Are expensive drugs worth it? New medicines can be very costly to the health of other patients
New drugs can be a lifeline for millions of patients, but over two decades in England, public spending on them has come with significant trade-offs that show money paid for new drugs could be better spent on other health services, has found a new analysis. After England's National Institute for Care and Excellence (NICE) recommends a new drug for patients, the National Health Service (NHS) must pay for it if it has been prescribed by a doctor.
But with a tight budget, NHS spending on new drugs means other health services will not be funded and this is not always taken into account when policymakers and health professionals weigh up the cost-effectiveness of new drugs, according to the study in the journal Medical Lancet.
With this gap in mind, researchers from UK and US universities modeled how this trade-off shapes the health of the general population of England. Other analyzes have shown that, on average, it costs around £15,000 (€18,000) to pay for a year of health, a measure known as quality-adjusted life years (QALYs).
The researchers used this figure to estimate the number of healthy years that could essentially be bought with the £75.1 billion (€90.2 billion) the NHS spent on new drugs between 2000 and 2020, if the funding had been allocated to other services medical or treatments. They found that the new drugs gained nearly 3.75 million QALYs for about 19.8 million patients, but if this funding had been used for other health services, it could have supported 5 million QALYs. This is a net loss of about 1.25 million healthy life years.
For example, in 2010 NICE recommended the drug trastuzumab for patients with late-stage stomach cancer, estimating that around £43,200 (€51,900) of trastuzumab buys a year of healthy life. In the analysis, this translates to 2.88 healthy years lost elsewhere. Part of the challenge is that NICE coverage prioritizes patients with more serious unmet health needs who may benefit from new medicines, such as those with cancer or undergoing end-of-life care. Often, these drugs are more expensive than other treatments, such as hip or knee replacement.
During the 20-year study period, two-thirds of new drug reviews were for cancer and immunology treatments, while only 8% were for more common vascular issues such as stroke or coronary artery disease. The study found that only 19% of the 183 new medicines recommended by NICE had generic or biosimilar alternatives, which are usually cheaper than branded medicines.
Amitava Banerjee, a professor of clinical data science at University College London, said the findings show more needs to be done to encourage drug development for more common diseases to maximize the health benefits of government spending. The findings are particularly salient as health systems in the UK and other European countries debate whether to pay for new anti-obesity drugs that can also help patients manage other health conditions.
Health officials have been concerned about the long-term budget hit of these drugs, which drugmakers have suggested could be taken forever. The study's authors said the UK government should consider adjusting the way it decides on the cost-effectiveness of new medicines, and could even push to lower drug costs to make them more compliant. with other medical services.
However, such a move is likely to face stiff opposition from the pharmaceutical industry. Meanwhile, Naci said NICE should be more transparent about the potential consequences of prioritizing new drugs over other treatments.
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