I read with interest recently an article in the HSJ by my colleague and friend, Michael Rawlins, the chair of NICE. He usefully explained his views on innovation in the healthcare system, but I did fundamentally disagree with one point he made – namely, if a new innovation is “cost ineffective” it cannot be truly considered innovative to the NHS. Let me explain why I disagree.


In any debate on what does or does not constitute medical innovation, the most important views are that of the patient. Of course, we need to take into account other opinions and considerations, including that of government and the NHS, but ultimately, it is ordinary people who stand to gain the most from innovation, whose perspective must be given precedence.

That is why in a state funded health care system like the NHS, the decision as to whether we should pay for innovation is a political one made by society, and not always at the sole discretion of national regulators. In fact, the introduction of the Cancer Drugs Fund in 2010 was an example of such a decision intended to reflect the expressed desire of society to be able to receive the benefits from all innovative cancer medicines and not just those that have been reviewed and approved by NICE.

But even where medical innovation is expensive, we shouldn’t assume that it won’t save NHS money in both the short and long term. Take the medicines that have been developed to treat stomach ulcers. There was an upfront cost to the NHS of purchasing these new treatments, but it has all but ended the need for expensive, invasive surgery, not only improving the lives of patients, but reducing spend significantly on secondary care.

And in the long run, where would be without the adoption of more expensive innovations? HIV is a case in point. The cost to industry of researching and developing treatments for the disease in the 1980s was hugely expensive and as a result the medicines themselves were expensive for the healthcare system. But the huge initial investment allowed extensive scientific research to start the development of medicines that now effectively make HIV a chronic disease rather than a terminal one. In fact, many of the treatments we now have for HIV cost very little to produce because they are available on the generics market. 

So not only does the adoption of innovation allow for significant advances in patient health, in the long run it reduces the cost of healthcare.

Of course, we need to take in to consideration the cost of innovation in healthcare, but this must always be considered in the context of what patients need, and with a view to the future.

Stephen Whitehead

ABPI Chief Executive

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