Healthcare systems need to adapt faster – but specialist drug costs a problem

Too many lives are still lost around the world because healthcare systems are adapting too slowly to ageing populations and growing incidence of chronic diseases.

That's the conclusion of a new OECD report, Health at a Glance, which has collected data from 33 countries, comparing their performance against a number of key indicators.

The report found overall health expenditure continues to rise slowly in many OECD countries in line with GDP growth, although spending fell in 2013 for a third consecutive year in Italy and Portugal and a fourth in Greece.

It concluded that no country consistently performs at the top of the country ranking on key indicators of quality of care – even those that spend the most on health. There is room for improvement in all countries in the prevention, early diagnosis and treatment of different health problems.

It gave examples of the United States, which is performing well in providing acute care for people who have a heart attack or a stroke and preventing them from dying, but is not performing well in preventing avoidable hospital admissions for people with chronic conditions such as asthma and diabetes.

It says the reverse is true in Portugal, Spain and Switzerland, which have relatively low rates of hospital admissions for certain chronic conditions, but higher rates of mortality for patients admitted to hospital for a heart attack or stroke.

Finland and Sweden were found to perform well in saving the lives of people following diagnosis for cervical, breast or colorectal cancer, while Chile, Poland, the Czech Republic, the United Kingdom and Ireland were all below average.

Specialist drugs will put pressure on budgets

The report dedicated a chapter to the role of medicines in healthcare, surveying spending levels across the countries.

In 2013, OECD countries spent an average of more than $500 per person on retail pharmaceuticals. As frequently confirmed in other studies, US spending was far higher than any other, being twice the OECD average, and more than 35 per cent higher than in Japan, the next highest spender. At the other end of the scale, Denmark spent less than half the OECD average.

The survey found that pharmaceutical spending reached around $800 billion across OECD countries in 2013, representing about 20 per cent of total healthcare spending.

While there has been a slowdown in overall spending growth, the OECD says ageing populations and the high cost of new speciality drugs for diseases like cancer and hepatitis will probably cause spending to rise again.

It highlights new specialist drugs which are forecast to make up 50 per cent or more of pharmaceutical spending growth over the next five years.

It quotes a statistic from Express Scripts, which found that specialist drugs represented just 1 per cent of total prescriptions in the US but accounted for 25 per cent of total prescription drug spending in 2012.

The report states that the wave of new treatments for hepatitis C (most notably Gilead's Sovaldi and Harvoni) is posing 'unprecedented challenge' to many OECD countries, adding that the extremely high costs of orphan drug prices were also causing problems.

Stepping into the hot topic, the report authors commented: "While some of these high-price medicines bring great benefits to patients, others provide only marginal improvement in the health of patients and are not cost-effective," and noted the increasing use of price controls and health technology assessment (HTA).

The report concludes that this situation: "challenges both the static and dynamic efficiency of pharmaceutical spending and raises questions about the best ways to align societies' interests with those of pharmaceutical companies and investors."

Read the full Health at a Glance 2015 report:

Healthcare improving too slowly to meet rising strain of chronic diseases