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Vol 51 | No 12 | December 2013
134 DTB Select: 12 – December 2013 137 Thank you to contributors
138 Antivirals for Bell’s palsy? 141 Drug assessment: UK style
Appraising medicines: improving but not perfect Twenty years ago, the NHS spent around £2.6 billion/year on drugs prescribed in general practice. At that time, DTB hosted a symposium to consider the relationship between drug costs and treatment choices noting that “in a time of severe financial constraints for the NHS it is important that the money available is well spent. In the case of treatment that means the benefits must be worth the cost. There is, however, no agreed way of deciding when a particular health benefit to an individual is worth the cost to the NHS”.1 The symposium concluded that “drug costs might become more manageable if there was open unfettered discussion of costs and therapeutic value between health professionals, NHS managers and researchers, medicine producers and health service users”. Twenty years later and expenditure on drugs dispensed in primary care has increased four-fold to over £10 billion/year and the NHS is under even greater financial pressure.2–5 However, would those who attended the meeting in 1993 be pleased with the progress that has been made to meet DTB’s aspiration for a robust process for considering the cost and value of medicines in the NHS? In fact, much has changed for the better in a relatively short time. An article in this month’s issue highlights the processes that have evolved to provide guidance on the use of medicines in England, Scotland, Wales and Northern Ireland.6 In little under 15 years, three authoritative bodies have been established that have robust mechanisms in place and have developed expertise in assessing and appraising new medicines.
Patients, healthcare professionals, clinical experts and pharmaceutical companies are routinely involved in the assessment processes. In addition, all three organisations use the appraisal process to formulate guidance on the status and place of appraised medicines within their devolved health services. However, the health services in Scotland and Wales use their appraisal process to provide advice on the majority of new medicines and licensed indications. In England it remains the case that the responsibility for appraising most medicines falls to local commissioning groups. In addition, given that all three national organisations will review the same data, it could be argued that in a time of financial austerity it might be more economical to run a single UK appraisal service to supply the same information to each appraisal committee (national or local). Of particular interest is the fact that between 30% and 40% of appraisals had to be terminated because of non-submission of evidence by the pharmaceutical company. In Scotland and Wales this usually results in a recommendation not to support the use of a medicine. However, in England such decisions are left to the discretion of local decision making bodies with the inevitable duplication of effort and the potential for postcode availability.7 We believe that England should follow the example of Scotland and Wales and not support use of a medicine when the company does not comply with the submission processes.
1. Drug costs and treatment choices: a DTB symposium. DTB 1993; 31: 41-4. 2. Health and Social Care Information Service, 2013. Prescriptions dispensed in the community: England 2002–2012 [online]. Available: https://catalogue.ic.nhs. uk/publications/prescribing/primary/pres-disp-com-eng-2002-12/pres-disp-com-eng-2002-12-rep.pdf [Accessed 20 November 2013]. 3. Llywodraeth Cymru/Welsh Government, 2013. Prescriptions dispensed in the community in Wales, 2002–2012 [online]. Available http://wales.gov.uk/docs/ statistics/2013/130320-prescriptions-dispensed-community-2012-en.pdf [Accessed 20 November 2013]. 4. NHS Services Scotland, 2013. Prescribing and medicines: prescription cost analysis financial year 2012–2013 [online]. Available: http://www.isdscotland.org/HealthTopics/Prescribing-and-Medicines/Publications/2013-06-25/2013-06-25-Prescribing-PrescriptionCostAnalysis-Report.pdf?22027224303 [Accessed 20 November 2013]. 5. HSC Business Services Organisation, 2013. Prescription cost analysis 2012 [online]. Available: http://www.hscbusiness.hscni.net/services/2437.htm [Accessed 20 November 2013]. 6. Drug assessment—UK style. DTB 2013; 51: 141–4. 7. National Institute for Health and Care Excellence, 2013. Developing and updating local formularies [online]. Available: http://www.nice.org.uk/mpc/ goodpracticeguidance/GPG1.jsp [Accessed 20 November 2013]. DOI: 10.1136/dtb.2013.12.0219
To comment on material published in DTB, please email [email protected]
[email protected]
Downloaded from http://dtb.bmj.com/ on August 5, 2015 - Published by group.bmj.com
Appraising medicines: improving but not perfect DTB 2013 51: 133
doi: 10.1136/dtb.2013.12.0219 Updated information and services can be found at: http://dtb.bmj.com/content/51/12/133
These include:
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This article cites 2 articles, 2 of which you can access for free at: http://dtb.bmj.com/content/51/12/133#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Articles on similar topics can be found in the following collections Public health (198) Licensing / marketing authorisation (29) Therapeutic indications (27) General practice / family medicine (71) Respiratory medicine (97)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
Downloaded from http://dtb.bmj.com/ on August 5, 2015 - Published by group.bmj.com
Vol 51 | No 12 | December 2013
134 DTB Select: 12 – December 2013 137 Thank you to contributors
138 Antivirals for Bell’s palsy? 141 Drug assessment: UK style
Appraising medicines: improving but not perfect Twenty years ago, the NHS spent around £2.6 billion/year on drugs prescribed in general practice. At that time, DTB hosted a symposium to consider the relationship between drug costs and treatment choices noting that “in a time of severe financial constraints for the NHS it is important that the money available is well spent. In the case of treatment that means the benefits must be worth the cost. There is, however, no agreed way of deciding when a particular health benefit to an individual is worth the cost to the NHS”.1 The symposium concluded that “drug costs might become more manageable if there was open unfettered discussion of costs and therapeutic value between health professionals, NHS managers and researchers, medicine producers and health service users”. Twenty years later and expenditure on drugs dispensed in primary care has increased four-fold to over £10 billion/year and the NHS is under even greater financial pressure.2–5 However, would those who attended the meeting in 1993 be pleased with the progress that has been made to meet DTB’s aspiration for a robust process for considering the cost and value of medicines in the NHS? In fact, much has changed for the better in a relatively short time. An article in this month’s issue highlights the processes that have evolved to provide guidance on the use of medicines in England, Scotland, Wales and Northern Ireland.6 In little under 15 years, three authoritative bodies have been established that have robust mechanisms in place and have developed expertise in assessing and appraising new medicines.
Patients, healthcare professionals, clinical experts and pharmaceutical companies are routinely involved in the assessment processes. In addition, all three organisations use the appraisal process to formulate guidance on the status and place of appraised medicines within their devolved health services. However, the health services in Scotland and Wales use their appraisal process to provide advice on the majority of new medicines and licensed indications. In England it remains the case that the responsibility for appraising most medicines falls to local commissioning groups. In addition, given that all three national organisations will review the same data, it could be argued that in a time of financial austerity it might be more economical to run a single UK appraisal service to supply the same information to each appraisal committee (national or local). Of particular interest is the fact that between 30% and 40% of appraisals had to be terminated because of non-submission of evidence by the pharmaceutical company. In Scotland and Wales this usually results in a recommendation not to support the use of a medicine. However, in England such decisions are left to the discretion of local decision making bodies with the inevitable duplication of effort and the potential for postcode availability.7 We believe that England should follow the example of Scotland and Wales and not support use of a medicine when the company does not comply with the submission processes.
1. Drug costs and treatment choices: a DTB symposium. DTB 1993; 31: 41-4. 2. Health and Social Care Information Service, 2013. Prescriptions dispensed in the community: England 2002–2012 [online]. Available: https://catalogue.ic.nhs. uk/publications/prescribing/primary/pres-disp-com-eng-2002-12/pres-disp-com-eng-2002-12-rep.pdf [Accessed 20 November 2013]. 3. Llywodraeth Cymru/Welsh Government, 2013. Prescriptions dispensed in the community in Wales, 2002–2012 [online]. Available http://wales.gov.uk/docs/ statistics/2013/130320-prescriptions-dispensed-community-2012-en.pdf [Accessed 20 November 2013]. 4. NHS Services Scotland, 2013. Prescribing and medicines: prescription cost analysis financial year 2012–2013 [online]. Available: http://www.isdscotland.org/HealthTopics/Prescribing-and-Medicines/Publications/2013-06-25/2013-06-25-Prescribing-PrescriptionCostAnalysis-Report.pdf?22027224303 [Accessed 20 November 2013]. 5. HSC Business Services Organisation, 2013. Prescription cost analysis 2012 [online]. Available: http://www.hscbusiness.hscni.net/services/2437.htm [Accessed 20 November 2013]. 6. Drug assessment—UK style. DTB 2013; 51: 141–4. 7. National Institute for Health and Care Excellence, 2013. Developing and updating local formularies [online]. Available: http://www.nice.org.uk/mpc/ goodpracticeguidance/GPG1.jsp [Accessed 20 November 2013]. DOI: 10.1136/dtb.2013.12.0219
To comment on material published in DTB, please email [email protected]
[email protected]
Downloaded from http://dtb.bmj.com/ on August 5, 2015 - Published by group.bmj.com
Appraising medicines: improving but not perfect DTB 2013 51: 133
doi: 10.1136/dtb.2013.12.0219 Updated information and services can be found at: http://dtb.bmj.com/content/51/12/133
These include:
References Email alerting service
Topic Collections
This article cites 2 articles, 2 of which you can access for free at: http://dtb.bmj.com/content/51/12/133#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Articles on similar topics can be found in the following collections Public health (198) Licensing / marketing authorisation (29) Therapeutic indications (27) General practice / family medicine (71) Respiratory medicine (97)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
