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Prescribing
Cost-Effectiveness of Donanemab for Early Alzheimer Disease in Australia
Objectives To evaluate the cost-effectiveness of donanemab, an anti-amyloid-β monoclonal antibody recently approved in Australia, for treating early-stage Alzheimer disease with confirmed amyloid-β pathology from healthcare system and societal perspectives. Design A Markov microsimulation model simulating long-term Alzheimer disease progression, treatment costs and health outcomes for donanemab compared with standard care. Setting, Participants Australian healthcare context, applying published clinical and economic inputs. A hypothetical cohort of people with early symptomatic Alzheimer disease, consistent with TRAILBLAZER-ALZ eligibility criteria: mean age 75years, amyloid-β-positive, with mild cognitive impairment or mild dementia because of Alzheimer disease and excluding individuals with APOEE4 homozygotes, in line with the Australian labelling. Donanemab administered every 4weeks with magnetic resonance imaging (MRI)-based amyloid-β-related imaging abnormalities monitoring and treatment suspension upon amyloid-β clearance or progression to severe Alzheimer disease, compared with standard care. Main Outcome Measures Incremental costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). Secondary analyses included sensitivity and distributional equity analyses. Results Donanemab increased total healthcare costs ($300,689 vs. $178,121) and societal costs ($389,113 vs. $283,618) compared with standard care per capita, while improving health outcomes (4.38 vs. 4.01 QALYs) per capita. The ICER was $342,424 per QALY from the healthcare perspective and $294,701 per QALY from the societal perspective, exceeding frequently cited Australian willingness-to-pay thresholds. Sensitivity analyses identified drug cost and efficacy as key drivers of uncertainty. Distributional analysis suggested inequitable health gains by remoteness because of differences in diagnostic and treatment infrastructure. Conclusion Donanemab provides clinical benefits but is unlikely to be cost-effective under current Australian thresholds. Policymakers should balance economic evidence with unmet need, equity considerations and healthcare sustainability when making reimbursement decisions. Further research using real-world evidence and disaggregated analyses by geography and socioeconomic status is warranted.
Lan Gao, Rosie Watson, Nawaf Yassi
Uptake and Costs of the 60-Day Dispensing Policy for Antihypertensive Medicines in Australia: A Mixed Methods Study
Objectives To evaluate the uptake of a new 60-day dispensing policy for antihypertensive medicines and estimated cost savings compared with conventional 30-day dispensing; and to explore general practitioner and pharmacist perspectives on the new policy. Study Design Mixed methods design; analysis of Pharmaceutical Benefits Scheme (PBS) dispensing claims from 1 September 2023 to 30 April 2025; and semi-structured interviews with 20 general practitioners and four pharmacists from 13 June 2024 to 24 September 2024 to gauge their perspectives on 60-day dispensing. Setting, Participants General practitioners and pharmacists practising in New South Wales, Victoria and Queensland, Australia. Main Outcome Measure Antihypertensive prescription volumes; patient and government cost savings; and perceptions of the policy from general practitioners and pharmacists. Results The 60-day antihypertensive prescription volume increased from 75,500 to 877,700 over 20months, accounting for 21.2% of all antihypertensive dispensing by 30 April 2025. We estimate the total cost savings for patients were up to ~$65 million, and the government saved ~$87 million and paid pharmacies ~$86.7 million via the Additional Community Supply Support (ACSS) payment program, with a net effect of ~$0.3 million. In interviews, general practitioners indicated varied utilisation of 60-day prescriptions, with some actively providing 60-day prescriptions, but some rarely or not at all. Barriers included keeping abreast of eligible and ineligible medicines for 60-day prescriptions and perceived resistance from pharmacists. Pharmacists were concerned about incorrect dispensing and potential medication shortages. Conclusion At 20months after the introduction of the new policy, 21.2% of antihypertensive prescriptions were for 60-day dispensing. The slow uptake is likely due to low uptake among general practitioners and resistance from pharmacists. The 60-day policy has demonstrated substantial financial savings for patients. If uptake of 60-day dispensing increased to 50%, annual savings from antihypertensive medicines could rise to up to ~$165 million for patients and ~$11.6 million for the government.
Tian Wang, Huy L. Nguyen, Isabella Tan, Dean S. Picone, Emily Atkins, Sonali R. Gnanenthiran, Michael O. Falster, Sallie-Anne Pearson, Anthony Rodgers, Aletta E. Schutte
Antidepressant Prescribing in Australian Primary Care: Time to Reevaluate
Gin S. Malhi, Erica Bell, Kinga Szymaniak, Philip M. Boyce, Jeffrey C. L. Looi
Antidepressant Prescribing in Australian Primary Care: Time to Reevaluate
Katharine A. Wallis, Joanna Moncrieff
Valproate Prescribing for Female Adolescents and Management of the Associated Teratogenicity Risk, Royal Children's Hospital, Melbourne, 2022–2024: A Retrospective Audit of Medical Records Data
ObjectivesTo assess the frequency of valproate prescribing for female patients of childbearing age at the Royal Children's Hospital, Melbourne, and to assess the frequency of documented discussions with these patients about the teratogenicity of valproate and the discussions or prescribing of contraception.Study DesignRetrospective audit of hospital electronic medical records data; analysis of Pharmaceutical Benefits Scheme (PBS) valproate dispensing data.Setting, Participants13- to 18-year-old girls or women prescribed valproate at the Royal Children's Hospital, Melbourne during 29 May 2022–29 May 2024; PBS valproate dispensing data for Australia for the 2023 calendar year.Main Outcome MeasuresCharacteristics of adolescent female patients prescribed valproate; documented discussions of valproate-related teratogenicity, and discussions or prescribing of contraception; population valproate prescribing rates for Australia and by state.ResultsValproate was prescribed for 245 female patients aged 13–18years during 2022–2024 (median age, 16years; interquartile range [IQR], 14–17years); the median prescribed daily dose was 600mg (IQR, 400–800mg; range, 200–2000mg). Valproate was prescribed for treating epilepsy for 221 patients (90%), including 97 (44%) with drug-resistant epilepsy; 160 patients (65%) had neurodevelopmental disabilities. Teratogenicity was discussed with 32 patients (13%), less frequently with patients with a neurodevelopmental disability (9% vs. 20%; odds ratio [OR], 0.41; 95% confidence interval [95% CI], 0.19–0.88). Contraception was discussed with 69 patients (28%); the proportion was larger for patients with neurodevelopmental disabilities (34% vs. 16%; OR, 2.66; 95% CI, 1.37–5.14). Contraception was prescribed for 50 patients (20%); the proportion was larger for patients with neurodevelopmental disabilities (25% vs. 12%; OR, 2.50; 95% CI, 1.18–5.30). The national PBS-subsidised dispensing rate during 2023 was 621 per 100,000 girls and women aged 13–18years; in Victoria it was 556 per 100,000 girls and women aged 13–18years.ConclusionDespite the risk of teratogenicity, valproate was prescribed for a considerable number of female adolescents at the Royal Children's Hospital during 2022–2024 and across Australia during 2023. Its teratogenicity was discussed with few patients, nor were discussions or prescribing contraception frequent. Contraception was more frequently discussed and prescribed for patients with neurodevelopmental disability, but teratogenicity was discussed less often.
Briana Davis, Monica S. Cooper, Michael South, Jeremy L. Freeman, Emma Macdonald-Laurs
Medications for early treatment of COVID‐19 in Australia
An increase in options available would appear to be our best chance at living alongside SARS-CoV-2
Adam Polkinghorne · James M Branley
Nocebo effects in practice: methotrexate myths and misconceptions
Providing patients with accurate information will help overcome obstacles to the use of an effective treatment for rheumatoid arthritis
Mark H Arnold · Jane Bleasel · Inam Haq
Is ketamine ready to be used clinically for the treatment of depression?
A single dose of ketamine produces rapid antidepressant effects, but attaining lasting remission remains a challenge
Colleen Loo MB BS, MD, FRANZCP
