New Zealand has been ranked last in a comparison of 14 developed nations on their use of selected medicines.

New Zealand was far below Australia in the study, which was done for the British Government and tallied medicine use for 11 conditions.

New Zealand came last for cancer, dementia, multiple sclerosis, osteoporosis, rheumatoid arthritis and an eye condition called "wet" aged-related macular degeneration.

But the country was ranked third for acute heart attack, for which the United States came 13th. New Zealand came seventh for antipsychotics and for cholesterol-reducing statins, ninth for respiratory distress syndrome and 12th for hepatitis C.

The author, Britain's national cancer director, Sir Mike Richards, emphasised a high or low ranking should not be taken to imply good or poor performance. And he noted "countries that spend the most on health do not always have the highest levels of usage and low spenders can be high users of drugs".

As well as being the lowest user of medicines in the study, New Zealand was also the lowest health spender in 2007, at US$2510 ($3460) per capita and the US was the highest, at US$7290.

In New Zealand, Pharmac is the state's gatekeeper for deciding which medicines will be subsidised at community pharmacies and it has been given an expanding role in buying hospital medicines. It has kept prices down, but its work has also led to taxpayer funding for drugs, such as Herceptin for breast cancer and donepezil for Alzheimer's disease, is often delayed, sometimes by years.

The Cancer Society's medical director, Associate Professor Chris Atkinson, said it was not surprising New Zealand had come last among the list of countries chosen.

More targeted cancer therapies, which could cost $50,000 per patient, were becoming available and they were of benefit to relatively small numbers of patients. Many were not curative drugs, extending life in some cases for only a few months.

"I don't think there's going to be a country that's easily able to afford everything. A wee country like ours, with not as many people paying taxes, is going to struggle more than some."

Health Minister Tony Ryall said the Government has subsidised, for the first time, an Alzheimer's drug, and had expanded access to medicines for hepatitis, osteoporosis and various cancers.

Use of medicines per capita for 11 conditions:
1 United States (highest)

2 Spain

3 France

4 Denmark

5 Australia

6 Switzerland

7 Canada

8 Britain

14 New Zealand