BBC: Health/Wonder drugs could bankrupt NHS
Saturday, November 21, 1998 Published at 16:20 GMT
Viagra: massive potential cost to the NHS
The inexorable advance of modern technology is about to
pose the biggest problem the NHS has ever faced.
Scientists using the latest techniques are producing ever
more effective drugs to combat a range of diseases that
until now have defeated modern medicine.
However, this technology comes at a price - a price that
the NHS will struggle to afford, no matter how much
extra cash is pumped in by the government.
A survey published this week by the National
Schizophrenia Fellowship has found that nearly half of
health authorities in the UK cannot afford modern
anti-psychotic drug treatments for schizophrenics.
Drugs such as clozapine, olanzapine and resperidone
that can transform the lives of seriously mentally
patients are blacklisted up and down the country.
Instead, thousands of patients are being given old, less
effective drugs which have serious side-effects.
Health authorities are taking a tough line, but, with finite
resources, they have no real choice. The NSF says a
yearly course of the new drugs can cost up to £5,800
per person, compared with £100 a person for a course of
the old ones.
Multiple sclerosis patients, too, have found that they
cannot be prescribed Beta Interferon on the NHS, even
though the drug has been clinically proven to have a
dramatic effect on a potentially crippling disease.
The impotence treatment Viagra threatens to cost the
NHS so much money - approximately £1bn a year - that
ministers have blocked its prescription until they decide
how best to meet demand. There are many more
examples.
Stephen Thornton, chief
executive of the NHS
Confederation, which
represents health authorities
and trusts, said: "There are a
growing number of very
expensive and clinically
effective drugs coming on to
the market. In the last three
or fours we have seen a
number, and in the next few
years we will see even more.
"They (health authorities)
have to take some critically difficult decisions, weighing
up on balance whether they invest in a drug like this, or
whether they invest in other new procedures and
interventions in other parts of the health service."
There appears to be no easy answer. Certainly, the
drugs industry claims costs cannot be cut back.
Richard Ley, spokesman for the Association of the
British Pharmaceutical Industry, said: "We have done
the easy stuff, and we are left with the much more
difficult and complex problems which often require very
expensive new technologies."
The government has denied that rationing of care is
necessary in the NHS.
But critics claim plans to make GPs responsible for
local health care provision are merely an attempt by
ministers to ensure that patients who are told they
cannot have treatment blame their doctor, not their MP.
'Don't pass the buck'
Godfrey Horridge, a full-time negotiator for the pharmacy
industry, said tough decisions about the rationing of drug
treatments was inevitable and they should be the
responsibility of the government.
"The government as the caretaker of the NHS should
take responsibility rather than trying to pass the buck,"
he said.
"If the NHS cannot afford new drugs then someone has
got to take responsibility for making tough decisions.
Difficult decisions will have to be made, and priorities will
have to be set.
"Public expectation has always run ahead of available
resources, and as patients have become better educated
expectations have grown. People now expect expensive
treatment to be available almost on demand, but
realistically those expectations will never be met."
Mr Horridge said ensuring patients received cheaper
generic drugs, rather than brand names, could save a
small amount of money.
However any attempt to change current regulations so
that drug companies cannot market their new treatments
exclusively when they first hit the market would backfire,
he claimed. Profits would be hit too hard, and innovation
would be stifled.
Public pressure
Dr Judy Gilley, a GP
negotiator for the British
Medical Association,
believes the government
reforms have created a
mechanism by which public
pressure can be brought to
bear on the government to
ensure that the NHS does
prescribe clinically effective
treatments.
Primary care groups, led by
GPs, will be responsible for
commissioning local health care services, but they will
have to abide by guidance on suitable treatments laid
down by the government's new National Institute for
Clinical Excellence (NICE).
"PCGs will be able to argue that, yes, a treatment is
expensive, but it has been recommended for use by
NICE so it should be used," said Dr Gilley.
"Then, if there is a shortfall in the prescribing budget as
a result it will be up to the PCG together with patient
interest groups - which must be consulted under the
government's proposed reforms - to utilise public opinion.
In that way the rationing dilemma can be shared with the
public."
Dr Gilley, however, is not convinced that the advent of
new treatment will necessarily mean that costs rise in
perpetuity.
"It may be that there are long term cost benefits from
expensive new drugs," she said.
"They may reduce morbidity tremendously and may
reduce the need for surgical interventions and hospital
stays.
"People should not think in knee-jerk terms. New
treatments don't necessarily mean more money is
needed, what is needed is careful, on-going review."
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