Replies to LegCo questions

LCQ5: Hospital Authority Drug Formulary

Following is a question by the Dr Hon Yeung Sum and a reply by the Secretary for Health, Welfare and Food, Dr York Chow, in the Legislative Council today (November 8):

Question:

Since July last year, the Hospital Authority (HA) has gradually implemented the Hospital Authority Drug Formulary (the Formulary) in public hospitals and clinics. Some drugs in the Formulary, including such expensive drugs as "Paclitaxel" for breast cancer and "Imatinib" for stomach cancer, have to be purchased by patients at their own expenses. In this connection, will the Government inform this Council:

(a) whether it knows HA's average annual expenditure on drugs for each patient since the implementation of the Formulary, and how the figure compares to those of the past;

(b) whether, in each case where it has been clinically assessed by attending doctors that certain drugs should be prescribed for patients for appropriate treatment, HA will consider requiring the patients concerned to pay the standard charges only and not the full costs of such drugs; and

(c) whether the Government will consider setting up a committee, independent of HA and comprising non-officials as well as representatives of the relevant professional bodies and patient groups, to regularly review the Formulary so as to avoid queries that HA has, due to resource considerations, inappropriately classified drugs as patients' self-financed items or failed to include efficacious new drugs in the Formulary as standard-charge items?

Reply:

Madam President,

(a) The Hospital Authority Drug Formulary (the Formulary) was implemented by phases in the seven hospital clusters starting from July 2005 and was fully implemented in October the same year.

Before implementation of the Formulary, in the period from July 1, 2004 to June 30, 2005, the Hospital Authority (HA)'s average expenditure on drugs for inpatient service was HK$83.4 per patient per day and that for non-inpatient services was HK$89.1 per patient per attendance. After implementation of the Formulary, from July 1, 2005 and June 30, 2006, the HA's average expenditure on drugs for inpatient service was HK$83.7 per patient per day, while that for non-inpatient services had increased to HK$92.8 per patient per attendance.

(b) At present, there are over 1 300 drugs in the Formulary, including many expensive drugs, for treatment of various acute and chronic diseases. All these drugs have evidential support for their clinical efficacy, therapeutic effectiveness and cost-effectiveness. The Formulary contains two categories of drugs, namely General Drugs and Special Drugs. General Drugs refer to drugs with well-established indications and effectiveness which are available for general use as indicated by the patients' clinical conditions. This group comprises around 80% of the drugs in the Formulary. Special Drugs refer to drugs which are to be used under specified clinical conditions with specific specialist authorisation. This group comprises around 20% of the drugs in the Formulary. Both the two aforesaid categories of drugs are currently provided by HA at highly-subsidised rates and are included in the standard fees and charges of HA's services.

In developing the Formulary, the HA had considered whether patients should be required to purchase certain drugs at their own expenses. One of the major guiding principles is that the HA, as a public organisation, has responsibility to ensure that public resources are utilised in the most equitable and effective way. Due to limited resources, we should aim to deliver services that can best serve the interests of the community at large and provide services to the largest possible number of patients. Given the targeted subsidy principle and having considered the opportunity cost, some drugs that have proven to be of significant benefits to patients but extremely expensive are not included in the Formulary. Patients who require such expensive treatment and can afford to pay should pay for these drugs at their own expenses. That said, the HA will use the Samaritan Fund as a safety net to offer assistance, to ensure that no one will be denied treatment because of lack of means. In addition, for drugs which only have preliminary medical evidence or marginal benefits or are for meeting the needs of individual life style, patients will have to purchase them at their own expenses. Such an arrangement is considered to be more in line with the principle of equitable and rational use of public resources.

(c) The evaluation and review of the list of drugs in the Formulary is a complicated decision-making process, which involves considerations from different perspectives such as science, medical ethics and clinical analysis, etc; and requires in-depth and thorough discussions among the professionals. HA has set up an internal expert team comprising of clinical experts and pharmacologists from the HA and universities to review the list of drugs in the Formulary according to a set of explicit and comprehensive evaluation criteria. The set of criteria includes efficacy, safety, and cost effectiveness of the drugs vis-�j-vis other viable alternatives, and overseas experience, etc. In the course of evaluation, reference needs to be made to international medical literature, coupled with thorough analysis and proof, so as to ensure transparency and accountability of the review process. The HA is a statutory body established under the Hospital Authority Ordinance to manage the public hospitals in Hong Kong independently and is accountable to the Hong Kong Special Administrative Region Government. The development and management of the Formulary is part of the HA's daily operation and should not be interfered with by other organisations or committees.

The review of the Formulary is an ongoing process. New drugs will have to be duly evaluated before they can be included in the Formulary. Similarly, drugs currently in the Formulary will also be reviewed from time to time to determine whether their continued inclusion is appropriate.

The HA has maintained close ties and dialogues with patient groups. Apart from the bi-monthly sharing sessions, patients' views and concerns about the Formulary are also solicited through individual contact or other occasions. In fact, communication between the HA and patient groups has been effective which enables HA to understand better and more comprehensively the views of patient groups on the implementation of the Formulary. For instance, when the HA carried out its consultation on the Formulary last year, some patients urged the HA to enhance the transparency and objectivity of the assessment criteria of the Samaritan Fund. In the light of their views, the HA revised the assessment criteria of the Samaritan Fund with reference to those of the Supplementary Legal Aid Scheme. Under the revised criteria, the patients' disposable financial resources will be used to determine the amount of subsidy to be granted. The adoption of the new criteria is to ensure that patients' quality of life would be maintained largely even if they have to purchase the more costly drugs.

Since implementation of the Formulary in July last year, the updated Formulary has been uploaded onto the HA homepage for public access. Members of the public can also give their views on the Formulary through the established consultation framework and channels. Through counselling on the use of drugs and drug education activities available at its hospitals and clinics, the HA provides counselling services for patients and strives to enhance their awareness of the efficacy and side effects of drugs. In reviewing the Formulary, the HA will ensure that the public views can be adequately reflected and welcome suggestions and monitoring by the public in an open and transparent manner.


Ends/Wednesday, November 8, 2006
Issued at HKT 13:06

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