Tuesday, October 24, 2006


In today's column about Velcade, Polly Toynbee writes:

Disgracefully, Andrew Lansley, the shadow health secretary, claimed at the weekend that he would prescribe the drug, adding an absurd promise that he would also "renegotiate" its price with the manufacturers. As if.

Paying no attention to Nice's rebuttal, ITV's The Sunday Edition paraded three patients with bone-marrow cancer desperately seeking the drug, understandably anxious for any shred of extra hope. Who wouldn't be?

Andrew Lansley's interview on The Sunday Edition is, at the time of writing, available online here.  What he actually said was:

I think we should give patients the drug and allow the NHS to negotiate with the drug company concerned, Johnson and Johnson, in order to arrive at a price for the drug that is cost-effective.  Because, the problem is at the moment that NICE have no ability to negotiate with the drug company.  The price is given.

When asked by the interviewer:

So you are very clear then that if you were Health Secretary, and indeed the current Healthy Secretary should give the drug to myeloma sufferers now?

He replied:

Yes, through that process [the one described above] and I do have to be clear about this.  Because there is no point in having NICE and then taking the decision yourself.  They do a professional job at trying to assess cost-effectiveness.  But the price is given to them.  They can't negotiate it.  I think what the NHS should be doing, what the Secreatry of State should be doing is negotiating the price with the drug company, doing in effect a risk-sharing deal with drug company so the NHS can continue to treat patients and depending on the effectiveness of the drug... I mean Jacky [one of the three sufferers who were "paraded" by ITV on the television.  Note that their website is here] was saying to us just a few minutes ago she thinks it can prolong life by two or three years.  Well, if that is proven in a population of myeloma sufferers who get the drug, then actually it would be a cost-effective drug.

This is not Lansley trying to "prescribe" the drug -- not something which would be terribly practical in any case for someone who is not a doctor.


Polly also writes:

Scotland has approved it for only a tiny number of patients in the last weeks of life.

Actually, no.  The SMC says that Velcade is:

accepted for use within NHS Scotland for the treatment of patients with multiple myeloma who have already received at least two therapies, have seen their disease progress on the last therapy and who are unresponsive to alternative licensed treatments for this stage of the disease. [Source]

This is not the same as "in the last weeks of life."


She also says that:

Its first trial of strength with the drug companies was its defining moment. When Nice said no to the flu drug Relenza (except for exceptional conditions), Glaxo threatened to pull out of Britain in revenge. Nice held firm, Glaxo stayed.

Actually, Frank Dobson said no to Relenza (source) in October 1999.  Sir Richard Sykes complained about "recently enforced price cuts" and criticised "the government's innaction over parallel imports" and "condemned the goverment's failure to maintain the level of science study among sixth formers despite its claim to favour a science and technology-based society." (source).  According to the Guardian:

Although the spokesman said Glaxo - which spends more than 50% of its research budget in, but derives only 6% of its sales from, the UK - was not threatening to move offshore, he added: "These factors call into question the attractiveness of the UK to a global company." The company suggested that others in the sector might also consider moving out of the UK.

"If you continue to make the environment antagonistic to this industry then by defini tion it will start to move elsewhere," said Sir Richard.

That's not a threat to pull out of Britain.

Nonetheless, NICE "held firm" for about a year before the Guardian was reporting that "Relenza receives limited approval" in November 2000 (source).


gordon-bennett said...

Welcome back.

Lansley's on to a good point here. If NICE are saying that a given drug is not cost effective at the manufacturer's price but were allowed to say at what price the drug would be cost effective then that would give the manufacturer a marketing decision to make.

As long as manufacturers didn't come to believe that NICE is just forcing down prices then they might take a broader view about how they recoup ther costs in the UK.

ScotsToryB said...

Yes, welcome back.

I agree with you & g-b above.

There is also an additional problem within the NHS of management insisting on buying lower cost alternatives(especially prosthetics - I understand but I am thinking of the overall budget) which are not suitable for every patient and cannot be modified as their design & cost mean they disintegrate so the patient has to return for treatment when either a design specific replacement arrives or the initial, expensive but modifiable, choice is bought in and modified in situ. Every time this happens the original, cheaper alternative is discarded or, more often, time expires. Net result? NHS buys in the cheaper model to satisfy management but continues with the previous, proven, system.

If Polly wants to meet some very angry buyers within the NHS I'll be more than happy to arrange it.


Anonymous said...

Surely the best line of the lot is:

"again anecdote trumps evidence in the press"


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