Decision relating to volatile anaesthetics in DHB hospitals

Hospital devices Medicines

Decision

PHARMAC is pleased to announce the approval of an agreement with Baxter Healthcare Limited (Baxter) for price reductions on the volatile anaesthetics sevoflurane, desflurane and isoflurane which are used in DHB hospitals during general anaesthesia.

This was the subject of a consultation letter dated 30 June 2016. The proposal was approved as consulted on.

In summary, the effect of the decision is that from 1 September 2016 there will be:

  • a reduction in price across all three volatile anaesthetics supplied by Baxter currently used in DHB Hospitals; and
  • continued supply of loan vaporisers for the administration of sevoflurane, desflurane and isoflurane as required by DHB hospitals.

Details of the decision

Sevoflurane, Suprane and Aerrane

  • Baxter’s Sevoflurane, Suprane and Aerrane will remain listed, in Part II of Section H of the Pharmaceutical Schedule at the following decreased prices from 1 September 2016 (ex-manufacturer, excluding GST):

Pharmaceutical

Presentation

Brand

Pack size

Current price

New price

Sevoflurane

Soln for inhalation 100%, 250 ml bottle

Baxter

6

$1,365.00*

$840.00

Desflurane

Soln for inhalation 100%, 240 ml bottle

Suprane

6

$1,414.50

$1,350.00

Isoflurane

Soln for inhalation 100%, 250 ml bottle

Aerrane

6

$1,173.00

$1,020.00

* Confidential rebate currently exists
  • Hospital Supply Status will apply to the above three pharmaceuticals from 1 September 2016 until 30 June 2019 (the HSS Period) with a 1% DV limit.
  • As indicated in the RFP document, the HSS Period for each pharmaceutical could be extended for an additional period of 12 or 24 months at PHARMACs discretion.
  • PHARMAC has retained the ability to delist Aerrane (isoflurane) from Section H of the Pharmaceutical Schedule if no longer required, however a delisting is not being progressed at this time.

Vaporisers

  • Baxter will continue to provide and support a sufficient number of vaporisers on loan to DHB Hospitals for the administration of sevoflurane, desflurane and isoflurane as required in each DHB Hospital. The range of supported vaporiser models available on loan and specified in the agreement has been expanded to include new models manufactured by Dräger, GE and Maquet.
  • Some DHBs currently own, or may wish to purchase their own vaporisers as part of anaesthetic machine upgrades. For DHBs that do not require loan vaporisers for a pharmaceutical, or require loan vaporisers for less than 25% of their needs for a pharmaceutical and can commit to purchase their remaining vaporiser requirement within an 18 month period, the following alternate pharmaceutical prices would apply (ex-manufacturer, excluding GST):

Chemical

Presentation

Brand

Pack size

Alternate price per pack

Sevoflurane

Soln for inhalation 100%, 250 ml bottle

Baxter

6

$720.00

Desflurane

Soln for inhalation 100%, 240 ml bottle

Suprane

6

$1,230.00

Isoflurane

Soln for inhalation 100%, 250 ml bottle

Aerrane

6

$900.00

  • The above prices would not be recorded in Part II of Section H of the Pharmaceutical Schedule; they would be made available from Baxter directly to DHB Hospitals.

Feedback received

We appreciate all of the feedback that we received and acknowledge the time people took to respond. All consultation responses received by 8 July 2016 were considered in their entirety in making a decision on the proposed changes. All responses were supportive of the proposal:

Theme Comment
Several responders were supportive of the expanded range of loan vaporisers available on loan. Noted.
One DHB responder, although supporting the proposal for sole supply, requested additional information on the plan for the next RFP, so they can budget for the purchase of their own vaporisers if required. PHARMAC will work with DHBs to plan for the next competitive process with respect to vaporiser loan arrangements.
Several responders noted isoflurane has a potential use during cardiac anaesthesia, however, there is no strong clinical justification why sevoflurane can’t be used as an alternative.One DHB responder noted that if a switch to sevoflurane was proposed, their DHB would require older generation vaporisers for its bypass machines. They also noted that higher minimal alveolar concentrations (MACs) of sevoflurane are required compared to isoflurane which could potentially result in an increase in expenditure for some departments.One responder considered that neither sevoflurane nor desflurane are suitable substitutes in paediatric cardiac anaesthesia.One responder noted niche uses for isoflurane such as during MRI for children with seizures, those who have excessive movement when exposed to sevoflurane and long endoscopic removal of airway foreign bodies. PHARMAC does not intend to progress a delisting of isoflurane at this time.PHARMAC would seek further advice from the DHBs still using isoflurane prior to progressing any proposed delisting.
One responder noted that consideration needs to be given to the supply of vaporisers compatible with all differing anaesthesia machines in use in New Zealand as well as the filling systems for the vaporisers proposed.Noted that a having a sole-supplier for a critical product requires careful management, especially considering the lack of alternatives compatible with the current vaporiser filling systems. Under this proposal the current vaporiser loan arrangements would continue to be available, with an expanded range of models. Agreed.  Baxter has supplied volatile anaesthetics in New Zealand under sole supply arrangements since 2009, without any supply interruptions.
One responder expressed a preference for integrated bottle fillers. PHARMAC notes that only desflurane (Suprane) will be supplied with an integrated bottle filler.  Sevoflurane will continue to require a bottle adaptor for vaporiser filling.One advantage of the bottle adaptor system is that it allows compatibility with all vaporiser fill systems as a range of bottle adaptors is available.

More information

If you have any questions about this decision, you can email us at enquiry@pharmac.govt.nz.