply of drugs, and many drugs were now available for conditions that ‘‘some years ago'' might not have been treatable, he said.

While it was easy for specialists to prioritise spending within their own departments, it was much more difficult to look at the overall picture, he said.

‘‘It is when you start trading off priorities for eyes, for hearts, for grommets in your ears; that is what is difficult.''

The board needed to develop a process that was ‘‘totally transparent'' for dealing with funding requests for costly drugs, Mr Bunton said.

‘‘We have to try to be fair and equitable in how we distribute our funding . . . because to each of these individual patients it is the most important thing for them.''

The board had to take a proactive approach and needed definitive leadership on the issue, he said.

The Dunedin Hospital's clinical board had received a request for advice on the clinical introduction of a new and costly drug, but it did not feel there was a mechanism in place at the hospital to deal with such requests.

If a process was developed, it would need to incorporate clinical departments, the planning and funding department, and the medicines review committee, which reviews new agents and comments on their clinical effectiveness.

The board's annual budget for pharmaceuticals was more than $11 million this financial year.

In the year ending June 30, the board has already overspent on pharmaceuticals by $962,000.

Some of that overspending had been caused by having more patients than were budgeted for and from non-budgeted high-cost drugs such as Herceptin.

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