Medical expert Tinatin Turdziladze says the case of Duchenne muscular dystrophy (DMD) poses one of the toughest dilemmas for the Georgian government - how to finance extremely costly treatments in a way that is fair, effective, and financially sustainable. In a detailed post, she stresses that the state must avoid two harmful extremes: either refusing to fund new therapies altogether or purchasing every available medication at the expense of other healthcare programs.
According to Turdziladze, more rational approaches exist within the Health Technology Assessment (HTA) framework. One option is restricted reimbursement - financing drugs only for specifically defined patient groups based on clinical criteria such as age, disease stage, genetic profile, or functional status. In parallel, she says the state should begin systematic collection of real-world data to inform long-term decisions. Another key tool is a Managed Entry Agreement (MEA), where the government and manufacturers share financial and clinical risks through pre-agreed pricing, performance conditions, and monitoring requirements.
A second model involves a structured multi-step evaluation process, including clinical evidence assessment, cost-effectiveness analysis, budget-impact projections, and negotiations with manufacturers on price reductions or risk-sharing. Turdziladze notes that these approaches demonstrate realistic and balanced alternatives to the current stalemate, allowing access to medication while protecting the healthcare system’s sustainability.
For over a year, parents of children with DMD have urged the government to import and fund life-extending therapies. Health Minister Mikheil Sarjveladze recently stated that safety concerns and high costs remain major barriers, noting that some requested drugs lack EMA authorization. He said treatment for around 100 patients could cost the state up to 100 million GEL annually. Turdziladze argues that although the decision is complex, viable solutions exist and children must be given a chance.
