It is well known that many developed countries ration new drugs. That is one reason drugmakers agree to sell their products to some rich countries at a discount of what Americans pay. In England the National Health Service (NHS) is made up of regional health authorities and one regional may invest more in newer drugs than another. Or in some cases a regional NHS health authority budgets a set amount for certain drugs and when the money is gone the drugs becomes unavailable. This means a high-priced cancer drug may be available in one area while not in another. This is what the British press sometimes calls the post code lottery. The NHS has been working to narrow the gap across regions but access to many treatments varies by region, including waiting lists for treatments. Writing in in Euro News:
New medicines can be a lifeline for millions of patients – but over two decades in England, public spending on them came with significant trade-offs that indicate the money paid for new drugs may be better used on other health services, a new analysis has found.But with a limited budget, NHS spending on new drugs means other health services won’t be funded – and this isn’t always considered when policymakers and health professionals weigh the cost-effectiveness of new medicines, according to the study in the Lancet medical journal.
In other words, British public health experts admit new drugs benefit some patients, but they come at a cost to other patients. This is known as the opportunity cost. Between 2000 and 2020 the NHS spent roughly £75.1 billion on new drugs, or about $94 billion at current exchange rates. The benefits of new drugs are estimated using quality adjusted life years (QALY). The QALY is about $20,000 by their calculations.
They found the new drugs earned nearly 3.75 million QALYS for about 19.8 million patients – but if that funding had been used for other health services, it could have supported 5 million QALYs.That’s a net loss of about 1.25 million healthy life years.
Officials didn’t specify any particular drugs that are a poor value, but the following is an example that illustrates their point.
For example, in 2010 NICE recommended the drug trastuzumab for patients with later-stage stomach cancer, estimating that about £43,200 (€51,900) worth of trastuzumab buys one healthy life year.
In the analysis, that translates to 2.88 healthy years lost elsewhere.
Economist Jason Shafrin reports the British cannot even agree on a common standard, saying:
Does the UK use £15,000, £30,000 or a £70,000 per QALY cost effectiveness threshold?
The United States uses a much higher standard. In the mid-1990s I was taught $40,000 was the value of a year of life and it’s gone up since then, although different organizations use different standards. The NHS argues these are necessary trade-offs when resources are limited:
A NICE spokesperson acknowledged that spending money on new medicines does displace funding for other health services, but said that the agency only recommends new treatments that “offer value-for-money for the taxpayer”.“Every pound 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 for some patients anyway, leading to disparities in access at the local level.
European officials are currently debating whether to cover GLP-1 anti-obesity drugs. GLP-1 drugs would increase spending and likely increase longevity of those taking them, but at what cost to others? That’s the question public health officials are trying to answer. Experts propose the NHS negotiate down the price of drugs or limit their use to equalize the cost per life years saved across drugs and other medical services. Doing so would maximize the years of life saved per dollar (i.e. British pound) of resources. However, experts warn such a move would likely face opposition from drug companies.
This is an interesting argument. Drug therapy is the most efficient form of medical care, costing far less than hospitalization for example. The British are looking more closely at which drugs are efficient, and which ones take resources away from other services due to their costs. Although morbid, these types of discussions are worth having.