Dr Richard Stein, Gastroenterologist, MD, FRACP, FACG, FAGA,
Chairman, Crohn’s and Colitis New Zealand Charitable Trust,
Senior Clinical Lecturer, University of Otago, Wellington.
As a practicing gastroenterologist, much of my time is spent doing procedures such as colonoscopies.
I meet most of my patients before the procedure, speak with them afterwards, and, in most cases, our doctor-patient relationship ends in the recovery area.
That is not the case with Crohn’s disease and ulcerative colitis.
People with these conditions are much younger. They are not people in their sixties being screened for bowel cancer. They are often in their twenties or thirties, sometimes in their teens, having the procedure because they are losing weight, suffering from severe abdominal pain, and experiencing bloody diarrhoea.
New Zealand has not funded a new medication for the treatment of Crohn’s disease or ulcerative colitis for over ten years. There are two medications we use here; one was approved by the United States’ Food and Drug Administration in 1998, and the other in 2007.
Sometimes these medicines don’t work for a patient, or they stop responding to them after around five years. In these cases, we have nothing to offer our patients except surgery.
Depending on the nature of the disease, this can involve removing the colon or sections of the large or small bowel might need to be resected. In the case of both Crohn’s and ulcerative colitis, these diseases can require the creation of a temporary or permanent ‘stoma’ which is an opening of the bowel on the wall of the abdomen, requiring the patient to wear an ostomy bag.
Since 2009, the last time a medication for these diseases was funded in New Zealand, several new and efficacious medications have come to market. They offer hope to those who have failed the few medications which are available. They are publicly funded in over 35 countries across the developed world including Australia, the United Kingdom and Slovenia.
There are countless studies and real-world data attesting not only to the efficacy of the new medicines, but the cost-effectiveness of them.
Despite Pharmac’s own Pharmacology and Therapeutics Advisory Gastrointestinal Sub-Committee recommending these medications receive funding with a “high priority”, they remain unfunded.
The irony is that these medications, if available, would create savings for our economy and the New Zealand taxpayer. Once these diseases are in remission, patients, and the parents of children with these diseases can return to work, young people can complete university, and people in their 20s and 30s can continue to pursue their careers. There would be fewer visits to A&E, fewer hospitalisations, and fewer surgeries. If these drugs were funded, the savings across our economy would be in the millions.
And, finally and most importantly, how can you place a price on the quality of life of the 20,000 New Zealanders who suffer from Crohn’s and colitis?
Doctors in my specialty are not paid to advocate for these medications. All we see is an injustice that needs correcting.