english.prescrire.org > Positions > Access to healthcare > Resource allocation

Theme: Access to healthcare

Providing quality healthcare for all is one of the most pressing challenges facing every nation on earth today. The need to reconcile quality of care with availability concerns citizens, policy makers, regulators and healthcare professionals alike.

Resource allocation

It is increasingly urgent that the "competent" authorities who allocate public resources do the work for which citizens and people covered by insurance pay them, without giving in to industry pressure.

Reading Prescrire's "New Products" section, it is easy to come to the conclusion that many new drugs are overpriced, in view of the limited improvements they provide in terms of patient care.

This is the case with yet another "anti-cancer drug": panitumumab. It was approved for treatment of certain advanced colorectal cancers. The main clinical trial showed that 2 months' treatment prolongs survival by only about 5 days without the worsening of cancer. But at a cost of 3500 euros per month.

Dexrazoxane, an existing drug, has now been approved for anthracycline extravasation. For superficial extravasations, a local treatment, dimethylsulfoxide, has long been available, at a cost of a few dozens euros. There is no evidence that dexrazoxane is more effective. Where we would expect to see the most benefit from injectable dexrazoxane, extravasations involving a deep vein, the clinical evaluation includes... just one case! The cost per treatment: about 2000 euros.

This is even more extreme than is the case with many new cancer drugs.

Take pioglitazone, for example: France's Transparency Committee (which assesses the medical benefits of new drugs and provides advice concerning drug reimbursement) stated in 2008, after years of delay, that the drug did not provide a therapeutic advance for diabetic patients. But the price remains more than double that of metformin, a drug that has a demonstrated benefit in terms of mortality. And so on.

It is increasingly urgent that the "competent" authorities (national governments?) who allocate public resources do the work for which citizens and people covered by insurance pay them, without giving in to industry pressure.

©Prescrire 2008

Source: "Allocation de ressources" Rev Prescrire 2008; 28 (301): 805.