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Home > Seanad Eireann debate. Drugs payment scheme coverage [Alcohol].

[Oireachtas] Seanad Eireann debate. Drugs payment scheme coverage [Alcohol]. (26 Nov 2014)

URL: http://oireachtasdebates.oireachtas.ie/Debates%20A...


Senator Colm Burke: ......It was announced today that the National Institute for Health and Care Excellence in the United Kingdom, the equivalent of the National Centre for Pharmacoeconomics, had recommended the use of Selincro for people with an alcohol dependence. This meant that the medicine would be available to patients within 90 days. This treatment has been recommended and proved to have a positive effect. We are awaiting a decision on its use.

The issue was raised that if we were to introduce the drug if there would be a need to provide for the availability of appropriate psycho-social supports. The European Medicines Agency has recommended the provision of psycho-social supports focused on treatment compliance and alcohol reduction. General practitioners are aware of this and conscious that such supports must be put in place if we are to introduce the drug which is not suitable for everyone. I understand the National Centre for Pharmacoeconomics has assessed the cost of introducing it at between €6.7 million and €12 million over a five year period. It was announced in April that the decision should be seriously considered. I ask for clarity as to when we are likely to see that decision being made. Will it be made the end of the year or will it take longer? It would be helpful for everyone involved in the area to know.

There has been a huge increase in alcohol consumption. A report has revealed that in 2010 the average Irish consumer drank 11.9 litres of pure alcohol, equivalent to 482 pints of lager, 125 bottles of wine or 45 bottles of vodka. This highlights the fact that if a person has a drink problem and there is a drug that can assist him or her in reducing his or her alcohol consumption, its use should be carefully considered.

Minister of State at the Department of Health (Deputy Kathleen Lynch):   I thank the Senator for raising this important issue. Anything to do with alcohol consumption in an Irish context is very important.

The decisions on which medicines are reimbursed by the taxpayer are not political or ministerial; rather, they are made on objective, scientific and economic grounds by the Health Service Executive, on the advice of the National Centre for Pharmacoeconomics, NCPE. The HSE has statutory responsibility for decisions on the pricing and reimbursement of medicinal products under the community drug schemes in accordance with the provisions of the Health (Pricing and Supply of Medical Goods) Act 2013 which requires consideration of a range of statutory criteria prior to reimbursing any medicine, including clinical need, cost-effectiveness and the resources available to the HSE.

The HSE received an application for the inclusion of nalmefene in the GMS and community drug schemes. Nalmefene, or Selincro, to give it its brand name, is indicated for the reduction of alcohol consumption in adults with an alcohol dependence who have a high drinking risk level, without physical withdrawal symptoms, and who do not need immediate detoxification. The application is being considered in line with the procedures and timescales agreed by the Department of Health and the HSE with the Irish Pharmaceutical Healthcare Association for the assessment of new medicines. In accordance with these procedures, the NCPE conducted a pharmacoeconomic evaluation of nalmefene and its report was published in April. It estimated that the investment required by the taxpayer to provide access to nalmefene would be between €6.7 million and €12 million in the next five years, as the Senator indicated. The advice of the NCPE to the HSE also made it clear that the introduction of nalmefene required the availability of appropriate psycho-social supports. The availability of these supports is being considered by the mental health, health and well-being and primary care divisions of the HSE.

The HSE assessment process is intended to arrive at a decision on the funding of new medicines that is clinically appropriate, fair, consistent and sustainable. It is appropriate for the HSE, prior to committing scarce resources, to assess whether the required supports are in place and, if not, the resources required to put such supports in place to ensure appropriate use of this medicine. While medications such as nalmefene can be used at the individual level to impact on alcohol consumption, at a wider societal level more must be done to reduce alcohol consumption and tackle alcohol misuse. To address this issue, the Government approved an extensive package of measures to deal with alcohol misuse, including the drafting of a Public Health (Alcohol) Bill. It is hoped to publish a general scheme of the Bill shortly.  

I will endeavour to find out for the Senator the status of the application in the process and when we are likely to have a decision on it.

Senator Colm Burke  I thank the Minister of State for her comprehensive reply and fully agree with her. We discussed with the Minister for Health earlier how the cost of medications in the ten year period 2000 to 2010 had increased from €570 million to €2 billion. We need to be conscious of this, but there would be many advantages in introducing this drug. I also accept that back-up support would be required.

I met some people who were dealing with this matter. They have produced a document - BRIEFcases - which will be presented to general practitioners. It sets out how they could assist people with this problem. It is comprehensive and lists the supports available to GPs in dealing with someone with this problem. It would be helpful if this medication was available. It would not help everyone, but it might help some and could help to reduce the risk for those engaging in excessive alcohol consumption. Anything that could be done in that regard would be helpful.

I again thank the Minister of State for her comprehensive reply but what everyone is looking for is a time guideline in dealing with this matter.

Deputy Kathleen Lynch  As I said, I will endeavour to find out for the Senator. It is not indicated in the answer, but this is one of the tools in the box in treating excessive alcohol consumption. It is not, however, the total picture......

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