An endocrinologist says New Zealand’s type 2 diabetes drugs are ‘third world’. Why won’t Pharmac fund the medicines experts want?
In his early twenties Ben Tawhai was a 120kg lock, playing senior rugby for Otago.
In his mid-50s he’s hooked up to a dialysis machine five hours a day, three times a week. “It’s pretty hard,” he says. “I watched my dad go through this too. I always said to myself I don’t want to be in this position but it’s too late.”
Now his two adult children are watching him. “They have come in here a couple of times. They don’t like to see me like this.”
Plugged into the dialysis machine next to him is another Māori man, a little younger. His left leg has been amputated below the knee.
This is what end-stage renal failure looks like, explains Dr Brandon Orr-Walker, an endocrinologist at Middlemore Hospital, which has the largest dialysis service in Australasia.
The ravages of diabetes have killed off most of the kidney function and the dialysis machine has to do the work, removing waste from the body.
The faces in this room are all brown.
Māori have double the rates of diabetes, five times the rates of renal failure and three times the number of lower limb amputations compared to non-Māori.
“If type 2 diabetes was a city, it would be Hamilton,” Orr-Walker says, as we head off to meet more of his patients.
“It would be our fourth biggest city. It’s 240,000 people.”
Yet Orr-Walker, who is also president of the Society for the Study of Diabetes, says New Zealand’s access to type 2 diabetes medicines is atrocious: “We’re working with a pharmaceutical kete which looks like the same one that you would use in a third world country. But the moment you slip into kidney failure, you will have first world provision of dialysis services.”
Even our drug-buying agency Pharmac admits the insulin it funds isn’t the ideal drug for type 2 diabetes. So, why, when we have a Hamilton-sized diabetes problem, don’t we have better medication?
Saving money on medicines isn’t really cutting costs for the health system if those people end up on dialysis, he says. There are 645 people on dialysis at Middlemore Hospital, at a cost of $50,000 to $100,000 each per year.
New Zealand’s first-line type 2 diabetes medicine is Metformin. It works, Orr-Walker says, but it’s been around since the 1970s and it’s “dirt cheap”, costing about 5c per tablet.
Many developed countries have been publicly funding three new classes of drugs to treat type 2 diabetes for the past five to 10 years.
The first class are gliptins, the second class are the GLP-1 agonists and the third class are flozins.
These drugs might sound like droids from a sci-fi movie, but actually help manage blood sugar control with less risk of hypoglycemia and weight gain than insulin. Orr-Walker calls them “game changers”.
Pharmac has repeatedly turned down applications to fund these drugs.
It funded one of them in 2004, but it was another 14 years until it funded another.
Ask Sarah Fitt (Pharmac chief executive) about the Vildagliptin deal and the lack of clinical advice and she says this: “We would have had original advice, but I’m not sure if we went back to [the expert committee] once we got that proposal.”
Tell her there is no record of any consultation with the diabetes expert committee and she says sometimes “we get advice through other ways”.
What advice did Pharmac obtain on Vildagliptin? “I’m sorry, I just can’t recall.”
The way Pharmac went about funding the latter drug, last year, left Orr-Walker asking whether Pharmac was more about commerce than health and science.
The drug it funded was Vildagliptin, and it funded it because of a key tool in Pharmac’s commercial negotiating playbook, known as bundling.
Bundling, to use a blunt analogy, is the equivalent of buying a frying pan and a rice cooker and getting cheap steak knives thrown in for next to nothing.
Pharmac might cut a deal with a drug company for some medicines it really wants – and the drug company will throw in a couple of medicines Pharmac isn’t so interested in as part of the bargain. Continue reading
- Guyon Espiner is a New Zealand print and television journalist.
- Image: Stuff