Penny Wise and Pound Foolish?
The idea of universal health care - coverage for every American man, woman, and child - probably sounds pretty appealing to many people living with diabetes. No more out-of-pocket expenses and deductibles, and the uninsured would get the treatment they need. As we often hear, other countries have been doing it for years, and they're the model of efficiency....or are they?
A recent UK decision highlights one of the problems with universal coverage, and interestingly enough, it isn't that different from an issue faced by Americans under many managed care programs - cost pressures that deny life-enhancing drugs. The National Institute for Health and Clinical Excellence (NICE) has recommended that Exubera inhaled insulin not be prescribed by national health care physicians for the treatment of type 1 or type 2 diabetes. The reason? The hefty pricetag.
Exubera, which already has regulatory approval in the UK and throughout Europe, is predicted to cost £1,100 per person per year (about $1,763) - and that doesn't include the cost of injected insulin that type 1 patients will have to continue to take. The UK has had government-run, universal healthcare coverage since the formation of the National Health Service (NHS) in 1948. NICE is the branch of the NHS charged with the task of determing which medical technologies and treatments should be adapted based on their clinical and cost effectiveness. Although NICE acknowledged that published clinical trials of patients taking the drug have reported a high degree of patient statisfaction and improved quality of life, deputy chief executive Andrea Sutcliffe told the BBC: "Our review of the evidence indicated that inhaled insulin should not be recommended because it could not be proven to be more clinically or cost effective than existing treatments."
She added: "The clinical experts we asked advised us that using injected insulin is not usually a concern for the majority of people with diabetes." We wonder if they asked any 'patient experts' how they felt about the topic.
It will be interesting to see how high U.S. managed care organizations set the bar for coverage of the drug once Pfizer announces retail pricing for the product and releases it to the marketplace this summer.
The NHS is taking public comment on NICE's preliminary decision until May 10, and will issue final guidelines later that month.
Comments
- At 05:50 PM on Wed, Apr 19, 2006 Kaci wrote:
I am on insulin and wondered how effective the inhaler would be. I know a customer trying the inhaler and hasn't had the greatest blood sugars while on it which is what I foresaw. It just seems our bodies mesh with insulin as it is what we are missing rather than a drug through the air. I'm currently on the pump and it works like a charm as it interacts closer to a human pancreas. I am aware of the studies for pancreas transplants. I believe we are getting closer to a cure for diabetes, however, as a patient expert I am just leary about the inhaler.
Drugs that are not worth the cost will always be dropped from a health care program, just as they are dropped by the plans. In the case of inhaled insulin, a country with universal coverage is better served by looking to the future and prevention of diabetes with more nutrition education and regulation of food products to enhance the health of their popoulation rather than purchasing the more expensive drugs that are not any better than the old ones.