New diabetes medicine funded by Pharmac not what the doctors ordered

New diabetes medicine funded by Pharmac is not what the doctors ordered.
Photo credit: supplied

As of October, Pharmac is funding a new Type 2 diabetes medicine called Vildagliptin.

Endocrinologist Dr Brandon Orr-Walker says it's one of three new classes of diabetes medicines. But the other two classes would be more valuable for meeting the needs of diabetes patients in New Zealand, in particular those with kidney or cardiac disease.

"The funding of that drug took everyone by surprise, there was no clinical input from anyone outside of Pharmac, as far as I'm aware," Dr Orr-Walker said.

Heather Verry, CEO of Diabetes New Zealand, says the 'new' drug Pharmac is funding is really an old one, and they're not looking at what else is on offer.

"For every $3 spent on new medicines, $10 is saved in hospitalisation costs," she said.

Newer agents, funded in other countries like Australia, Canada and Britain, for up to 15 years, aren't funded here. Agents like GLP-1 agonists and SGLT2 inhibitors.

"Crucially, some of the GLP-1s have been shown to reduce harm to kidneys and to reduce heart attacks and strokes, as well as being effective for glucose control," Dr Orr-Walker said.

"NZ's funding of diabetes drugs lags behind every other OECD country. We're still using medicines that were developed in the 1970s and 1980s."

In Counties Manukau in 2016 there were 9000 people with diabetes with such poor sugar control that they were running 'high-speed' towards complications.

"2000 of those have significant kidney complications as well. They're on a fast track to heart disease and dialysis, and they're likely to be Maori or Pacific," Dr Orr-Walker said.

"We know that if they don't die of heart disease, more than 50 percent of them will need dialysis in the next decade."

The new medicines wouldn't be the only solution, but would form part of the solution, Dr Orr-Walker said.

He says there are large numbers of people at risk because of how high their glucose levels are, and because their kidneys are leaking protein, which is a marker of strain on the kidneys.

"New Zealand is probably world-leading in diagnosing diabetes, after detection became a health target in 2013. But the value of that isn't to label a patient, or document their decline, but in being able to successfully manage it via lifestyle and medicines," Dr Orr-Walker said.

"You need a 600 horsepower truck for this load, but you've only got a 200 horsepower mini-truck at the moment."

"It's not what 'might happen' to these people in the short term. It's a projection of certainty that people in that position will proceed to kidney failure, unless they die first from their heart disease," Dr Orr-Walker said.

The prospect is living with a bad complication, or dying early.

A patient receiving dialysis for Type 2 diabetes.
Photo credit: supplied

Dr Orr-Walker says there's always tension in healthcare, wanting to do more for the patient in front of you and what you are able to offer. But these patients will get state-of-the-art, expensive, hard-to-live-with therapies like dialysis down the track.

"It would be much easier for them to remain productive and take another tablet, rather than be on dialysis for five hours, three times a week," says Dr Orr-Walker.

"You scratch your head and say, why are we not doing more for that person before they get to that point? For me, to be with a person who's about to go on dialysis and look back and think what a lost opportunity, that's very sad.

"Broadly, the healthcare sector has started to normalise poor healthcare of diabetes, as if that's ok," he says.

Dr Orr-Walker says specialists get little response from Pharmac when they voice their concerns.

"It's like 'talk to the hand'," he said.

"Where unmet needs aren't associated with protests up and down the streets, Pharmac thinks they can get away with it."

Sarah Fitt, Pharmac Chief Executive, says vildagliptin and vildagliptin with metformin offer a new choice of treatment in New Zealand that can deliver benefits for many people living with type 2 diabetes.

The deal to fund these medicines was part of a major funding package involving 10 medicines in seven key therapy areas through an agreement with Novartis New Zealand Ltd.

"Funding vildagliptin and vildagliptin with metformin will not prevent the funding of other antidiabetic treatments at any time," she said.

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