Approving new drugs in the UK comes at a huge cost to the health of many others through lost funding, new research has found.
New medicines can be a lifeline for millions of patients, but public spending on new medicines in the UK for more than 20 years has come with significant trade-offs, meaning money paid for new drugs could be better spent on other health services. A new analysis has revealed that there is. .
When Britain’s National Institute for Care Excellence (NICE) recommends a new drug to a patient, the National Health Service (NHS) must pay for it if a doctor prescribes it.
But with limited budgets, spending by the NHS on new drugs means that other health services are left unfunded. Additionally, this is not always taken into account when policy makers and health professionals weigh the cost-effectiveness of new drugs. The Lancet Medical Journal.
With this gap in mind, researchers from British and American universities modeled how this trade-off shapes the overall health of the UK population.
“We know that patients benefit from new medicines, but that also means that society has to be denied access to services because funds need to be reallocated to paying for medicines rather than something else. For others, it comes at a cost,” said associate Hussein Nasi. Professor of Health Policy at the London School of Economics and lead author of the study told Euronews Health.
“These are the invisible people who are suffering losses as a result of explicitly prioritizing the health benefits derived from drugs.”
Public spending trade-offs
Other analyzes show that it costs on average around £15,000 (€18,000) to stay healthy for a year, a measure known as a quality-adjusted life year (QALY). .
The researchers used this figure to calculate how much of the £75.1bn (€90.2bn) the NHS spent on new medicines between 2000 and 2020, if that money had been allocated to other health and care services. , estimated the number of years of health that one can actually buy. Treatment.
They found that the new drug provided nearly 3.75 million QALYs in revenue for approximately 19.8 million patients. But if that money had been used for other health services, it could have supported 5 million QALYs.
This amounts to a net loss of approximately 1.25 million years of healthy lifespan.
The researchers did not link the QALYs sacrificed to specific medical care, but rather estimated the aggregate health impact, Nasi said.
For example, in 2010 NICE recommended the drug trastuzumab for patients with late-stage gastric cancer and estimated that trastuzumab, worth around £43,200 (€51,900), could buy a year of healthy life.
According to the analysis, this amounts to 2.88 healthy years lost elsewhere.
A NICE spokesperson acknowledged that spending on new medicines displaces funding for other health services, but NICE only recommends new treatments that “offer value for money for taxpayers”. He said that
A NICE spokesperson said: “Every pound in the NHS budget can only be spent once,” and even if the agency does not recommend a new drug, it is likely to be prescribed to some patients anyway. He added that this would lead to disparities in access at local medical institutions. level.
Which drugs are covered?
One challenge is that NICE coverage prioritizes patients with more severe unmet health needs who could benefit from new medicines, such as cancer patients or those receiving end-of-life care. That’s what I’m doing. These drugs are often more expensive than other treatments, such as hip and knee replacements.
Over the 20-year study period, two-thirds of new drug evaluations were for cancer and immunotherapy, but only 8% were for more common vascular problems such as stroke and coronary artery disease.
The study found that of the 183 new medicines recommended by NICE, only 19% had generic or biosimilar alternatives, which are generally cheaper than name brand medicines.
Amitava Banerjee, professor of clinical data science at University College London, said the findings could help accelerate drug development for more common diseases to maximize health benefits from government spending. He said this shows that more needs to be done.
When it comes to cancer drugs, policymakers and researchers are focusing on the gap between surrogate outcomes, such as changes in tumor size on imaging, and long-term effects on reducing mortality and improving quality of life. We should,” Banerjee said in a statement.
A more comprehensive view of drug cost-effectiveness
This finding is particularly salient for health systems. in the UK and other european countries Debating whether you should pay for a new blockbuster anti-obesity drug that could also help patients manage it Other health conditions.
Health officials are concerned about the long-term hit to budgets because drug companies have suggested these drugs could be taken for a lifetime.
The study authors say the UK government should consider adjusting how it determines the cost-effectiveness of new medicines, and may also push for lower drug costs to bring them more in line with other health services. , he said.
However, such a move would likely face fierce opposition from the pharmaceutical industry.
Meanwhile, Mr Nashi said NICE should be more transparent about the potential impact of prioritizing new medicines over other treatments.
“I think if committee members within NICE were presented with that trade-off, they might reach a different decision,” Mr Nasi said.
“We only talk about profits [of new drugs] As if there were no opportunity costs or unintended consequences of those benefits at the population level. ”