Driving in my car on Monday I had the radio on and was listening to a discussion on, among other things, pharmaceutical drug costs here in the UK. Obviously, they’re sky high. Well, of course, drugs are generally expensive to develop, test and market, but could other factors be at play too? One of the individuals commenting on this radio broadcast was an ex-drug sales representative. He claimed that within the industry the National Health Service here in the UK is generally seen as a bit of a ‘cash cow’. Apparently, the prices the industry charged to the NHS are higher than anywhere else in Europe.
What might be what amounts to a bit of corporate greed in the area of pharmaceutical medicine did not come as much of a shock to me, and I thought no more about it. No more, that is, until yesterday I picked up a copy of this week’s British Medical Journal to read on the tube. In the letters section I read an offering from Andrew Lee (lecturer in public health at the University of Sheffield) and John Radford (director of public health in Rotherham). Their letter concerned the drug of ranibizumab (Lucentis) for age-related macular degeneration which I mention in passing here. Just to recap, this drug has recently been deemed appropriate for prescription by the National Institute for Health and Clinical Excellence (NICE) here in the UK.
The point of the letter was partly to draw our attention to the exorbitant price charged by the manufacturer of this drug (Roche and Genentech). They point out that the bill for this drug could cost the UK National Health Service (NHS);300 million pounds a year.
But the other major point in the letter was that an alternative to ranibizumab appears to exist in the form of bevacizumab. According to the authors of the letter this drug (similar in form to ranibizumab) has been found to be effective and generally safe, and is an internationally recognised treatment for age related macular degeneration. And one major boon this drug brings over its chemical cousin is its cost: bevacizumab costs around £100 per injection compared with more than seven times this amount for ranibizumab.
So, why doesn’t NICE take sanction the cheaper option. Well, apparently it can’t. It can’t, because bevacizumab does not have a licence here in the UK. And, according to the authors, the manufacturers are reluctant to apply for one. Why? Well, it might have something to do with the fact that bevacizumab is made by the same people that make the far more expensive ranibizumab.
The authors of the letter conclude: NICE’s position obliges primary care trusts to commission ranibizumab and will undoubtedly be trumpeted by patient groups as a victory for patients. However, it is a hollow victory, with cash-strapped trusts forced to redistribute finite resources. Some services and patients may gain, others will lose out. The only real winners are the pharmaceutical companies. Perhaps drug companies really do see the NHS as some sort of cash cow.
Lee ACK, Radford J. The ranibizumab saga of drug profiteering BMJ 2008;337:a1532