Wednesday, 2 February 2011
You Spent How Much!
£33.9 million was spent on aspirin (generic) and £18.8 million on paracetamol (acetaminophen), no doubt which would have been bought at the usual high prices, charged to the NHS. Why not tell people to buy their own, and just recommend the dose?
Close to £360 million was spent on the branded (expensive) and generic (cheaper) versions of HMG-CoA Reductase Inhibitors (or statins), with some £322 millions going to Pfizer's Lipitor. Generally, to treat patients for no scientific reason, other than a target for cholesterol lowering (a surrogate end point), which is considered now, to be of dubious benefit in primary care, especially for the worried well. Hopefully the 25 year long 'gravy train', enjoyed by Pfizer, will end, when the patent expires in June this year, on Atorvastatin (Lipitor), but they have enjoyed years of it being, the top selling drug in the world, at $12.4 billion sales in 2008. Duane Graveline (the space Doc) has a few points about this drug worth reading.
The other 'so called', cholesterol lowering agents figuring quite highly in the league table of costs is the Merck drug, Ezetimide at £73.5 million. This is despite the ENHANCE trial giving it a conclusive 'thumbs down', for its primary role, way back in 2008. NICE hasn't yet caught on to it's rather limited efficacy, and it's dangers, but GP's still seem ready to prescribe it.
Doctors, spent £106 million on anti-hypertensives, with some £68 million of that going on Merck's Losartan an Angiotestin 11 Receptor Antagonist, and the balance on generics. Well, this is down to the continual, ever lowering of the thresholds, for hypertension, both for the 'at risk' element of the patient cohort, and the belief amongst many, that we should all be treated, if we exceed certain levels irrespective of risk, simply because, being above that level confers risk in itself? Well, NICE, who set these guidelines, also calculated the 'absolute benefits' for this, at an increased life expectancy, of 8-11 months if you're 50, and 3-5 months, if you're 70. Wow!
Now to the drugs for Diabetics. Leaving aside the £71.5 million on the Type 1's, we spent £650 million on drugs for the Type 11's, amongst these, of course we have have the drug (now withdrawn) Avandia, from GlaxoSmithKline. I highlighted it's dangers, on the back of the Panorama investigation, back in September, but, despite the fact, that there had been doubts about it, as far back as 2007, £30 million was still spent on it! Drugs for Diabetes have risen in cost, during the last 5 years by 40%. But Diabetes, despite it's inexorable rise, has only risen from 3.3% to 4.1%, in the same time frame. So, one has to assume that more drugs, and more expensive drugs at that, are being prescribed. So, long as we continue with 'barmy' diet protocols for Diabetics, and for the population as a whole, this bill will never get smaller, and it is now the largest cost, for all drugs, across the NHS!
Of course, we do have some really expensive drugs. Eculizumab, costs £3150, a pop! And that works out for the patient with PNH, to about £400,000 a year! At about an incidence of 1 to 2 per million people, it's unlikely to bother many people. Why drug companies, can't be a little more benevolent, with highly specialised drugs, in view of their exorbitant profits, I cannot understand. Well, unless of course they are greedy, manipulative git's, but of course, I would never take that view.
So then Mr. Lansley. If you really want to save some money in the NHS, perhaps you should review the science behind these profligate and counter productive, prescribing protocols. And should you really be pinning all your hopes, on the 36,000 or so GP's responsible for this huge bill, to run the NHS of the future? You really ought to have better insight, with a Cardiologist brother-in-law, and an ex-wife as a GP.