29 October 2018 - Analysis of the first round of Public Summary Documents from the July 2018 PBAC meeting reveals some interesting insights.

The PBAC Guidelines recommend the use of the medicine/technology/intervention most likely to be replaced by the proposed drug as the main comparator in a submission.

"Most comparators will be one of the following:

A current PBS listed medicine. If the proposed medicine is likely to replace listed PBS medicines, the relevant comparator would be a medicine prescribed on the PBS to treat that target population."

The following medicines were recommended by the PBAC at the July 2018 PBAC meeting on the basis of a comparison with the lowest cost alternative, in most instances regardless of the level of the use of the alternative on the PBS:

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

In all cases, the lowest cost alternative has not been stated.

It will be interesting to see if some medicines were rejected because the submission failed to present a comparison with the lowest cost alternative. This is an interesting, some might say alarming, trend.