Recent developments in targeting access to high cost medicines in Australia
Tóm tắt
In Australia, the Pharmaceutical Benefits Scheme (PBS) has developed a set of arrangements to control access to high-cost medicines to ensure their use is cost-effective. These medicines include the tumour necrosis factor-alpha inhibitors (TNFIs) for the treatment of rheumatoid arthritis. The aim of this first phase of a qualitative study was to explore basic views on the restricted access to TNFIs in order to confirm where further investigation should take place in the next phase. Semi-structured interviews were conducted in 2004 with a member of the four relevant stakeholder groups. Participants were asked their opinions about features of the establishment, process and effects of the system of restricted access to TNFIs. Views on the collaboration between stakeholder groups in the decision-making process were also collected. The principle of 'controlled access' to TNFIs was supported in general. There were concerns regarding some of the specific eligibility criteria. Wider and more transparent stakeholder consultation was judged desirable. Some flexibility around prescribing of TNFIs by physicians, and regular review of the arrangements were proposed. These themes will inform the next phase of the study. This first phase highlighted a range of issues associated with the PBS arrangements restricting access to TNFIs. Timely review and report of issues and concerns associated with such policy developments that arose in practice are essential. There is a need for a more comprehensive exploration across a wide range of stakeholders with different perspectives that will in turn be helpful in guiding policy and practice around national arrangements to manage access to high-cost medicines.
Tài liệu tham khảo
Organisation for Economic Co-operation and Development (OECD): OECD Health Data: Statistics and indicator for 30 countries. 2005
Commonwealth Department of Health and Aged Care: The Australian health care system: an outline. Canberra. 2000
Sansom L: The subsidy of pharmaceuticals in Australia: processes and challenges. Australian Health Review. 2004, 28: 194-205.
Henry D: Economic analysis as an aid to subsidisation decisions: the development of Australian guidelines for pharmaceuticals. Pharmacoeconomics. 1992, 1: 54-67.
Productivity Commission: International pharmaceutical price differences: research report. 2001, Canberra: AusInfo
Sansom L: The Australian National Medicinal Drug Policy. Journal of Quality Clinical Practice. 1999, 19: 31-35. 10.1046/j.1440-1762.1999.00291.x.
Australian Institute of Health and Welfare (AIHW): Health expenditure in Australia 2002–03. AIHW Cat No HWE 27 (Health and Welfare Expenditure Series No 20). 2004, Canberra: AIHW
Symmons DP, Silman AJ: Anti-tumor necrosis factor alpha therapy and the risk of lymphoma in rheumatoid arthritis: no clear answer. Arthritis & Rheumatism. 2004, 50: 1703-1706. 10.1002/art.20312.
Fleischmann RM, Iqbal I, Stern RL: Considerations with the use of biological therapy in the treatment of rheumatoid arthritis. Expert Opinion on Drug Safety. 2004, 3: 391-403. 10.1517/14740338.3.5.391.
Lu CY, Williams K, Day R, March L, Sansom L, Bertouch J: Access to high cost drugs in Australia: Risk sharing scheme may set a new paradigm. BMJ. 2004, 329: 415-416. 10.1136/bmj.329.7463.415.
Commonwealth Department of Health and Ageing: Schedule of Pharmaceutical Benefits for Approved Pharmacists and Medical Practitioners (1 April 2005). [http://www1.health.gov.au/pbs/]
Vuorenkoski L, Toiviainen H, Hemminki E: Drug reimbursement in Finland – a case of explicit prioritising in special categories. Health Policy. 2003, 66: 169-177. 10.1016/S0168-8510(03)00042-3.
Singer PA, Martin DK, Giacomini M, Purdy L: Priority setting for new technologies in medicine: qualitative case study. BMJ. 2000, 321: 1316-1319. 10.1136/bmj.321.7272.1316.
Wirtz V, Cribb A, Barber N: Reimbursement decisions in health policy – extending our understanding of the elements of decision-making. Health Policy. 2005, 73: 330-338. 10.1016/j.healthpol.2004.12.002.
Australian Government, The National Health (Pharmaceutical Benefits) Regulations 1960 (made under The National Health Act 1953). [http://www.comlaw.gov.au/]
Medicare Australia. [http://www.medicareaustralia.gov.au/]
Wiseman V, Mooney G, Berry G, Tang KC: Involving the general public in priority setting: experiences from Australia. Social Science & Medicine. 2003, 56: 1001-1012. 10.1016/S0277-9536(02)00091-6.
Cayton H: Patient and public involvement. Journal of Health Services Research & Policy. 2004, 9: 193-194.
Florin D, Dixon J: Public involvement in health care. BMJ. 2004, 328: 159-161. 10.1136/bmj.328.7432.159.
Lu CY, Williams KM, March L, Bertouch JV, Day RO: Subsidised access to TNF-alpha inhibitors: is the rationale for exclusion of rheumatoid factor negative patients defensible?. Medical Journal of Australia. 2004, 181: 457-458.
Mann EL: Subsidised access to TNF-alpha inhibitors: is the rationale for exclusion of rheumatoid factor negative patients defensible?. Medical Journal of Australia. 2005, 182: 47-48.
Commonwealth Department of Health and Ageing: Recommendations made by the Pharmaceutical Benefits Advisory Committee in March 2005. [http://www.health.gov.au/internet/wcms/publishing.nsf/Content/pbacrec-pbacrecmar05]
Weekes LM, Mackson JM, Fitzgerald M, Phillips SR: National prescribing service: creating an implementation arm for national medicines policy. British Journal of Clinical Pharmacolology. 2005, 59: 113-116.