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Following is a question by Dr Hon Joseph Lee and a written reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (March 10):
Question:
It has been learnt that at present, patients suffering from age-related macular degeneration (AMD) receiving treatment in public hospitals under the Hospital Authority (HA) are required to purchase at their own expenses the medicines in the Hospital Authority Drug Formulary (the Formulary) prescribed to them. In this connection, will the Government inform this Council if it knows:
(a) the number of new cases of AMD patients in public hospitals in each of the past three years, as well as the total number of patients at present, and among such patients, the number of those who have purchased at their own expense medicines in the Formulary prescribed to them;
(b) the current number of the aforesaid patients who do not purchase at their own expense medicines in the Formulary prescribed to them; among them, the number of patients who cannot afford the medicine expenses, as well as the number of those who eventually lost their eye sight as a result;
(c) whether HA or other non-governmental organisations have subsidised those AMD patients who cannot afford self-financed medicines to purchase such medicines; if so, of the eligibility for subsidy, the number of patients subsidised, as well as the amount of subsidies provided; if not, the reasons for that; and
(d) whether HA will expeditiously review the existing system of the Formulary to ensure that patients' treatment will not be affected because of financial problems; if it will, of the details and the timetable; if not, the reasons for that?
Reply:
President,
(a), (b) and (c) Age-related macular degeneration (AMD) is an eye disease caused by degeneration of the retina due to old age. This disease can be classified into dry and wet forms. Patients with dry AMD will have degeneration and atrophy of the macula of the eye. At present, the medical profession has yet to establish any definite strategy to treat dry AMD. As for wet AMD, patients will have abnormal blood vessel growth in the macula. Treatment for the condition is still being developed. The HA has all along kept itself abreast of the developments in the treatment methods for various eye diseases and the scientific evidence, and makes assessment on different treatment methods on the basis of clinical evidence.
In the past few years, the medical profession has developed various treatment options for wet AMD, including the use of vascular endothelial growth factor inhibitors to alleviate the conditions. Nevertheless, these drug treatments are still being developed. Their long term safety, efficacy and cost-effectiveness in the treatment of wet AMD require the accumulation of more established clinical data to prove. These drugs have not been included as standard drugs in the HA Drug Formulary (the Formulary).
HA has not subsidised patients with AMD to purchase drugs in the past. We also do not have information on non-governmental organisations providing subsidies to patients for use of the drugs. In 2007-08, 2008-09 and 2009-10 (as at January 31,2010), there were respectively 110, 321 and 461 patients who bought Ranibizumab (a drug for wet AMD) from HA hospitals on a self-financed basis for the first time to commence the therapy. HA currently does not have formal statistics on the number of new AMD cases and the total number of patients with the disease. According to estimation by the ophthalmic profession, there are about 3,000 new cases of wet AMD in Hong Kong each year. Patients may seek medical treatment in the public or private healthcare sector.
The medical profession is now conducting several large scale studies to compare the efficacy of various vascular endothelial growth factor inhibitors on wet AMD. HA will pay close attention to the findings of these studies as well as the development of other scientific evidence. It will also consider whether to include individual drugs into the standard drug category of the Formulary for treatment of wet AMD having regard to the scientific evidence of the safety, efficacy and cost-effectiveness etc. of the drugs.
In the meantime, having regard to the recommendations by ophthalmology experts and with reference to international practice, we have earmarked additional recurrent funding of $12 million to HA in this year's Budget. This funding is for HA to explore providing wet AMD patients under suitable clinical conditions with subsidies for using the drugs on a trial basis through scientific research or other means in 2010-11. This will allow the accumulation of more local actual experience in the use of the drugs, thereby allowing further assessment of the safety, efficacy and cost-effectiveness of the drugs. This will provide local reference indicators to HA in considering whether to include the drugs concerned into the standard drug category of the Formulary.
HA will continue to closely monitor the needs of AMD patients and provide them with appropriate support having regard to their needs.
(d) The Formulary was implemented by HA with the main objective of ensuring equitable access to cost-effective drugs of proven safety and efficacy through standardisation of the drug policy and drug utilisation in all HA hospitals and clinics. At present, there are about 1,300 standard drugs in the Formulary. All of them are proven to have clinical efficacy, therapeutic effectiveness and cost-effectiveness. Patients who meet the relevant clinical conditions will be prescribed the drugs by doctors and the drugs will be provided by HA at standard fees and charges.
In accordance with established mechanism, HA regularly appraises new drugs and reviews the list of drugs in the Formulary through its expert committees (including the Drug Advisory Committee and the Drug Utilisation Review Committee) which comprise doctors, clinical pharmacologists and pharmacists. Changes will be made to the Formulary as appropriate to the circumstances. The review process takes into account a number of considerations such as scientific evidence, cost-effectiveness, technology advances in treatment options concerned, actual experience in the use of the drugs, as well as the views of professionals and patient groups etc. This is to ensure that public resources are used in an equitable and effective manner for provision of appropriate treatment to patients. We have earmarked additional recurrent funding of $194 million to HA in this year's Budget to expand the coverage of the Formulary by incorporating six drugs for rare genetic diseases and two drugs for cancer into the Formulary in 2010-11. The clinical application of nine drug classes will also be expanded in the same year.
Moreover, HA will continue to meet regularly with patient groups each year under the patient consultation mechanism on the Formulary as formally established in 2009 as well as through other channels. This is to gauge and consult their views on matters related to the Formulary with a view to making the best use of public resources to help the largest number of patients.
Ends/Wednesday, March 10, 2010
Issued at HKT 12:04
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