The California Healthcare Institute (CHI) and the Pacific Research Institute (PRI) assembled policy experts from Australia and the U.S. in San Francisco to discuss the pros and cons of applying prospective cost-effectiveness analysis to insurance coverage of prescription drugs and how doing so might influence patients' access to innovative medicines for cancer, Alzheimer disease and other conditions.

As state and federal policy makers search for ways to rein in drug spending, they are considering approaches used in foreign countries, particularly Australia, which requires evidence of comparative effectiveness and cost-effectiveness as prerequisites for drugs to be included in the National Health Service's Pharmaceutical Benefit Scheme.

"With so much emphasis on controlling drug costs in Medicare and Medicaid, policy makers need to ensure that 'cost-effectiveness' does not become a code word for rationing," said David L. Gollaher, PhD, president and CEO of CHI. "One of our top priorities is to make certain that patients have access to the best medicine, even when the best medicine is expensive."

A recent study by the Executive Health Policy Consortium titled "Second-Class Medicine: The Implications of Evidence-Based Medicine for Improving Minority Access to Life-Saving Drugs and Therapies" was discussed at the forum by one of the study's authors, Kwabena Adubofour, MD, medical director, East Main Clinic and Stockton Diabetes Intervention Center. "In theory, the concept of evidence-based medicine suggests a potentially powerful tool that can reduce healthcare inequities, and, in the long-term, cut healthcare costs," Adubofour stated. "However, the approach alone without other innovative measures will not adequately address disparities in healthcare outcomes for all patients."

In addition to Adubofour, the "Evidence, Economics, and Politics: Australia's Experiment in Evidence-Based Medicine" forum speakers included Meryl Comer, journalist and caregiver; Randolph Frankel, vice president of public affairs and government relations, IMS Health; Marjorie Ginsburg, executive director, Sacramento Healthcare Decisions; John R. Graham, director, Health Care Studies, Pacific Research Institute and former director of health and pharmaceutical policy research at Canada's Fraser Institute; Ruth Lopert, Harkness fellow in healthcare policy, George Washington University and principal advisor, Pharmaceutical Policy Taskforce, Commonwealth Department of Health and Ageing, Canberra, Australia; and Peter J. Pitts, co-founder and president, Center for Medicines in the Public Interest, and former FDA associate commissioner for external relations.

"The group of experts we...assembled are ideally suited to evaluate the advantages and limitations of applying cost-effectiveness analysis to U.S. healthcare coverage decisions," Sally C. Pipes, president and CEO, Pacific Research Institute, said. "Government and healthcare leaders must balance the desire for patients to have access to the best American medicine has to offer with the need to control healthcare costs in a manner that rewards innovation and investment."