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Greek drug shortage brings call for cost-effective approach

ATHENS — Ten years after entering the eurozone, Greece is faced with the herculean challenge of persuading pharmaceutical companies to strike a bargain and lower the cost of the medicines they sell in the country. At present, there are fears of drug shortages in certain hospitals as a result of unpaid bills. And concerns that the problem could grow have led to a call for the country to reevaluate the cost-effectiveness of drugs distributed in its public health system.

“If hard decisions are to be made, do what the British did: cover all major needs and let drugs with no substantial effect go uncovered,” says Kostas Syrigos, head of the oncology unit at the Sotiria General Hospital in Athens. “We used to mock the British for not using expensive drugs, but it is our health system in danger now, not theirs.”

During the last two decades Greece became a paradise for branded-drug producers, with generic medicines constituting only 12% of the drugs consumed in the country. Between 1997 and 2007, the amount of health spending per Greek citizen grew annually by 6.6%, bringing the country to fourth place worldwide, after South Korea, Turkey and Ireland, in terms of this growth.

The crisis comes, in part, as a result of the Greek National Health System racking up debts by treating pensioners and poorer locals with expensive branded drugs instead of generics. The government paid the pharmaceuticals mostly with state bonds that lost substantial value in the fiscal crisis, and, in response, they started turning off the faucet. The latest twist came on 3 November, when Germany's Merck KGaA formally announced that it had stopped providing Greek hospitals with the cancer drug Erbitux (cetuximab).

“Whatever temporary shortages appear in the Greek market are of branded drugs only,” notes Argiris Efstratiadis, scientific director of the Biomedical Research Foundation of the Academy of Athens, adding that the situation has not affected clinical trials.

For many months, pharmacies have been reporting shortages of medicines as some distributors have reexported comparatively cheap drugs from Greece over to Germany and other European markets, achieving monetary gains of as much as 600%. But the situation at hospitals is more complicated. Panos Minogiannis, president and chief executive of the St. Savvas Athens Oncology Center, says his clinic has not yet seen any shortages.

My big fat Greek debt

Pharmaceutical expenditures at Minogiannis's hospital dropped from €35 million ($45 million) in 2009 to €20 million in 2011 at the same time that patient volume increased by 13%. Overall, Minogiannis remains optimistic, but he has concerns about the immediate future as a result of cash flow issues: “We have paid pharmaceutical suppliers up to April of 2012,” he says. “But we have not received any payment from social insurance so far this year, and this places us at a very difficult spot.”

Since the beginning of this year, the Greek Ministry of Health has published four consecutive versions of a price list setting reduced price tags for state-insurance–covered medicines. But Syrigos insists that if these price limitations prove insufficient the national health system should take a more aggressive approach by more rigorously evaluating whether it should cover all of the drugs it currently distributes at hospitals.

“Our Balkan neighbors do not use expensive drugs in their hospitals, and this is the reason why many of their patients were coming to Greece for treatment,” he says. “We wouldn't like to get there, but maybe we'll be forced to.”

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Kafantaris, A. Greek drug shortage brings call for cost-effective approach. Nat Med 18, 1719 (2012). https://doi.org/10.1038/nm1212-1719

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