Asthma inhalers

Response to an Official Information Act request for information on asthma inhalers.

16 October 2019

[name and contact details redacted]

Dear [name redacted]

REQUEST FOR INFORMATION

Thank you for your request dated 18 September to Scott Metcalfe. We have treated this as a request for information under the Official Information Act 1982 (OIA).  You asked for:

  1. How many MDIs are supplied in NZ each year compared to powder inhalers and what the cost difference is?
  2. If MDIs are preferentially prescribed (if in fact they are – I don’t know that information) because they are cheaper, or if there are other reasons to prescribe MDIs such as better control of symptoms.
  3. I’m also interested to know if the factoid quoted in the independent that Each spray equivalent to releasing 500g of carbon dioxide into the atmosphere is true of MDIs used in New Zealand?
    1. Is there a recycling programme for MDIs which prevents release of GHGs in dispensers which are not fully used up that is promoted to patients and pharmacists?

PHARMAC response

Question 1: As you did not state a time period, we have provided data for the four years 2016 to 2019. Please advise us if you require additional data. Data is for year to June and is drawn from Ministry of Health pharmacy claims. “MDIs” is Metered Dose Inhalers, and one unit refers to one inhaler.

Units dispensed by Financial Year

 

2016

2017

2018

2019

MDIs

3,407,038

3,396,037

3,355,381

3,299,077

Dry Powder Inhalers

845,576

981,115

1,104,352

 1,208,360

Total

4,252,614

4,377,152

4,459,733

4,507,437

Prescriptions dispensed by Financial Year

 

2016

2017

2018

2019

MDIs

1,583,583

 1,572,673

1,544,666

1,505,080

Dry Powder Inhalers

357,480

 417,646

463,146

496,724

Total

1,941,063

1,990,319

2,007,812

2,001,804

Gross cost by Financial Year

 

2016

2017

2018

2019

MDIs

 $48,462,474

 $44,390,900

$41,785,626

 $39,945,395

Dry Powder Inhalers

 $42,980,398

 $42,142,567

 $48,919,260

 $54,719,970

Total

 $91,442,872

 $86,533,467

 $90,704,886

 $94,665,365

Question 2: PHARMAC does not have an opinion on the individual prescribing choices of clinicians, within their choices of medicines funded on the Pharmaceutical Schedule.

MDIs remain the mainstay of asthma management in New Zealand compared with dry power inhalers/ breath activated devices. PHARMAC decides to fund medicines using its Factors for Consideration, which cover a number of features.

Question 3: To provide this information, we would have to systematically assess and critically appraise the individual reports cited, including the extensive 2014 Report of the UNEP Medical Technical Options Committee(external link). This is not possible within the current timeframe for this request.

Question 4: PHARMAC does not have any information on a recycling programme for MDIs in New Zealand. You may wish to raise this issue with suppliers. We note the NICE information(external link)

(page 13, and page 6 of this resource(external link)) refers to some recycling programmes in the United Kingdom.

On the basis stated above for questions 2-4, those parts of your request are declined under section 18(g) of the OIA, as the information is not held by PHARMAC, and we have no reason to believe it is held by another agency.

You have the right, by way of complaint under section 28(3) of the OIA to an Ombudsman, to seek an investigation and review of our decision.

Please note that PHARMAC approaches its assessment of requests for information under the OIA on the basis that, once released, the information becomes publicly available.

We are making our information more freely available, so we will now publish selected OIA responses (excluding personal details) on our website.  Please get in touch with us if you have any questions about this.

Yours sincerely

Alison Hill
Director, Engagement and Implementation