"It's clear India will suffer like the rest of the world, perhaps more that the rest of the world."

Experts estimate a temperature rise of between 2 and 3.5 degrees centigrade, would cost India a loss of between nine and 25 percent of total agricultural revenue. Agriculture makes up around 22 percent of India's gross domestic product.

Stern said temperature rises would also mean vector-borne diseases like malaria and dengue fever spreading to higher altitude regions known for being free of mosquitoes.

As a result, there was a likelihood of more deaths that would result in lower productivity, he said.

The head of Britain's Economic Service said the melting of Himalayan glaciers would mean neighboring Bangladesh could experience serious floods as a result of rising sea levels, sparking mass migration across the border into India.

He said the flow of water from the glaciers would be curtailed during India's dry season and would have "serious consequences".

Experts say melting glaciers will affect one-sixth of the world's population residing mainly in the Indian subcontinent. India's Ganga River receives 70 percent of its summer water flow from the Himalayan glaciers and sustains over 500 million people.

Stern said India was making progress in adapting to the challenges faced in curbing emissions and investing in clean development mechanisms. But climate change was an inequitable process in which rich nations had to take the burden of responsibility, he said.

"This is a doubly inequitable process as it's the rich countries that are responsible for 75 percent of the greenhouse gases that are up there and it's the poor countries that will be hit earliest and hardest," he said.

"All countries must be involved, but equity demands that the rich countries bear the big majority of the cost."

Copyright © 2006 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.

U.S. should merge anemia drug, dialysis costs

Last Updated: 2006-12-06 15:00:54 -0400 (Reuters Health)

By Susan Heavey

WASHINGTON - Medicare, the U.S. insurance program for elderly and disabled Americans, should lump the price of anemia drugs with overall payments for kidney dialysis services to improve efficiency and contain costs, according to a government report released on Tuesday.

Medicare's method of paying separately for anemia drugs, primarily Amgen Inc.'s Epogen, and for dialysis services is a concern as use grows, the Government Accountability Office (GAO) said. Medicare covers about 43 million Americans and spent $2 billion on Epogen in 2005.

The report by the investigative arm of Congress was released ahead of a U.S. House of Representatives Ways and Means Committee hearing on Wednesday to discuss use of the drugs and growing government spending on dialysis patients.

Medicare has taken steps over the years to address its payment policy for kidney disease treatment, but lawmakers may need to intervene, the GAO said.

"The Congress should consider establishing a bundled payment system for all (end-stage renal disease) services, including drugs, as soon as possible," the GAO said.

Analysts have said they do not expect any major changes in reimbursement after the hearing.

Critics have said the Medicare price structure drives up use of the drugs, and the program does not limit the dose doctors can administer with government reimbursement.

Industry analysts have said bundling anemia drug reimbursement with dialysis payments would remove the profit incentive for doctors to use the drugs.

Recent studies also linked higher doses of anemia drugs with heart-related complications.

Currently, the U.S. Medicare program reimburses dialysis providers for Epogen at the average sales price (ASP) plus a 6 percent premium. Under that formula, the higher a drug is priced, the more money doctors make.

"The ASP method relies on market forces to moderate manufacturers' prices, however, Epogen is the product of a single manufacturer and has no competitor products," the GAO said.

Medicare bundles drug prices with other costs for most other types of therapies it covers.

Separately, Centers for Medicare and Medicaid Services Acting Administrator Leslie Norwalk said the agency agreed such reforms would help promote efficiency and flexibility for dialysis centers.

Amgen's Aranesp, a longer lasting anemia drug, is not generally marketed to dialysis clinics, according to the GAO. Johnson and Johnson's Procrit drug also treats anemia in kidney patients but is not approved for those on dialysis.

The GAO report is online at http://waysandmeans.house.gov/media/pdf/healthdocs/120506gaorpt.pdf

Copyright © 2006 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.