29 October 2018 - Further analysis of the first round of Public Summary Documents from the July 2018 PBAC meeting reveals some concerning insights.

The PBAC recommended the (revised) listing of six medicines/combination products on the PBS on the basis of a comparison with the lowest cost alternative:

• Carmellose
  
• Hypromellose
  
• Bictegravir sodium with emtricitabine and tenofovir alafenamide fumarate
  
• Ixekizumab
  
• Guselkumab
  
• Tildrikizumab
  

In contrast, the PBAC recommended three medicines on the basis of a comparison with placebo:

• Guanfacine hydrochloride
  
• Golimumab
  
• Midostaurin
  

and another five medicines/combination products on the basis of a comparison with best supportive care:

• Everolimus
  
• Lumacaftor with ivacaftor (6-11 years)
  
• Lumacaftor with ivacaftor (12 years and above)
  
• Tolvaptan
  
• Trifluridine with tipiracil hydrochloride
  

These results need to be interpreted with caution as they are dependent on the mix of submissions considered by the PBAC which varies from meeting to meeting.  The medicines/combination products recommended on the basis of a comparison with placebo/best supportive care were on a cost-effectiveness basis whereas the medicines/combination products recommended on the basis of a comparison with the lowest cost comparison were on a cost-minimisation basis.

While many of the medicines/combination products recommended by the PBAC on the basis of a comparison with the lowest cost alternative are for the biological disease-modifying anti-rheumatic drugs (bDMARDs), they are not limited to them.

Users of MAESTrO are able to search for all medicines/combination products recommended by the PBAC on the basis of a comparison with the lowest cost alternative; for the submission for tildrakizumab, the comparator (outcome) is 'biological disease-modifying anti-rheumatic drug (bDMARD) (lowest cost)'

This is the first PBAC meeting where more submissions were recommended on the basis of a comparison with the lowest cost alternative when compared with either placebo or best supportive care. It will be interesting to see if this trend continues over time.