In recent decades, the Norwegian life span has grown larger and larger. Now it is more common to be overweight than not to be. Increasing obesity in Norway is referred to as a national disease. But new slimming drugs give hope to many of those who struggle to get rid of unhealthy fat. This summer, both researchers and patients advocated that the state should include these drugs in the blue receptor system. They point to Wegovy, which is the obesity medication that has the greatest weight-reducing effect. The health authorities are provisionally opposed to the proposal. The Directorate for Medical Products (DMP) has concluded that the costs exceed the effect of the medicine. The health politicians Bård Hoksrud (Frp) and Kristoffer Robin Haug (MDG) are positive about Wegovy on blue prescription. They believe that the refusal from DMP is based on too narrow a calculation. – Yes, there is a large cost in using these treatments, but socio-economic calculations show that there are significantly greater costs that can be avoided by preventing people from being chronically overweight for a long time, says Haug (MDG). INVESTMENT: MDG health policy spokesperson Kristoffer Robin Haug believes that society will save money by publicly financing diet pills. Photo: Hans Ivar Moss Kolseth / news Will change the rules of the game The question is technical, but could be decisive for access to slimming drugs in Norway in the future. In 2025, the government must present the priority report to the Storting. One of the topics is what kind of criteria should be used when the health authorities assess whether medicine should be available on a blue prescription. Today, it is the Directorate for Medical Products (DMP), formerly the Norwegian Medicines Agency, that makes these assessments. They look at three things: Resources: A medicine is prioritized higher the fewer resources it requires. This applies to the costs of the medicine itself, and how resource-intensive it is to use it in the healthcare system otherwise. Benefit: Measured in terms of how many good years of life the medicine gives on average to the patients in question, compared to other treatment. Severity: Is measured by how many good years of life the patients lose on average if they do not receive treatment with the medicine. Source: dmp.no It is the first of the three points the unusual political duo wants to make. Hoksrud admits first and last that diet pills are expensive. VEGER ALTERNATIVES: Bård Hoksrud (Frp) believes that the slimming medicine Wegovy can save society from large expenses, even though the pharmaceutical companies, according to him, are well paid. Photo: Hans Ivar Moss Kolseth / news Only halfway through 2024, the state had spent 1.4 billion on Ozempic on a blue prescription, until the governing authorities on 1 July said stop and tighten up. But, Hoksrud objects: – The alternative is not no expenses. Obesity contributed, among other things, to large social security costs for people who dropped out of working life. It is therefore important to see the whole picture, not just the health budget. Can come to the Storting Neither the Progress Party nor the Green Party have adopted a policy that they are in favor of Wegovy on a blue prescription. Both Hoksrud and Haug emphasize that the decision should be made by professionals. This summer, the pharmaceutical company Novo Nordisk submitted an application to the Norwegian health authorities to give Wegovy on blue prescription to patients with morbid obesity (see fact box further down in the case). Novo Nordisk has sent new documentation on the documented effect of the treatment. The Directorate for Medical Products has a deadline of 180 days for processing. POLITICAL: If Wegovy is to be incorporated on a blue prescription, the Storting will probably have to vote on it. Photo: Lise Åserud / NTB If DMP gives its support to introducing Wegovy on blue prescription, the matter will probably come to the Storting. All decisions on prescription drugs with a price tag of over NOK 100 million must be dealt with in the Storting. As of now, the MDG and FRP respond as follows on the matter: – When we look at the socio-economic effect, we think it could be a good arrangement, says Haug. – These medicines can save society large expenses in other areas. Then it makes sense, says Hoksrud. Shutterstock What do the other parties say? news has asked the following questions to the other Storting parties: How does the party stand up to Wegovy on a blue prescription? Should societal costs be assessed more holistically in the assessment of public funding of medicines? Marius André Jenssen Stenberg Lisa Marie Ness Klungland, health policy spokesperson for SenterpartietSp emphasizes that decisions about medicines and treatment should be made by professionals. – In this context, I will decide what the basis for prioritization should be, and here we must think carefully before deciding. – Their proposal will mean that, for example, people who are not in work, and who also do not have the opportunity to do so in the future, end up at the back of the queue. I don’t want such a society. NTB Alfred Jens Bjørlo, health policy spokesperson for the Liberal Party 1. The Liberal Party is positive about considering Wegovy on a blue prescription. – It can contribute to both better health and quality of life for many who struggle with obesity, reduced social costs and positive social benefits. 2. – The time is overdue to assess societal costs more wholeheartedly in the assessment of public funding of medicines. The Liberal Party will take the initiative for this in the Storting in the autumn. Stian Lysberg Solum Ida Lindtveit Røse, deputy head of KrF – We are positive that new medicines and medicinal products will become available to the population more quickly. There is now an application for Wegovy on a blue prescription for handsaming in the DMP, and I am excited about what kind of decision they make. – I think it is useful that the societal perspective is part of the basis for making decisions within the health sector. At the same time, the health perspective must be taken care of, so that everyone gets the help they need. Synnøve Sundby Fallmyr Irene Ojala, parliamentary representative and leader of Patient Focus – I am not entirely sure whether Wegovy should be obtained on a blue prescription or not, but I am open to the possibility that it may be a correct priority. – PF completely agrees that societal costs should be assessed when prioritizing medicines. It is too narrow a calculation to only include costs in the health sector. Much else is relevant: participation in working life, social life, less need for aids, etc. news Seher Aydar, health policy spokesperson for Rødt Aydar, says that if doctors think the medicines contribute to better health, they should be on blue prescription. – It cannot be the private economy that determines whether people have access to the medicines they need. – The individual benefits greatly from participating in working life and being active in society. Therefore, it is something that should always be assessed in general in the health service, also when it concerns medicine. SV and HøgreSV and Høgre have not responded to news’s inquiries. The Labor Party responds further down in the matter. Strong increase in obesity and overweight Since the 1980s, the increase in weight in the Norwegian population has been large. Between every sixth and seventh Norwegian is now overweight, while around 1 in 4 adult men and women are obese, according to the Health Survey in Trøndelag (HUNT). The different levels of overweight are divided according to body mass index (BMI – see fact box). With a high BMI comes a greater risk of diseases and ailments, including: Type 2 diabetes Cardiovascular disease Certain types of cancer Stopping breathing at night (sleep apnea) Stigmatization, psychological problems and dissatisfaction Source: FHI In 2019, a high BMI was linked to around 2,800 deaths in Norway – close to 7 percent of all deaths nationwide, according to the Norwegian Institute of Public Health (FHI). Body mass index (BMI) Body mass index, or BMI (body mass index), is an international measure to be able to measure and compare the health risks of being overweight and underweight, and to follow the development in the own population. BMI does not take into account the distribution of excess weight between muscle tissue and fat tissue. With Dimed, for example, bodybuilders will be able to appear overweight, even if they have a low fat percentage. BMI is defined as body weight divided by the square of the height given in meters (kg/m2). Underweight: Lower than 18.5 Normal weight: 18.5 – 24.9 Overweight: 25 – 29.9 Obesity: Over 30 Morbidly overweight: Over 40 or over 35 with a co-morbidity. For example: If one is 170 cm tall and weighs: 66 kg = 23 BMI (normal) 78 kg = 27 BMI (overweight) 87 kg = 30 BMI (obesity) (Source: Store norske lexikon, Folkehelseintituttet) Seen at the population level, patients start to burden the healthcare system when the BMI is over 25, i.e. overweight, explains health economist and professor at UiO, Jonas Minet Kinge. – It is because of the other diseases for which obesity is a risk factor. For example, diabetes is very resource-demanding, says Kinge. Money-sucking In a report from 2023, Menon Economics estimates the total social costs of obesity and overweight at NOK 238 billion annually. The report has been carried out on behalf of Novo Nordisk, the pharmaceutical company that produces Wegovy and Ozempic, among others. The report separates the costs into three categories: Healthcare costs: About 90 per cent of the costs are related to diseases related to overweight and obesity, and 10 per cent is weight-reducing treatment. Loss of production: It is the total loss of value from reduced work effort: lost income for employees, reduced profit for businesses and lost tax revenue. Burden of disease: Burden of disease is the loss of health-related quality of life as a result of illness, and loss of years of life as a result of early death. To calculate that, a quarter of a year of life lost gives a value of NOK 1.41 million, in line with guidelines from the Norwegian Directorate of Health. The number may be staggering, but is it a reasonable estimate? – Yes, they have used approved standard methods to calculate this. But there are many uncertainties in such calculations too, says health economist Kinge. He highlights the figure for the burden of disease, and points to disagreement in the research field linked to the valuation of lost years of life. THE CHICKEN AND THE EGG: “What is the origin of what” is the question from health economist Christina Edwards. Photo: Privat / news Another problem is linked to causal relationships, points out Christina Edwards, who is a health economist and postdoctoral fellow at the Department of Community Medicine and Nursing at NTNU. – Even if people with obesity have a disease that costs money to treat to a greater extent, compared to a person who is not obese, it does not necessarily mean that the cost would disappear if obesity were removed, says Edwards. DOCUMENTATION: Professor Jonas Minet Kinge is concerned that the effect of medicine is thoroughly documented. Photo: Privat / news Jonas Minet Kinge has another monkey, now linked to potential gains in productivity. His point can be summed up like this: Suppose you are disabled and are given diet pills that result in a 15 percent weight loss. Does that mean you will be 15 percent more capable of working? – Not necessarily. It may be that way, but it must be well documented if it is to form a basis for prioritizing medicine, says Kinge. Fears for other patients Truls Vasvik, spokesperson for health policy in the Labor Party, fears that the changes that Hoksrud and Haug are advocating for could go awry and have consequences for other patient groups. For example, medicine, which is more widespread among pensioners, may be given lower priority if productivity gain is part of the assessment criteria, since they are not in work. – It is startling that the Frp and MDG want to create a system where whether you can work or not will determine whether you get help from the health service, writes Vasvik in an e-mail. – We are now working on creating new prioritization criteria. We must do that in a thorough manner. But we are not going to create prioritization criteria that create an A and B team in the health service. CRITICAL: Health policy spokesperson in the Labor Party, Truls Vasvik, is afraid that new prioritization criteria may have strange results for other patients. Photo: news Vasvik is nevertheless excited about the further development of the new slimming drugs. But he will not promise a blue prescription. – Wegovy has been assessed based on today’s prioritization criteria. If the price goes down and we get better documentation of the effect, then it is natural that a new assessment will be made as to whether Wegovy should be on a blue prescription. Published 16.08.2024, at 14.08
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Will change the rules – news Norway – Overview of news from different parts of the country
