Tuesday, 4 November 2014
Long-Term Illness Scheme
I thank the Minister for staying on. He has had a very long afternoon here and has given comprehensive replies to all our questions. I felt it was more appropriate to raise this matter with him through an Adjournment debate rather than to bring it up during the statements. I refer to the i-port Advance medical device. There is no need for me to tell the Minister what it is with his background in medicine, but for the record of the House I should explain that this is a cannula device that is attached to a child. It administers the insulin shots for them via this port. The port is replaced every three days. Its use results in injections and skin piercings being reduced from 120 per month to just ten. It is revolutionary and has been in use in America for years. It was introduced in Ireland on 1 June but it is not covered under the general medical services, GMS, scheme or the long-term illness scheme. It is very expensive to buy, costing about €200.
Just a few moments ago, the Minister referred to health insurance covering the cost of items. Health insurance in Ireland does not cover pump training, insulin pumps or i-ports. There is a device called a continuous glucose monitor, CGM, which can be attached to the body. It takes a reading every five minutes and transmits that information to an external device. This is excellent for keeping a close eye on blood glucose levels. In the United States, insurance companies cover the cost of these, but in Ireland they can only be obtained through a hospital and they are expensive, so the HSE only gives them out on a loan basis, for a week, to check blood glucose patterns. I understand there is a petition going around by parents, especially for children with type 1 diabetes, for this i-port to be included in the GMS or the long-term illness scheme as are other diabetic services. It would reduce the discomfort and pain that children get from injecting their skin up to four times a day or 120 times a month.
I wish to thank the Senator for raising this important matter. At the outset I think it is important to state that decisions on which medicines and appliances are reimbursed by the taxpayer, are not political or ministerial decisions. They are made on objective scientific and economic grounds by the HSE. The HSE has statutory responsibility for decisions on pricing and reimbursement of medical appliances under the community drug scheme in accordance with the provisions of the Health (Pricing and Supply of Medical Goods) Act 2013. The HSE received an application for the inclusion of the i-port Advance injection port to its non-drugs reimbursable lists on 1 July 2014. This application is now being considered in line with the provisions of the Health (Pricing and Supply of Medical Goods) Act 2013.
I understand that the i-port device is an injection port through which injectable medication can be given. It can be worn for up to 72 hours thereby reducing the number of injections required for those on multiple daily injections. The device should lessen the burden of daily injections and improve quality of life for patients which would be particularly beneficial for people with type 1 diabetes. The development of such innovative products and the obvious benefits the i-port may provide are welcomed. Nonetheless, the HSE must consider a wide range of criteria when assessing an application for a new product on the reimbursable list. In addition to the health needs of the public, the HSE will consider issues such as the effectiveness of the product, the proposed cost, the benefits, side-effect profile and risks of the product as well as the resources available to the Executive.
An expert group has been convened to assist the HSE in their consideration of this product. It is being led by the clinical lead for the national clinical programme for diabetes. The group has been tasked with assessing the clinical evidence to support the use of the product, to consider if the product is appropriate for reimbursement under the community drugs schemes and to assist in determining the value that the innovation presents. Its work will aid the HSE in its decision-making process. I want to assure the Senator that both the HSE and I fully understand the concerns of patients regarding the availability of this product. However, the HSE has a responsibility to undertake rigorous assessment of all applications for reimbursement so that decisions around the funding of products are clinically appropriate, fair, consistent and sustainable.
I am glad to see that the device is being considered under the Health (Pricing and Supply of Medical Goods) Act 2013. The Minister might give an indication of when he expects a decision to issue on it or when the expert group will report back. As he will appreciate, parents know this device is available. I understand that it is being used in some of the hospitals, that they are giving it out in the clinics. Parents would wish to have anything that would make it easier and less painful for their children, but it comes at a cost and a lot of parents simply cannot afford it. Again we have the "chequebook rule", where people who have the money can purchase a device or treatment while people who do not are under pressure. No-one would want to see a child suffer just because the parents cannot afford the device. Considering that all things for diabetics do come under the long-term illness scheme, I would appreciate if the Minister might get a report back from the expert group at some stage, although I understand he does not have a say in the decision.
I do not have a timeline for Senator Moloney but I will certainly check on it to see whether there is a timeline for it.
I conducted a quick research check before responding to the debate. Unfortunately, I have not been able to find a significant amount of research on it, although there is one paper which suggests that, while there is no statistically different improvement in HbA1c in outcomes in the sense that a port and a pump work equally well, the use of a port is less expensive. The small bit of research that I managed to find seems to suggest that it would be cost effective but, as I stated, it would be inappropriate for me to be making these decisions. What is really required is that the National Centre for Pharmacoeconomics, NCPE, and the HSE national drugs committee, which is made up of doctors, specialists and persons with the correct economic expertise, make these determinations, and I hope they can in this case, sooner rather than later.