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Saturday 10 October 2009

Drug funding delay "putting lives at risk"

Posted in: HIV, New Zealand Daily News
By Jay Bennie - 23rd June 2009

Government drug funding agency Pharmac is deflecting criticism that by not yet funding two new "life saving" HIV drugs it is relegating New Zealand HIV treatment to second class status and putting lives at risk.

Raltegravir, marketed as Isentress
Since the late 1990s effective treatments for people living with HIV have been developed, with daily medication known as antiretroviral therapy suppressing HIV. However, the virus builds resistance to HIV medications over time and new medications are constantly being developed to keep people well.

The New Zealand AIDS Foundation, a senior HIV and infectious diseases specialist and an HIV positive people's peer support and advocacy group have all voiced criticism of Pharmac's failure to yet fund the drugs Raltegravir and Darunavir. The drugs are considered "extremely effective in suppressing HIV for people who have run out of other treatment options," according to Eamonn Smythe, the NZ AIDS Foundation's Director Positive Health Services. Both have been assessed and approved for use in New Zealand but until Pharmac provides funding only a small number of patients already on 'compassionate access' or those able to pay the steep costs of such drugs will have access to them.

According to one of New Zealand's most senior specialists in HIV treatment, Dr Mark Thomas of Auckland Public Hospital, the lack of funded access to Raltegravir and to Darunavir is already having "an impact on the control of HIV infection in a small proportion of our patients who have HIV that is resistant to most currently funded drugs." Thomas believes it is "inevitable" that if these patients do not gain access to drugs that work better than the currently funded medications "they will develop AIDS illnesses and risk death."

Thomas says such patients must currently make do with treatments that are failing them but this is only a short term option measured in months. "I am very disappointed that Pharmac has delayed the approval of these drugs," he says. Asked if New Zealand is lagging behind our Tasman neighbour, Thomas states "Yes. New Zealand is again significantly behind Australia."

In Australia, Darunavir was funded for use in November 2007 and Raltegravir in July 2008.

Thomas's criticism and concerns are echoed by the AIDS Foundation. "In the past few years New Zealand has been able to catch up with Australia for funding antiretroviral medications. However, the gap in funded HIV treatments between New Zealand and Australia is beginning to grow wider again," says Eamonn Smythe.

Body Positive Auckland is also extremely concerned about the situation. "We are returning to the dark old days when Pharmac dragged their heels over funding new medications," says the peer support and advocacy organisation's CEO, Bruce Kilmister. "The funding application for Darunavir was lodged with Pharmac in 2007. It is estimated that more than 25 people will be in desperate need of these new drugs before the end of the year. New delays by Pharmac in modelling costs are likely to delay these new drugs [until] mid-2010. Who knows how many will be dead by then."

A spokesperson for Pharmac says Darunavir and Raltegravir have not been declined funding and are currently in an assessment process. "With any new medicine, Pharmac needs to carefully assess its place in therapy and decide whether this is a good investment compared to other investments [we] could make. This ensures the money we have to spend on new medicines is used carefully."

In recent months, Pharmac says, it has approved funding for new treatments for leukaemia, hepatitis, mental health, prostate cancer and migraines, among others. "Currently we fund eighteen HIV/AIDS medicines for 1293 people, with a total cost of about $15 million."

Pharmac says a number of other new funding decisions will be implemented "early in the 2009/10 financial year," but does not indicate if
Darunavir and Raltegravir are likely to be seen as priorities.

Jay Bennie - 23rd June 2009

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