Readers are invited to write in with their questions about decisions of the Pharmaceutical Benefits Advisory Committee (PBAC). Australian Prescriber publishes selected questions from readers, together with answers from the PBAC. Questions may address issues such as regulatory decisions, pharmaceutical benefits listings and withdrawals.
This exclusive arrangement helps Australian Prescriber readers understand how the contents of the Pharmaceutical Benefits Scheme (PBS, see www.pbs.gov.au) are determined.
Letters and responses are reviewed by the Editorial Executive Committee and may be edited before publication. It may not be possible to reply to all individual questions.
Your question to the PBAC
As a pharmacist doing home medicines reviews, I frequently come across patients suffering from osteoarthritis who are taking (selective or non-selective) non-steroidal anti-inflammatory drugs (NSAIDs) for relief. As these patients often also suffer from conditions such as hypertension or heart failure, my recommendations include comments about NSAIDs interfering with blood pressure control, or aggravating heart failure. Many patients are on ACE inhibitors, diuretics and the NSAID, which constitutes the 'triple whammy' that puts them at increased risk of acute renal failure. Problems arise when I wish to suggest alternatives. Regular maximum dose paracetamol is fine if it works. There is evidence that glucosamine is effective, and may slow the progression of the disease. However, many patients will not take glucosamine because of the cost, compared to their NSAID which is subsidised by the Pharmaceutical Benefits Scheme. Considering the amount spent on COX-2 inhibitors and the cost of dealing with patients hospitalised by adverse effects (gastrointestinal complications, aggravated heart failure, acute renal failure), I am surprised that glucosamine is not subsidised.
I would like to know whether a cost-effectiveness formula has been applied to glucosamine, and what the chances are of it being subsidised. Has it been considered at all? Is there no multinational drug company out there lobbying for it, so it doesn't even find its way to the Pharmaceutical Benefits Advisory Committee (PBAC). Does the PBAC only consider drugs that are presented by the drug companies, or do you ever go searching (through the clinical trials) for other (cost-effective) drugs?
The Pharmaceutical Benefits Advisory Committee (PBAC) bases its recommendations on the evidence submitted to it. An application for listing requires appropriate data and evidence supporting the submission so manufacturers are usually in the best position to provide such information. The PBAC cannot compel a manufacturer to make an application for a particular drug or condition. To date, no application meeting the criteria for listing on the Pharmaceutical Benefits Scheme (PBS) has been submitted. Consequently, the PBAC cannot recommend that glucosamine be listed on the PBS.