Introduction

The Pharmaceutical Benefits Advisory Committee (PBAC) has recently published its latest outcomes, which include several new drug listings and recommendations. These advancements are particularly significant for the elderly population, who often battle with multiple health challenges. As we focus on global healthy ageing this month, we will explore the PBAC’s recommendations and their potential impact on elderly healthcare in Australia.

Apalutamide: A New Strength for Prostate Cancer Treatment

Apalutamide, marketed under the brand name Erlyand®, has been recommended for a new strength (240 mg tablet) by the PBAC. This drug treats non-metastatic castration-resistant carcinoma of the prostate (m0CRPC) and metastatic castration-sensitive carcinoma of the prostate (mHSPC). The PBAC recommended this based on their assessment. They believed the new strength would be cost-effective if it matched the lowest cost comparator. This comparator includes apalutamide (60 mg), enzalutamide, or darolutamide. This decision is crucial for elderly men undergoing concurrent androgen deprivation therapy, offering them a more potent treatment option.

Estradiol: Flexible Dosing for Menopausal Symptoms

Estradiol, sold as Sandrena®, has been recommended for a new strength of 500 micrograms in a 0.5 g gel sachet. This recommendation allows for greater flexibility in dosing and simplifies dose titration for women experiencing climacteric symptoms after natural or surgical menopause. The PBAC also advised that estradiol should be used with progestogen in women with an intact uterus. This new listing offers a more tailored approach to hormone replacement therapy, which is particularly beneficial for elderly women.

Levodopa with Carbidopa and Entacapone: Advanced Parkinson’s Disease Treatment

The PBAC has recommended the listing of levodopa with carbidopa and entacapone intestinal gel (LECIG) for the treatment of advanced idiopathic Parkinson’s disease. This recommendation addresses severe motor fluctuations despite optimised alternative pharmacological treatment. The PBAC’s decision was based on the cost-effectiveness of LECIG, provided it is cost-minimised against levodopa and carbidopa monohydrate intestinal gel (LCIG). This new treatment option offers hope for elderly patients struggling with advanced Parkinson’s disease, enhancing their quality of life.

Leqembi: A New Hope for Alzheimer’s Disease

Leqembi (lecanemab), a solution concentrate for intravenous infusion, has been proposed for the treatment of early Alzheimer’s disease (EAD). The initial submission suggests PBAC could potentially use Leqembi for mild cognitive impairment due to Alzheimer’s disease. This includes prodromal Alzheimer’s disease or mild Alzheimer’s dementia. If PBAC approves, Leqembi could be a vital new treatment for elderly patients in Alzheimer’s early stages. Furthermore, it could potentially slow disease progression and enhance cognitive function.

Prasugrel: Acute Coronary Syndrome Management

Prasugrel, in combination with aspirin, has been recommended for the treatment of acute coronary syndrome (ACS). This includes myocardial infarction (MI) or unstable angina managed by percutaneous coronary intervention (PCI). The PBAC’s recommendation, however, was based on a cost-minimisation approach, considering the doses of prasugrel, ticagrelor, and clopidogrel as equivalent. This new listing provides an effective treatment option for elderly patients with ACS, potentially reducing the risk of recurrent cardiac events.

Osteoporosis Therapy Restrictions Review

The PBAC has reviewed the potential broadening of restrictions for osteoporosis therapies, including alendronate, risedronate, and zoledronic acid. The review considered expanding the age range for PBS-listed osteoporosis medications to those under 70 years of age. However, the PBAC deferred making a recommendation pending a review of the Medicare Benefits Schedule (MBS) implications. The PBAC observed that the inclusion of bone mineral density (BMD) testing costs in the cost-utility analysis resulted in a 12-fold increase in the ICER ($ per QALY gained) for risedronate. They suggested a further investigation into the cost-effectiveness of limiting its use to high-risk subpopulations within the 65-69 years age group. They identified these groups using the FRAX tool and First Nations people, and recommended against repeat testing. 

Conclusion

The latest PBAC outcomes offer promising advancements in elderly healthcare. Therefore, these new drug listings and recommendations that address critical health challenges. These innovations offer better and customised treatments for conditions like prostate cancer, menopausal symptoms, advanced Parkinson’s disease, early Alzheimer’s disease, and acute coronary syndrome. If implemented, these recommendations could greatly enhance the quality of life for elderly patients in Australia.