New drugs 'benefit patients, but maybe not populations'

The money spent by the NHS on newly approved therapies recommended by NICE might have been better spent elsewhere, according to a new study.

The paper – published in The Lancet - revolves around an analysis of the 183 new medicines appraised for NHS use by NICE between 2000 and 2020 and concludes that there would have been a better return for society if the money had been invested in improving existing NHS services.

The analysis found that across all the 339 appraisals carried out for the new medicines, the median gain in quality-adjusted life years (QALYs) was 0.49 – in other words, they contributed around half a year of additional healthy life. QALYs measure the effects of improvements in both the quantity and quality of life associated with a treatment.

Extrapolating that to the patient population, the researchers calculate that the NHS spent £75.1 billion to generate 3.75 million QALYs in the 20-year period. However, they estimate that if that amount had been spent on NHS services that could not be funded due to the allocation of resources to new drugs, an estimated 5 million additional QALYs could have been generated.

The authors acknowledge that "few decisions in health care lead to as much controversy as those concerning the funding, or lack thereof, of new drugs," but point out that new medicines often carry high prices even though the evidence for their benefits remains uncertain at launch.

"Our finding emphasises the trade-offs and implicit prioritisation of people who will directly benefit from new drugs at the expense of people who will not," according to the scientists from the London School of Economics, University of York, and Brown University in the US.

The work has been praised for tackling the very complicated issue of drug innovation is funded in the NHS and other health systems around the world, and reinforces the view held by some that the use of new drugs – even within cost-effectiveness thresholds set by health technology assessment (HTA) agencies – may reduce overall population health as a whole.

University of Leeds health economist Dr Daniel Howdon said the new study is "excellent and well-founded" and probably represents the best estimate carried out to date on the societal impact of new medicine cost-effectiveness.

"While it may seem counterintuitive that the provision of a new clinically effective treatment may damage population health, the health gain arising from such a new clinically effective treatment must be seen set against the health loss arising from the denied alternative use of the funds used to provide it," he commented.

"Those who benefit from a newly-provided expensive treatment are identifiable – and are understandably given high prominence in reporting on these decisions. Those whose health does not benefit from alternative services…are, however, no less real for their lack of identifiability, and it would seem ethically problematic to consider their health to be less important," he added.

The authors of The Lancet paper recommend that changes to NICE's evaluation framework are made to "ensure that the inherent health trade-offs made by NICE – and the implicit prioritisation of some patient populations over others – align with societal views and preferences."

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