The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.
Letter to the Editor
Editor, – We read with interest the editorial 'Can we deny patients expensive drugs?' (Aust Prescr 2006;29:146-8). We agree with many of the author's arguments, but take exception to the suggestion that Pharmaceutical Benefits Advisory Committee (PBAC) processes be bypassed for drugs targeting rare diseases and for which no PBAC submission has been made. The authors suggest that in such cases the Pharmaceutical Benefits Scheme (PBS) 'subsidise the use of these medicines for an indication after conventional therapies have proven ineffective'. We infer that such medicine be subsidised irrespective of costs. This implies society is willing to accept a higher cost per unit of health (for example a year of life) on the basis that the disease is rare. Some things need to be clarified; rare does not mean severe and expensive does not mean better. We acknowledge that efficiency should not be the only criteria in resource allocation decisions and that equity considerations need to be taken into account also. However, the fact that a person has a rare, as opposed to a common, condition is not a good moral basis for accepting higher opportunity costs. Such a system would send all the wrong signals to the research and development community. Locally, pharmaceutical companies would stop applying for PBS funding for drugs that target rare diseases. On a global level, such a system signals our willingness to pay infinite amounts for uncertain benefits for rare conditions, at a time when we want more research and development in areas where we can make substantial gains in reducing the health burden.
Kees van Gool
Research Officers, Centre for Health Economics and Research Evaluation
University of Technology