Dr Richard Greville says medicines are key to tackling illnesses, but face a tough challenge in the current political climate.
Healthcare systems across the developed world are facing a double whammy – rising demand for services alongside increased financial constraints. In Wales, addressing these issues within the current public spending environment is a tough challenge that can only be met by everyone involved in the nation’s health working together. This is why initiatives like the IWA’s “Let’s Talk Cancer”project, which brings people together to support innovation in the delivery of healthcare, are so important.
How society places a value on medicines has never been easy, and at times it has proven highly controversial. In an era of devolved healthcare, differences in policy across the UK can give rise to stark choices for individual patients and clinicians. Each time we hear of or read about a patient travelling over the border to receive a treatment they can’t access at home, it throws a spotlight on the issue of how different systems evaluate medicines, and how patients ultimately want the best care they can find.
Medicines, more so than any other intervention, have been assessed for their value and effectiveness for over 15 years. What makes that possible is the extraordinary, extensive research base in which innovative pharmaceutical companies, our members, invest. However, bringing medicines to life remains a risky, costly business. Without any guarantee of success, it costs £1.2billion per medicine, on average, to undertake the required research and development.
In a survey being launched this autumn and sponsored by the ABPI Cymru Wales Oncology Therapy Group, a sample of Welsh oncologists and haematologists overwhelmingly reported less and inconsistent access to new treatments within Wales.
These views support the work of a senior British oncologist, Professor Mike Richards, who in 2010 looked at international variation in the use of medicines. The Richards report compared the level of uptake for best-practice medicines in the UK and thirteen other countries. He found that the UK finished in the bottom four in the case of seven out of sixteen medicine groups – including for cancer medicines launched in the last five and ten years.
Professor Richards’ research was updated earlier this year by the Office of Health Economics, who expanded it to show results at a devolved nations’ level. Wales was shown to be using just above average amounts of the very newest, under 5-year old, cancer medicines (105%). However, for older treatments (launched over 10 years ago) the use was 70% of the average and, most worryingly, the data showed that for those treatments launched between 6 and 10 years ago, usage was at only 21% of the average.
This low usage is particularly disappointing when the pricing of medicines is taken into account. The Pharmaceutical Price Regulation Scheme (PPRS) is a voluntary agreement between the UK government (on behalf of all the nations of the UK) and the pharmaceutical industry, designed to control how much the NHS spends on branded medicines. This gives companies greater predictability in the UK – recognising the high cost of researching and developing innovative new drugs – while at the same time setting a limit on how much is spent on branded medicines in order to give stability for the NHS and the taxpayer. If the branded medicines bill in the UK exceeds the agreed level – i.e. if the pharmaceutical industry sells more than was agreed – then industry pays back the difference with limited exceptions, to the Department of Health.
What all this means in cash terms is that for this financial year (2015-16) the Department of Health has forecast that industry will make payments of up to £1 billion and this is expected to reach £4billion over the length of the current scheme.
At a devolved level, this equates to some £200 million coming into the Welsh Government’s budget.
The key priorities of everyone involved in healthcare must be focused on patients and delivering improved outcomes; working in partnership and improving patient access to the treatments that profoundly change their lives for the better. Medicines can play a vital role in the health of our nation, transforming the lives of people suffering from life-threatening illnesses and long-term conditions. In cancer alone, new therapies have contributed to a 20% fall in deaths since the 1990s, with two out of three people diagnosed with cancer now surviving at least five years.
There is a long way to go and there needs to be a commitment to collaboration with all those involved in the health system in Wales. Through initiatives, such as ‘Let’s talk cancer’, there is the opportunity to ensure that everyone, no matter what the disease or where they live, has the right access to the right medicine at the right time.