Dr Linda Sheahan1
1South East Sydney Local Health District, 2Sydney Health Ethics
The cost of healthcare continues to rise in Australia across all sectors, most notably the rapidly growing cost of pharmaceuticals. Considerations regarding the ‘judicious’ use of medicines, or ‘good’ decision making around medicine approvals, are, to some extent, values- based. While the Pharmaceutical Benefits Scheme provides robust processes for assessing value for money at a population level, it does not provide a process for considering individual claims for access at a local level. The use of high cost medicines for individual patient use – off label, non PBS funded, or for experimental or as yet unproven indications – is rising across the Australian health care system. At the individual application level, the the local Drug and Therapeutic Committee is charged with deliberating on the proposed ‘value’ of the health outcome, and whether it is thought to be proportional to the cost. This involves the DTC considering, and to some extent agreeing upon, what goals and outcomes they think are worthwhile or important, and making some judgement as to whether the particular high-cost medicine can be considered ‘value for money’. From the ethics perspective, there are no guidelines for them to use in order to ensure these deliberations are consistent, transparent, comprehensive and ethically robust. The SESLHD Clinical Ethics Service has developed a High Cost Drug IPU deliberation and decision matrix to improve the quality of DTC decision making in this regard, to ensure that all the relevant ethical considerations have been integrated, and that the process aligns with procedural justice principles.
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