By Peter Lake
and Chris Wurm
Migraine is a common, disabling, problem which affects 10-20% of adults. It comes in different forms and varies in frequency and intensity. Severe episodes can be very distressing, while even mild attacks probably interfere with the lives of thousands of Australians.
Many of these people get good relief from simple treatments such as rest and paracetamol or aspirin. Apart from this, there are other drugs which are useful for more severe attacks. In addition, people who have frequent attacks can often be helped with preventive medications and lifestyle changes. A small proportion of migraine sufferers, however, have bad headaches which will not respond completely to any of these treatments.
Recently, a new anti-migraine drug, Sumatriptan, has become available. Sumatriptan seems to be a genuine advance, offering relief to those migraine sufferers who would otherwise have to resort to narcotics for pain relief during acute attacks. Unfortunately, however, Sumatriptan is very expensive — $192 for six tablets. Generally, two tablets are needed for each attack.
In an aggressive marketing campaign targeting all prescribing doctors, the drug company concerned had been providing free promotional dinners at expensive venues around Australia. Doctors have also been personally visited by sales representatives and provided with Sumatriptan samples to give out.
The salespeople make it clear that, because the drug is so expensive, they want it to be used (We are doing you and your patients a favour by letting you in on the big secret!). Furthermore, they promise a return visit to check up and provide more samples.
The aim of this well-proven strategy is product substitution. As happens with many other consumer items, drugs go in and out of fashion. Once a
particular drug has been around for a few years, its patent expires and any company can manufacture it. Competition forces down the price once this monopoly ceases.
Consequently, drug companies make large profits and recoup development costs by charging high prices in the years immediately following a drug's release to the market — this is what is about to happen with Sumatriptan. Naturally, being good capitalists, its makers want maximum market share. In addition to those people who genuinely need Sumatriptan, many others who are at present being quite adequately treated with older and cheaper remedies will inevitably be switched to Sumatriptan.
The catch is that so far the federal government has resisted pressure to add Sumatriptan to the pharmaceutical benefits list. PBS listing would mean a government subsidy reducing the price of a course of Sumatriptan to $15.90, or $2.60 for pensioners — equivalent to striking gold for Sumatriptan's makers. Unfortunately, on past performances the government is very likely to bow to pressure from doctors and the drug company and allow PBS listing sooner or later.
During an ABC TV interview recently, health minister Graham Richardson pointed out that Sumatriptan's bid for PBS listing is typical of an increasing number of difficult health policy choices facing the government and the Australian community.
His department has estimated that Sumatriptan alone has a potential market of at least $240 million per year. This amounts to 15% of the cost of the whole pharmaceutical benefits scheme, or approximately four times as much as the total federal government expenditure on health promotion and illness prevention.
The lesson is that while new technology may be greatly expanding medical treatment and diagnostic possibilities, the costs are often enormous. Limits and trade-offs are inevitable, and the community must be involved in the debate.
[The writers are members of the Doctors Reform Society of South Australia.]