Both EpiPen formulations were recommended for listing on the basis of acceptable cost-effectiveness overall, although the estimates of incremental cost-effectiveness were both high and uncertain. The PBAC therefore recommended a rigorous Pharmaceutical Benefits Scheme (PBS) listing that would prevent use in those instances where cost-effectiveness had not been demonstrated.
To maximise the cost-effective use of the products, the PBAC sought to minimise the number discarded due to the short expiry date by limiting the number of auto-injectors that can be prescribed. Consequently, it recommended that the maximum quantity be limited to one auto-injector for adults and two auto-injectors for patients under 17 years of age, and that no repeats apply.
Data presented to the PBAC indicated that listing with these restrictions would meet the clinical needs of most patients given that on average, the number of auto-injectors required per patient per year (as a replacement for either a used or an expired auto-injector) would be covered by one prescription.
With respect to the short expiry date, I have been advised by the manufacturer that most auto-injectors will expire around 12 months after being dispensed, but it is actively pursuing ways of extending the expiry dates.
