Abstract
BackgroundSubsidised access to high-cost medicines in Australia is restricted under national programs (the Pharmaceutical Benefits Scheme, PBS, and the Repatriation Pharmaceutical Benefits Scheme, RPBS) with a view to achieving cost-effective use. The aim of this study was to examine the use and associated government cost of biological agents for treating rheumatoid arthritis over the first two years of subsidy, and to compare these data to the predicted outcomes.MethodsNational prescription and expenditure data for the biologicals, etanercept, infliximab, adalimumab, and anakinra were collected and analysed for the period August 2003 to July 2005. Dispensing data on biologicals sorted by the metropolitan, rural and remote zones and by prescriber major specialty were also examined.ResultsA total of 27,970 prescriptions for biologicals was reimbursed. The government expenditure was A$53.1 million, representing only 19% of that expected. Almost all prescriptions were reimbursed by the PBS (98%, A$52 million) and the remainder by the RPBS. Approximately 62% of the prescriptions were for concessional patients (A$32.9 million). There was considerable variability in the use of biologicals across Australian states and territories, usage roughly correlating with the per capita adjusted number of rheumatologists. The total number of prescriptions continued to increase over the study period. Etanercept was the most highly prescribed agent (74% by number of prescriptions), although its use was beginning to plateau. Use of adalimumab increased steadily. Use of infliximab and anakinra was considerably lower. The resultant health outcomes for individual patients are unknown. Prescribers from capital cities and other metropolitan centres provided a majority of prescriptions of biologicals (89%).ConclusionThe overall uptake of biologicals for treating rheumatoid arthritis over the first two years of PBS subsidy was considerably lower than expected. Long-term safety concerns and the expanded clinical uses of these drugs emphasise the need for evaluation. It is essential that there is comprehensive, ongoing analysis of utilisation data, associated expenditure and, importantly, patient outcomes in order to enhance accountability, efficiency and equity of policies that allocate substantial resources to subsidising national access to high-cost medicines.
Highlights
Subsidised access to high-cost medicines in Australia is restricted under national programs with a view to achieving cost-effective use
The fiscal sustainability of the Pharmaceutical Benefits Scheme (PBS) has been under intense scrutiny by federal health and financial public policy makers in recent years because government outlays on subsidised prescription medicines have continued to increase at a rate greater than other areas of health care [3]
This study was a retrospective analysis of data on the national utilisation and expenditure for etanercept, infliximab, adalimumab, and anakinra under the PBS and Repatriation Pharmaceutical Benefits Scheme (RPBS) for the period August 2003 to July 2005
Summary
Subsidised access to high-cost medicines in Australia is restricted under national programs (the Pharmaceutical Benefits Scheme, PBS, and the Repatriation Pharmaceutical Benefits Scheme, RPBS) with a view to achieving cost-effective use. The fiscal sustainability of the PBS has been under intense scrutiny by federal health and financial public policy makers in recent years because government outlays on subsidised prescription medicines have continued to increase at a rate greater than other areas of health care [3]. In part, this disproportionate expenditure reflects the cost of the new biotechnologyderived drugs. Careful examination of the recent developments in targeting access to high-cost medicines in Australia is instructive in informing the debate concerning the principles and processes that might underpin appropriate and ethical access to expensive medicines under the PBS or similar reimbursement systems
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.