Currently we as a nation spend about 1% of our GDP on pharmaceuticals. Maybe surprisingly we spend at least as much on takeaways and fast food. Two research papers published this week suggest now is the time that we as a society think about how we spend our money, the sort of health we want for ourselves and our children, and importantly, how much we should invest in achieving this.
The first of these papers, Affording the future? commissioned by the ABPI, questions the UK's overtly quantitative approach to making decisions on the use of new medicines in the UK. There is a need to strike a balance between being overly restrictive with the number of approved medicines our patients have access to, and sustaining the UK as a key country for investing in the development of new medicines. The second paper from the British Pharmacological Society, UK drug funding framework needs an overhaul to ensure the right areas are being prioritised, calls for a detailed assessment and rational debate to understand the public views on where NHS medicines expenditure should be focused.
When deciding if society should spend more money on health, and indeed medicines, we must not consider price of these medicines in isolation, but also must include other savings to the healthcare, educational system and social care systems that a new medicine brings. More broadly, the value that the pharmaceutical industry brings to the economy and to the UK's esteemed science and technology industry must also be a key consideration. Individual decisions on medicines should always be balanced against ensuring successful businesses and academic programmes can sustain medicines research to address our future health priorities and make our lives longer and healthier.
In the UK, there are no other areas of public spending under greater scrutiny than medicines. It is now proposed that NICE's already very rigorous appraisal of medicines is bundled together with further restrictions by NHS England to inhibit uptake based on estimated future spend. This combined with Brexit, pressure to lower the NICE threshold and recent changes to the Cancer Drugs Fund can only negatively impact the UK's already low and slow uptake of new medicines. Companies must start to see a reversal in this trend, so they may achieve sufficient reward for developing new medicines and making them available in the UK. Without reward why would any global business choose to keep investing research & development efforts in the UK when there are many other attractive options? The whole ecosystem of drug development must therefore be considered when deciding where as a society we should invest in new medicines.
But this begs the questions; what is sufficient reward? And why should the cash-strapped NHS prioritise spending on medicines? There has been relative stability of NHS pharmaceutical costs over the past two decades; PPRS, patents, NICE appraisal and competition all play important roles in ensuring prices of medicines are kept in check. As David Taylor reports, the UK spends 10-20 per cent less of its national income on health and social care than France, Germany, Sweden and The Netherlands. America spends twice as much of its GDP on health care than the UK. It is time to stop over scrutinising the 0.1% of GDP we spend on anti-cancer medicines and start asking the bigger questions. Whilst we all want a hamburger once and a while, surely we as a society, value the cost of saving people's lives more than fast food? Science may not yet be delivering the solutions as fast as we would like, but history tells us that decreasing investment in medicines, at such a time of great progress, would be very difficult to justify to future generations.
Richard Erwin is General Manager for Roche Products Limited and Chair of the ABPI Value and Access Working Group.