How does the operation of PHARMAC's 'Community Exceptional ...

analysis is simply an analysis of cost and tries to measure out a
useful gain of using one medicine against another, or against other
things. (Interviewee G)
‘G’ felt this approach unfair because in almost all of the NZORD cases where
cost-utility analysis has been used there were no appropriate alternatives to
compare the claimant’s application. Therefore, there was no rational basis to
compare equivalent costs. This meant that the Exceptional Circumstances
Panel had only gross figures of the cost of medicines which appeared to them
to be far too high. The other concern ‘G’ expressed was the narrow range of
information which went into a cost-utility analysis. The costs to the patient and
the family were not considered and ‘G’ believes they should have been.
‘G’ was concerned at the apparent high weighting given to the cost-utility
analysis compared to the eight other decision making criteria. ‘G’ stated that
because there was no way of knowing exactly how the decisions on the criteria
are weighted by PHARMAC, this caused inconsistency and suspicion.
According to ‘G’, other values were as important, if not more important than the
cost-utility analysis.
Well, like I said I think cost-utility analysis is a useful tool, but it
cannot completely replace or over-ride other things that really matter
for example…ethics matter, values matter, cost to the patient
matters, community attitudes and values also matter. These are not
considered in a cost-utility analysis and I think they are just as
important in deciding what to fund. The problem is these things are
not easy to agree between people on their relative importance.
(Interviewee G)
‘G’ referred to NZORD advocacy for a man who had a rare form of brain cancer
who applied for a Community Exceptional Circumstances subsidy for a drug to
give him greater quality of life. PHARMAC denied the application because the
cost-utility analysis showed the cost to be above the allowable maximum. The
man died. The public, politicians and the media continued to pressure
PHARMAC who then acquiesced and a short time after the man died, they
began funding the drug.
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