Health Care Priorities Down Under are Upside Down

  • by: |
  • 12/18/2006
Last Friday (12/15) I participated on a joint CHI (California Healthcare Institute)/PRI (Pacific Research Institute) panel called "Evidence, Economics, and Politics: Australia's Experiment in Evidence-Based Medicine."

My fellow panelists included Ruth Lopert (Harkness Fellow in Health Care Policy, George Washington University, and a member of the Pharmaceutical Policy Taskforce, Commonwealth Department of Health and Aging, Canberra, Australia), Marjorie Ginsberg (Executive Director of Sacremento Health Care Decisions), Kwabena O.M. Audbofour, MD (a GP from Stockton, CA), Meryl Comer (journalist and Alzheimer's care giver), and Randy Frankel (VP, Public Affairs, IMS Health).

We used the new IMS report, "Australia’s Centralized Cost-Effectiveness Requirement for Pharmaceuticals: Potential Implications for U.S. Patients" as our point of departure.

Consider the facts and be afraid – very afraid – of the implications.

The IMS study included examination of osteoporosis and Alzheimer’s, where Australians are regularly denied access to medicines available to American patients. According to the new IMS study:

* By 2007, approximately 9.1 million patients in the United States with osteoporosis would be denied access to treatment choices if we adopted the Australian model of cost-based (aka, “evidence-based”) medicine. In Australia, for example, newer medicines for osteoporosis that are not “on the list” for reimbursement may be made available only after a patient suffers a fracture.

* IMS estimates that a 1.6 million Alzheimer’s patients could be impacted if we adopted the same system as Australia. The Aussie guidelines are identical for Aricept (donepezil), Exelon (rivastigmine), and Razadyne (galantamine) – and are highly restrictive compared with US guidelines. Australia also limits coverage of Alzheimer’s medicines to six months of treatment unless the patient shows “significant improvement.” In the US, the decision to continue treatment is based on patient (and care-giver) satisfaction – which includes maintenance of current mental status and prevention of mental decline – quite a difference from “significant improvement.”

Restrictive formularies that deny access to the right drug for the right patient at the right time but pay for more expensive and invasive procedures later on have their priorities upside down.

The IMS report can be found at

CHI will be posting a series of podcasts from the event. When these are available, we will call it to your attention. In the meantime, g'day mate.

Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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