Going against the flow: the impact of PHARMAC not funding COX-2 inhibitors for chronic arthritis.

COX-2 inhibitors have come under a lot of scrutiny lately, with questions raised regarding class effects and the risk-benefit of these pharmaceuticals. From 1999 to 2003 the New Zealand Pharmaceutical Management Agency (PHARMAC) evaluated the evidence on COX-2 inhibitors, including their efficacy, cost-effectiveness and budgetary impact. In September 2003 PHARMAC decided not to list celecoxib, rofecoxib and meloxicam on the Pharmaceutical Schedule. This decision meant that at least 18 other pharmaceuticals were able to be funded or have access extended, resulting in 437 'statistical lives' saved per year, with net health gains, and savings for District Health Boards. Had PHARMAC funded COX-2 inhibitors at the same time as Australia, it is estimated that this may have resulted in approximately 740 to 4220 excess myocardial infarctions (MIs) and approximately 330 to 1900 excess deaths from MI.