The NHS using Cheaper Untested Drugs to Cut Costs and make their Limited Resources Stretch Further

Posted by PITHOCRATES - May 6th, 2012

Week in Review

Who is more evil?  The pharmaceutical that has spent time and money to develop a new drug?  And then further time and money going through a lengthy clinical testing process to guarantee (as best as possible) that the new drug is safe?  When proven ‘safe’ by the regulators to sell it at a patent-protected price?  To cover all of these costs.  All the costs for the 20 new pills that failed along the way?  And the inevitable lawsuits when a proven ‘safe’ drug proves NOT to be safe after all?  Or is the health service using a cheaper drug that appears to give similar results?  That hasn’t gone through that extensive clinical testing process?  But they use the cheaper drug because they can treat more patients than they can with the more expensive but clinically tested drug?

Oh, it’s a perplexing and vexing question.  For we want new super drugs to cure all that ails us.  But we want those drugs to be cheap.  And safe.  But if they end up hurting us we’ll sue the bejesus out of everyone who allowed that drug to get into our system.  Which brings us to a great catch-22.  Drugs cannot be both cheap and safe.  For even the expensive ones sometimes prove not to be safe.  Especially if we rush them to market to save lives.  Only to find that by rushing those drugs to market they’ve harmed the lives we were trying to save.

Sadly, they have to balance the quality of health care with the cost of that health care.  Which is a never ending struggle in the NHS (see Using Avastin for eye condition wet AMD ‘could save NHS £84m’ by Branwen Jeffreys posted 5/6/2012 on BBC News Health).

The NHS could save £84m [about $135 million US] a year by using a cheaper drug to treat a leading cause of blindness, research suggests.

NHS-funded research says both Lucentis and Avastin have a similar effect in preventing loss of sight when used for wet age-related macular degeneration.

Lucentis costs about £700 an injection, and Avastin £60 – but Avastin is not officially approved for eye conditions.

Novartis, which markets Lucentis in the UK, is taking legal action against four NHS trusts for using the cheaper drug.

The company says the use of Avastin – developed to treat cancer – is undermining patient safety…

Lucentis is officially approved for use in eyes, and is the treatment recommended in England and Wales by the watchdog NICE.

Roche, which owns the rights to the similar, but cheaper, Avastin, has never sought to have it approved for use in eyes, which would involve further clinical trials.

But many doctors have been using Avastin at their clinical discretion…

As they both target blood vessels, the IVAN researchers particularly looked at whether there was an increased risk of heart attack or stroke…

Novartis argues that Lucentis has a safety profile proven in clinical trials and approved by the regulators.

It says the US research, which has just published data from the second year, highlights what it describes as “serious safety concerns” about the use of Avastin in this unlicensed treatment of eyes.

It points, for example, to a higher rate of stomach and gut disorders in patients given Avastin…

Cost pressures on the NHS have led to an increased use of Avastin…

The financial stakes are high both for the NHS and the pharmaceutical company.

Perhaps the question should be which is more evil?  The pharmaceutical industry?  Or a national health care system that has put cost considerations before patient care?  For the use of the cheaper drug is driven by the cost of the drug.  Not by the effectiveness of the treatment.  They may determine that the cheaper drug may be as safe as the more expensive drug.  The drug that was specifically clinically tested and approved by regulators for that specific use.  But this points out another issue.  Is the drug approval process not necessary for all drugs?  And, if not, why have it?  If it is only delaying bringing more life-saving drugs to market at affordable prices?  And if this is all true then should there be a ban on all lawsuits against pharmaceuticals?  Who were only doing what everyone demanded of them.  Rushing new life-saving drugs to market.

Perplexing and vexing questions, indeed.  And ones that we will hotly debate as Obamacare comes on line.  For Obamacare will have greater cost constraints than the NHS.  For Obamacare will treat far more people than the NHS.  About 5 times as many as the UK based on population sizes.  Which means the debate under Obamacare will not be about saving $135 million.   But about $683 million.  Over half a trillion dollars.  Or about half of the 2011 budget deficit.  So you know Obamacare will consider these cost savings.  And use drugs that haven’t gone through the clinical testing process like they are in the UK.  And actively search for other savings.  And place incredible pressures on the pharmaceuticals.  Making it very difficult for them to make a profit.  Or to even cover their costs.  And when that happens they will drop out of the business of finding new super drugs to cure all that ails us.  Making what ails us really ail us.  Reducing the quality of our lives.  Perhaps even killing us.

www.PITHOCRATES.com

Share

Tags: , , , , , , , , , , , , , , , , ,