‘Switch’ or miss a public health opportunity

05 September 2017

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Australia risks missing a public health opportunity and the chance to significantly reduce inflating healthcare costs, according to arguments that will be presented by an international panel of experts at the World Self Medication Industry (WSMI) Conference, which will be held at the ICC in Sydney October 18-19.

In recent years, Australia has lagged behind in the rate of reclassification of medicines from prescription-only to over-the-counter (OTC) access when compared to other nations.  However, presenters at the WSMI Conference will argue that this reclassification - known as 'switch' - should be closely linked to public health strategy.

Prescription to OTC switch has several success stories, including:

  • Analgesics for pain (e.g. ibuprofen)
  • Antihistamines and intranasal steroids for allergy
  • H2RA & PPIs for heartburn
  • Smoking cessation products (e.g. nicotine replacement therapy patches, etc.)
  • Antifungals

These switches have produced many public health benefits. For example, in Australia it has been estimated that 68,750 premature deaths were avoided through the use of OTC NRT.

All these products above were once only available with a prescription, but they progressed to OTC access after several years of consumer experience and familiarity with these medicines demonstrated that they could be used safely with reduced medical supervision. However, while other nations with similar health systems have forged ahead with switch, Australia has fallen behind.

In New Zealand, specially trained pharmacists can supply sildenafil under strict criteria to men aged 35-70 with erectile dysfunction. In Australia, sildenafil medicines remain prescription-only. Three years on from prescription-free access to sildenafil (the active ingredient in Viagra) in New Zealand, Natalie Gauld and Alison Van Wyk will explain to WSMI delegates how this 'switch' was a positive for men's health issues, as the pharmacy protocol for supplying the medicine identified men suspected of having possible underlying health conditions.

In Canada, Consumer Health Products Canada (CHPC) has conducted research that shows that switching just three specific drug categories - erectile dysfunction medicines, proton pump inhibitors and oral contraceptives - has potential savings of $1 billion per year. CHPC President Karen Proud's presentation will show how the majority of savings are from lower drug costs, followed by increased efficiency, and productivity gains from reduced physician visits without compromising healthcare outcomes. This research uses the same methodology used in similar studies in the USA, Mexico and Australia, which all reached comparable conclusions and figures on cost benefits. In Australia, research1 from Macquarie University Centre for the Health Economy (MUCHE) demonstrated that switching 11 prescription-only medicines produced total cost savings to the Australian healthcare system of $2.3 billion.

Dr Edwin Hemwall, a global industry expert on switch, will present the case that switch is a vital enabler of self-care. Dr Hemwall describes this as the logical first step in "the healthcare continuum" to be integrated with professional medical care in order to reduce costs and better utilize scarce healthcare resources. That is, enhanced self-management of health conditions through switch has the potential to send more engaged patients to physicians and other healthcare professionals.

Writing in Clinical Pharmacology and Therapeutics,2 Dr Hemwall explained that facilitating a greater rate of switch requires industry, regulators and consumers all fulfil a responsibility:

  • Industry- is required to develop and demonstrate the utility of safe and effective products with educational self-support programs.
  • Regulators- need to overcome their well-intentioned scepticism and narrow interpretation of laws and guidelines governing labelling and mode of sale.
  • Consumers- must be held responsible for adhering to balanced informative labelling and utilizing accompanying support programs providing direction as to when to seek professional counsel.

Of course, the onus is also on pharmacists, who will be the new point of consumer contact for medicines that are switched from prescription to OTC. Denise Hope from Griffith University will provide a world-first presentation of research that gauges the perspectives of Australian pharmacists on switching medicines, including issues such as barriers to change, motivations for switch, and the medicines that they recommend should and should not be switched.

These arguments from around the world show that switch is about much more than convenience of access. It provides both medical and economic benefits, playing a key role in addressing the challenges of chronic disease prevention, diagnosis and treatment, in addition to inflating healthcare costs.


REFERENCES

  1. Macquarie University Centre for the Health Economy: The Value of OTC Medicines in Australia, March 2014.
  2. Hemwall, E.L., Increasing Access to Nonprescription Medicines: A Global Public Health Challenge and Opportunity.Clinical Pharmacology & Therapeutics, Vol. 87 No. 3                                                           

Dr Edwin Hemwall, Karen Proud, Dr Natalie Gauld, and Denise Hope will all present in the session Optimising Self Care through Switch at the World Self Medication Industry Conference 2017, October 18-19 at the International Convention Centre, Sydney.

In just a day and a half, delegates will benefit from the insights gained from 28 presentations and five panels featuring 31 world-leading healthcare experts. The 2017 WSMI General Assembly is the must-see event for all those associated with consumer healthcare.