Recently, and by sheer coincidence, I had the fortune of rubbing shoulders with delegates to the 12th International Workshop on Clinical Pharmacology of HIV Therapy. Most of the rubbing of shoulders happened over dinner and pool side, since I wasn’t actually attending the conference. It was at one such rubbing of shoulders gathering that some of delegates, who mostly represented the United Kingdom’s National Healthcare Service (NHS) and pharmaceutical companies, began to complain about the new drug which NHS hospitals and trusts are almost, well actually are being forced to administer to their patients.
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| Some have accussed the consortium of taking a non-inclusive decision, through a very selective consultative process to procure and mandate the new drug at higher dosages because of perceived cost effeciency gains. |
According to the more vocal NHS pharmacists around the dining table, the drug in question had no particular benefits over anything else on the market – no higher efficacy or lower toxicity for instance, but the pharmaceutical company which owns the drug had struck a deal with the consortium buying the drug on behalf of the NHS that they would provide it at a much lower price if the consortium bought the much higher dosage than is currently the norm.
But surely the deal was struck with the consent of the consortium members?
Apparently not, and this example may surface what either is or may become a major flaw in David Cameron’s move to devolving purchasing power to the local level – equity and influence. In this brave new world a consortium has been appointed to purchase drugs and presumably other products and services on behalf of a number of hospitals in the London area and its peripheries. The only problem is that the said consortium chose only to consult with the larger teaching hospitals and more specifically a handful of ‘specialists’ within them before making the mammoth decision to not only purchase and mandate physicians to prescribe a drug blanketly but also recommend a higher dosage blanketly. And if my dinner dates were to be believed, almost 70 percent of the UK’s HIV patients are in London and seen by the smaller hospitals, who weren’t consulted and now face the likelihood of receiving steep fines if they don’t administer the new drug in order to meet presumably some of the terms agreed contractually with the Pharma company.
So what’s the big deal? Surely this is a win win for everybody?
The Pharma Company is definitely laughing all the way to the bank having more or less squeezed its main competitor out of the market; the NHS presumably is going to realise tangible cost reduction and well on average, the patient should be better off, right?
Taking the latter first; well, I’m no pharmacist, but fortunately I do have an iota of common sense, which leads me to agree with some of the pharmacists who were arguing that this approach is another step away from individual care to the idea of group based care, which can have quite significant impacts on patients. As with most therapeutic areas, HIV being no exception, we know that individuals and different demographic groups i.e. black Africans and Asians amongst others respond to and digest the same compounds very differently, how can moving towards the same dosage, and a higher one at that, for very disparate groups make best sense for the patients? ‘Ah’ you might say, ‘isn’t this all taken care of during clinical trials?’ While I can’t comment on the particular clinical trials for this drug, but I do know that through many clinical trials, for a number of reasons there is a notable absence of minority groups, it therefore becomes impossible to say ‘conclusively’ that the minority groups will respond to the drug in the same doses as the groups present in the clinic trials. Which then brings me to the second point; cost savings.
A recent article based on a report by Sundhiya Mandalia, states that the annual cost of providing HIV treatment and care in the UK could reach £758 million by 2013, and over £1billion when social and community care is included in the cost. The report goes on to state that “The direct cost for treatment and care for PLWHIV [people living with HIV] has risen 4.6 fold between 1997 and 2006,” and is projected to increase “1.5 fold” between 2007 and 2013. It concludes that the price is worth paying if the ‘cost effective’ regime maintains patients in better health, resulting in fewer health complications and social service needs and thereby generating fewer treatment and care costs. It is worth noting that according to some sources the care costs can amount to 60 per cent of the overall cost of treating a patient.
So why is any of this important? Well simply put, when we start moving away from individual treatment to group based treatment because the cost of procuring a drug at a higher dosage is cheaper it becomes more difficult to prescribe a course of treatment that will result in the best outcome for the individual, which is likely to result in more complications and higher care costs, which can make up the more significant proportion of the treatment costs. So are these cost savings simply a false economy?
And there you have it, what started off being a short vacation away from the pharma world, led to evenings in the sun pondering over the long term impact the current decisions Pharma companies and the NHS will have on individuals and society as a whole. When short term, short sighted cost reduction ambitions meet short term, short sighted top line growth ambitions, the mix could quite literally be deadly.
