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| Journal of the New Zealand Medical Association,
12-September-2003, Vol 116 No 1181
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Direct-to-consumer advertising – yes it can compromise
patient health
Barrie Saunders has recently written in the Journal about
direct-to-consumer advertising (DTCA).1,2 Space
precludes us debating the benefits and risks of DTCA. However, we do wish to
rectify omissions and misrepresentations about PHARMAC.
When PHARMAC wrote to Mr Saunders it said that there is good
evidence that DTCA leads prescribers to switch to new and more expensive
medicines that in many cases offer no real benefit for patients, eg, fluticasone
(from beclomethasone (BDP)) and proton pump inhibitors (from H2 antagonists).
Accompanying material explained the many ways that DTCA creates fiscal risk on
the limited government pharmaceutical budget, including increased demand for
PHARMAC to subsidise medicines that are advertised. A copy of the letter and
accompanying material sent to Mr Saunders is available on the PHARMAC website,
www.pharmac.govt.nz.
Mr Saunders also understates how
PHARMAC manages financial risks through not funding poor investments, alongside
demand-side activities, where both are based on assessment of costs and
benefits.3 DTCA-promoted medicines are
typically more expensive for little additional benefit. These include both
products that PHARMAC has not funded (for that reason), or funded products, such
as in the Flixotide switch campaign (when existing BDP is no less
effective).4 PHARMAC does not have an
‘iron grip’ over availability and
costs,2 as the effects of the recent Flixotide
DTCA campaign show.
We estimate that the 2002 Flixotide DTCA campaign caused 139
800 person-months of switching to fluticasone at the very least, costing more
than $900 000 extra compared with BDP (less costly but equally effective). This
public money is no longer available to DHBs. It would, for instance, fund 43
coronary artery bypass graft operations. Or it would gain 202 quality-adjusted
years of life (QALYs), along with saving $254 000 in other DHB costs, if
invested in other priority pharmaceutical areas. These are health improvements
that DHBs cannot access because money had to be spent funding patients who
switched from BDP to Flixotide directly because of DTCA.
We agree that there is a case for improving the uptake of
statins for those with proven cardiovascular
disease.5 PHARMAC is actively promoting
improved lifestyle and access to medicines where
appropriate,6 with its ‘One heart, many
lives’ campaign. But most statins are cost
effective.7 Most pharmaceutical products
promoted by DTCA may not be.
Finally, Mr Saunders needs to declare his conflicts of
interest here, including funding he receives from the pharmaceutical
industry.
Scott
Metcalfe
Wellington Wayne McNee, Peter
Moodie
PHARMAC, Wellington Conflicts of
interest: Wayne McNee is Chief Executive, Peter Moodie is Medical
Director, and Scott Metcalfe (public health physician) is externally contracted
to the New Zealand Pharmaceutical Management Agency (PHARMAC). PHARMAC is the
crown entity responsible for funding community medicines, on behalf of district
health boards. PHARMAC is currently involved in litigation with GlaxoSmithKline
relating to the 2002 advertising campaign for Flixotide.
References:
Editor’s commentAn editorial decision was taken not
to include specific conflict of interest statements with the articles relating
to direct-to-consumer advertising published in the previous issue of the
Journal, as the authors’ interests were felt to be self evident. All
authors clearly stated the extent of their personal involvement in the DTCA
debate within the text of their articles.
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