Anger at diabetes-drug rationing

By MARTIN JOHNSTON

The Government has finally agreed to fund a diabetes drug hailed by doctors, but only a tiny proportion of patients will qualify.

Pharmac, the Government's drug-funding agency, will pay for Actos tablets from next month, but the access criteria are strict. An estimated 3000 patients will eventually qualify.

Actos, like a rival product, Avandia, is a glitazone drug. They lower the body's resistance to insulin.

Two diabetes specialists said yesterday the restrictions on Actos were unacceptably tight.

Dr Russell Scott, of Christchurch Hospital, said 90,000 of the estimated 120,000 people in New Zealand diagnosed with diabetes could benefit from the drugs.

"The discussion document from Pharmac made it nearly impossible for anyone in the country to be funded for Actos."

To qualify, patients must continue to have high levels of glucose in their blood while trying out dieting and exercise and they must be unable to use one or both of the diabetes drugs metformin and sulphonylurea.

The complex criteria mean delays of six months or a year before starting Actos.

Dr Scott said the delay would be potentially disastrous for the patient and unethical for the doctor.

"It's completely inappropriate for a person to be left for six weeks, let alone six months, with that degree of metabolic derangement."

David Simmons, professor of medicine at Auckland University's Waikato Clinical School, said delaying control of glucose levels increased a person's risk of developing diabetes complications, such as damage to the eyes, kidneys and nerves and an increased pre-disposition to heart disease.

"There's a biological memory," he said.

"If you allow glucose levels to be poorly controlled for longer, your body doesn't forget it and you run the risk of a higher level of complications later on even if you reverse it."

He would not let patients wait a year. Instead he would put them on insulin, which was expensive and laborious because it was injected and required frequent blood tests.

Dr Scott said Pharmac's move was short-sighted, since diabetes numbers were rising fast and the complications of the disease threatened to swamp the health system.

But Pharmac's medical director, Dr Peter Moodie, said diabetes specialists who advised the agency did not think it unreasonable to try patients out for a year on sulphonylurea before allowing them to have Actos.

He would not reveal the cost of Actos to the Government.

When asked if Pharmac could not afford to allow greater access, he said: "At the present we are approaching it cautiously. We will keep it under review.

"If it's appropriate to widen access we will do that."

Dr Scott said he had put a number of patients on Avandia or Actos, at a cost to them of about $50 a week. None would meet the Pharmac criteria.


DIABETES DIAGNOSIS

An estimated 120,000 people have been diagnosed with type 2 diabetes.

The number is expected to exceed 165,000 by 2021.

It is New Zealand's leading cause of blindness, kidney failure and lower extremity amputation.

It is also a major risk factor for impotence, stroke, heart disease and premature death.

Treating diabetes and its complications costs an estimated $340 million a year, rising to $1 billion in 2021.

A new drug called Actos could help many patients, but state funding is restricted.