I recently read about British man who claimed that a new Alzheimer’s drug gave him his life back. When he began showing early signs of dementia his doctor recommended that he enroll in a clinical trial testing donanemab, an experimental Alzheimer’s drug. The man claimed he could tell the difference after he began taking it. Not discussed in the article is that after the clinical trial ends he will not be able to continue taking it unless he pays for it privately. Indeed, a recent headline for a similar drug from the same class read First drug to slow Alzheimer’s too costly for NHS:
The first drug to slow the progression of early stage Alzheimer’s will not be available on the NHS in England because health assessment body NICE says the benefits “are too small to justify the costs”.In trials, the drug was shown to slow cognitive decline by about a quarter in patients in the early stages of Alzheimer’s over the course of 18 months.But in draft guidance, NICE said there was a significant cost to the treatment including intensive monitoring for side effects and fortnightly trips to hospital for patients.
A back of the envelope calculation shows the drug cost about $50,000 a year. The NHS deemed that too costly compared to the benefits.
The British National Health Service (NHS) is a tightwad. It uses cost/benefit analysis to decide whether to provide access to specific drugs. Many expensive drugs do not make the cut due to their cost. The British health agency believes cheaper drugs that benefit many people are preferable to hyper expensive drugs that benefit only a few. A public policy research institute, The Kings Fund, explained the issue in a recent report:
Should the NHS increase drugs spending to pay for the latest drugs for hepatitis or cancer, drugs that might prolong life for some patients but cost tens or even hundreds of thousands of pounds per course of treatment? Or should it spend the money in other areas, for example, ensuring that people can see a GP when they need one, ensuring that vulnerable people get basic treatment for long term-conditions or tackling health inequalities? How health systems make these decisions determines, in large part, their effectiveness. The choices determine the quality of people’s lives and, in some cases, who lives or dies.
Another drug the NHS does not reimburse is Strensiq:
Strensiq (asfotase alpha) is a treatment for the rare disease paediatric-onset hypophosphatasia, with just seven people a year diagnosed with the condition in England every year.
At a cost of around $450,000 a year it is expensive. However, it is not just hyper expensive drugs the NHS refuses to cover. Some are blockbuster drugs that are money-saving compared to older therapies. Consider the drug Sovaldi, the first actual cure for Hepatitis C. It cost $1,000 a pill (80 needed for a treatment) back in 2014 when it came out. Sovaldi was criticized as an excessively expensive drug. It actually works and lessens the need for liver transplants. Yet, the NHS decided it was too expensive and would not pay for it even though their own calculations deemed it cost effective.
The list of drugs not available under the NHS is long and includes two new cancer drugs:
The National Institute for Health and Care Excellence (NICE) has ruled in its final draft guidance that two innovate drugs – olipudase alfa for acid sphingomyelinase deficiency (ASMD) Niemann-Pick disease, and trastuzumab deruxtecan for advanced HER2-low breast cancer – are too expensive for routine NHS use.NICE underlined that, despite demonstrating clinical benefits, neither drug represented value for money, and the cost the NHS was being asked to pay was too high in relation to the benefits each provided.
A drug for cystic fibrosis drug too costly, says NICE and a drug for prostate cancer. Even the blockbuster cancer drug Avastin was once on the list when it came out years ago. Many of the drugs Britain refuses to pay for the NHS admits are effective, even cost effective but says “no.” The British National Health Service would rather spend its money elsewhere.
Policies to provide benefits to large segments of healthy people rather than on the desperately sick have been described as the politics of medicine. People who are relatively healthy vote, whereas those who are sick often cannot. Recently I wrote about whether Medicare should ration drugs. It is easy to look at some hyper expensive drugs with questionable benefits and say Medicare should put its foot down. Yet, it also pays to look at what could happen if rationing is taken too far.