One issue has remained taboo in the two-year battle between campaigners and the UK's National Institute for Clinical Excellence (Nice) over Alzheimer's drugs: how the drug companies set their prices.
While anger and scorn have been heaped on the Government's medicines watchdog for its inhumanity in denying the drugs to sufferers of a dreadful disease, the drug companies who make and market the drugs have escaped almost without criticism.
Yet there is a simple move they could make to win Nice's support for their treatments: reduce the cost of the drugs. Not a single response from patients' organisations and pressure groups to yesterday's High Court decision criticised the companies for failing to adjust what they charge in the light of the drugs' limited effectiveness. This is not surprising. Most of the organisations firing off angry press releases yesterday via PR companies are funded by the drug manufacturers.
The drugs are widely quoted as costing "only" £2.50 a day. But this ignores the fact they only work in some people -estimates range from 15 to 50 per cent. Their effect in the mild stages is also "very, very limited", Professor Michael Rawlins, chairman of Nice, said yesterday.
The problem of the affordability of drugs is set to get much worse. Nice is under fire for restricting access to a drug, Lucentis, to treat macular degeneration, the commonest cause of blindness, on the ground that, at £9,000 a year, it is not cost effective. But some primary care trusts have taken matters into their own hands by authorising doctors to use an equally effective alternative, Avastin, which is available at a fraction of the price but not licensed for ophthalmic use.
Waiting in the pipeline are a host of new cancer drugs costing up to £100,000 a patient which will impose new burdens on the NHS. Herceptin, the breast cancer drug, which costs around £20,000 a patient, is already forcing NHS trusts to find savings elsewhere to pay for it.
The NHS budget is not a bottomless purse. Decisions have to be made how to spend the available cash to get the best results. The Government announced last week that it is to review the Pharmaceutical Price Regulation Scheme, its drug pricing agreement with the industry, in order to get better value for money.
Only if that review delivers a cut in prices will the NHS be able to buy more treatments.
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