Breaking new ground in switch
Breaking new ground in switch: Enhancing decisions through economics
Australia currently spends around 10 per cent of its GDP on healthcare. Expenditure on medicine accounts for around 12 percent of that (i.e. $20 billion).
Initially most medicines are available by prescription only, however decision makers may later ‘switch’, 'reclassify' or ‘down-schedule’ these medicines to being available over-the-counter (OTC). Decision makers largely focus on patient risk when making these decisions. For example, inaccurate or delayed diagnosis, inappropriate use, the incidence and severity of adverse events, and the need for advice from a medical practitioner or pharmacist.
However, there are also benefits to the patient and the healthcare system from allowing the medicine to be available OTC. It may improve patient health outcomes by reducing barriers to treatment. This may reduce the time to symptom relief, and improve treatment rates and adherence. Reducing barriers to treatment may also encourage patients to switch to more effective or safer treatments. Consequently, health-related quality of life may be improved, the onset of related diseases may be prevented, or disease progression may be delayed. Improved health outcomes may also lead to less demand for healthcare, such as diagnostic tests and hospitalisations.
While the existing framework for making scheduling decisions may not be broken, it could be improved. Indeed, a 2015 review of medicines and medical devices regulation conducted for the Federal Minister for Health recommended that the framework be reviewed. It also suggested adopting a formal risk-benefit framework might be useful.
MUCHE has developed an economic evaluation framework that can be used by regulatory bodies to assist in scheduling decisions.
This framework allows decision makers to synthesise data from a variety of sources, aggregate health outcomes into a single measure (quality adjusted life years, QALYs), consider healthcare resource use, identify areas needing further research, and explore regulatory scenarios through sensitivity analysis.
The application of the economic evaluation framework was demonstrated using two case studies: down-scheduling triptans and down-scheduling the oral contraceptive pill (OCP).
For information on this study, please contact: Bonny Parkinson
This research was funded by a grant from Consumer Healthcare Products Australia (previously known as the Australian Self-Medication Industry). The funding agreement ensured the authors’ independence in designing the economic evaluation, its inputs, interpreting results and writing the article.