A new study has found that the approval of new drugs in England has come at the cost of many other people’s health due to a loss of funding.
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New drugs can be a lifeline for millions of patients, but over two decades in England, public spending on them is accompanied by significant compromises which indicate that money paid for new drugs could be better used in other health services, according to a new analysis.
When England’s National Institute for Care and Excellence (NICE) recommends a new medicine for patients, the National Health Service (NHS) must pay for it if it is prescribed by a doctor.
But with a limited budget, NHS spending on new drugs means that other health services will not be fundedwhich is not always taken into account when policy makers and health professionals assess the cost-effectiveness of new drugs, according to the study published in the Lancet medical journal.
With this gap in mind, researchers from British and American universities have modeled how this trade-off impacts the health of the entire English population.
“We know that patients benefit from new medicines, but this comes at a cost to other members of society who may have to forgo access to services because funds must be reallocated to paying for medicines rather than anything else”Huseyin Naci, associate professor of health policy at the London School of Economics and lead author of the study, told Euronews Health.
“It’s the invisible people who lose because of the explicit priority given to the health benefits we derive from medicines.
Public spending compromises
Further analysis showed that on average it costs around £15,000 (€18,000) to pay for a year of health care, a measure known as quality-adjusted life years (QALYs).
The researchers used this figure to estimate the number of years of health that could be purchased with £75.1 billion (€90.2 billion) the NHS spent on new medicines between 2000 and 2020if the funds had been allocated to other medical services or treatments.
The researchers found that the new drugs saved nearly 3.75 million QALYs for about 19.8 million patients, but if these funds had been used for other health services, they could have supported 5 million QALYs.
This represents a net loss of approximately 1.25 million years of healthy life.
The researchers did not link the QALYs sacrificed to specific medical care, but rather estimated the overall health impact, Naci said.
For example, in 2010, the National Institute for Care and Excellence recommended trastuzumab for patients with advanced stomach cancer, estimating that around £43,200 (€51,900) ) of trastuzumab can buy a year of healthy life.
In the analysis, this translates to 2.88 years of healthy life lost elsewhere.
A NICE spokesperson acknowledged that spending on new drugs displaces funds intended for other health servicesbut said the agency only recommends new treatments that “offer good value for money for the taxpayer.”
“Each pound (currency, editor’s note) of the NHS budget can only be spent once”the NICE spokesperson said, adding that even if the agency did not recommend the new drugs, they would likely be prescribed to some patients anyway, leading to disparities in access locally.
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Part of the problem is that NICE coverage prioritizes patients with the most serious unmet health needs who could benefit from new medicines, such as people with cancer or those who are in end of life. Often, these medications are more expensive than other treatments, such as hip or knee replacements.
Over the 20 years covered by the study, two-thirds of new drug evaluations were for cancer and immunology treatments, compared with just 8% for more common vascular problems such as stroke or coronary heart disease.
Of the 183 new medicines recommended by NICE, only 19% had generic or biosimilar alternatives, which are generally cheaper than branded medicines, the study found.
Amitava Banerjee, professor of clinical data science at University College London, said the findings indicate there should be do more to encourage drug development for more common diseases in order to maximize the benefits of public health spending.
ADVERTISEMENTWhen it comes to cancer drugs, policymakers and researchers should “to examine the gap between surrogate outcomes such as changes in tumor size on imaging and the long-term impact on reducing mortality and improving quality of life,” Mr. Banerjee said in a statement.
A more global vision of the cost-effectiveness of medicines
The findings are particularly important as health systems in the UK and other European countries debate whether they should pay for new blockbuster obesity drugs, which may also help patients to manage other health problems.**
Health officials worry about the long-term budgetary impact of these drugs, which manufacturers say could be taken for life.
According to the study authors, the British government should consider adjusting the way it decides on the cost-effectiveness of new drugs, and could even lobby to lower drug costs so that they are more aligned with other medical services.
ADVERTISEMENTHowever, such a measure would probably come up against fierce opposition from the pharmaceutical industry.
In the meantime, Mr Naci believes that NICE should demonstrate greater transparency about the potential consequences of prioritizing new drugs compared to other treatments.
“I suspect the members of the NICE committee will make different decisions if presented with this compromise”said Mr. Naci.
“We only talk about the benefits [des nouveaux médicaments] as if there were no opportunity costs or unintended consequences of these benefits at the population level.”
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