Hospitalisations due to the adverse effects of drugs nearly doubled in the Australian state of New South Wales between 2001 and 2014. In 2019, it was estimated that adverse effects were responsible for 250 000 hospital admissions per year in Australia as a whole, and the country made medication safety a national priority. In this context, two academics examined Australia's pharmaceuticals market, analysing the authorisation status, reimbursement status and level of use of the drugs on Prescrire's annual list of drugs to avoid (1).

Of the 93 drugs on Prescrire's 2019 list of drugs to avoid, 57 were authorised in Australia at the time of the analysis, 9 of which were available over the counter (1,2).

As of 2019, 35 of these drugs were eligible for reimbursement through Australia's national drug insurance system, the Pharmaceutical Benefits Scheme. More than half of these drugs were used infrequently, but 16 were in frequent use despite the serious harms they cause. For example, 22% of patients treated for diabetes received a gliptin in 2016; more than 50 000 patients received a drug for Alzheimer's disease in 2014; and in 2017-2018, denosumab became the 8th most costly drug in terms of total government spending. Olmesartan and celecoxib were also frequently used despite their unfavourable harm-benefit balance. And in 2015, duloxetine, citalopram, escitalopram and venlafaxine accounted for almost half of antidepressant use in Australia (1).

Tolcapone is one of the 36 drugs on Prescrire's list of drugs to avoid that is not currently authorised in Australia. This drug, proposed for Parkinson's disease, was withdrawn from the European and Australian market 2 months after its authorisation, and subsequently reauthorised in the European Union but not in Australia. In 2011, Australia's Therapeutic Goods Administration advised against the off-label use of quinine for nocturnal cramps. However, for most of these 36 drugs that are not authorised in Australia, it was not possible to determine whether authorisation was sought and refused by the Australian authorities, or whether authorisation was not sought (1).

The authors of this study urged regulatory and reimbursement authorities to review the status of drugs whose harm-benefit balance is less favourable than that of alternative therapeutic options (1).

References 
1- Vitry A and Mintzes B ""Drugs to avoid" to improve quality use of medicines: how is Australia faring?" J Pharm Policy Pract 2021; online: 9 pages. 
2- "Towards better patient care: drugs to avoid in 2019" Prescrire Int 2019; 28 (203): 108-110.

©Prescrire 1 December 2023

Source: "Drugs to avoid: an analysis of Australia's pharmaceuticals market" Prescrire Int 2023; 32 (254): 306. Free.

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