Sir, – With the recent announcement by the CSO of an 8 per cent increase in the national population, it is worth noting that the demand on healthcare resources is similarly increasing while the budget of the HSE continues to diminish.
More efficient utilisation of remaining resources informed by best clinical evidence is one method to squeeze the most out of the shrinking healthcare budget.
O’Neill et al report that over €500 million is spent on stroke and its consequences annually with 75 per cent of this spent on the provision of long-term nursing home care. The value of interventions designed to prevent stroke and in particular the one-third of strokes resulting from atrial-fibrillation-associated, thromboembolic strokes are clear, in particular as this cause of stroke results in more significant rates of disability and a greater requirement for nursing home care (Kelly et al 2010).
It is surprising therefore that the HSE continues to refuse to reimburse novel preventive strategies for atrial-fibrillation-associated stroke. Several new drugs have been developed which in large randomised control trials have been shown to be safer and more effective in stroke prevention than existing therapies (namely warfarin). In addition, the use of these drugs does not require the frequent and inconvenient blood tests demanded for those treated with warfarin.
While these novel medications are significantly more expensive than warfarin, the reduction in total stroke numbers and the consequent reduction in the requirement for nursing home care (approximately €50,000 per annum per patient) would more than compensate for the increase in drug spending. If only 50 per cent of atrial fibrillation patients currently treated with warfarin were to switch to these novel drug therapies, approximately 175 strokes per annum could be prevented (extrapolation of results from the ReLy and AVERROES Studies), leading to approximately 100 less people requiring nursing home care – a saving of €5 million in the first year alone by conservative estimates, growing to over €6 million in year two. As well as drastically improving the quality of life of these patients and their families, this saving would more than cover the costs of the new drug therapies.
We can only hope common sense and intelligent use of clinical evidence will ultimately inform HSE decision making. – Yours, etc,