Cost of medical progress will be the NHS's biggest challenge, says expert

Published on Sunday 22 February 2009 22:25

PAYING for new drugs and treatments is now the biggest challenge facing the NHS and society as a whole, a leading cancer specialist told The Scotsman.

The huge number of therapies being developed by scientists means that the costs to the health service could sky-rocket in the coming years, according to Professor John Smyth from the University of Edinburgh.

The problem is being made worse by the current financial crisis, he added.

The expert's warnings came as concern continues to grow about current access to expensive treatments on the NHS in Scotland, and fears that decisions about which patients receive drugs are not being made fairly across the country.

Doctors and charities also called for more clarity and guidance from the Scottish Government to make sure everyone was given an equal chance of benefiting from expensive new treatments for cancer and other diseases.

Decisions about whether new treatments should be recommended for use by the NHS are made by the Scottish Medicines Consortium (SMC) in Scotland and the National Institute for Health and Clinical Excellence (NICE) in England and Wales.

About 30 per cent of drugs assessed by the SMC are not recommended to NHS boards after clinical and cost-effectiveness are considered.

But many patients and doctors still want to use these non-recommended drugs, meaning often difficult battles for funding for individual cases.

Prof Smyth said with 2,000 molecules currently being tested for use in cancer treatments alone, the NHS faced a huge challenge in making decisions about who gets treatment and who does not. He will lead a debate on the issue at the Edinburgh Science Festival in April, which will look into how society can make these decisions.

Prof Smyth told The Scotsman: "I don't think there is anything at all that challenges society more than this (the future funding of medical treatments]. Health is key to everything. You can have all the redundancies, you can have all the meltdown in the banking world, but if you don't have your health none of it is worth a candle."

Prof Smyth said that medical progress was "absolutely irresistible" and scientists should not stop seeking new drugs: "The challenge is that we have to resource it."

Prof Smyth said that new ways of making decisions on what drugs were available needed to be looked at.

He said one possibility which could be tested in Scotland was involving a wider range of people in the decision-making process, such as ethicists, philosophers and people from religious backgrounds.

In 2007/08, the budget for drugs for NHS boards in Scotland stood at about 1.2 billion. But many boards had underspends of millions of pounds.

Campaigners have suggested that maybe this money – while only a tiny part of the overall drugs budget – could be set aside for funding exceptional cases involving non-approved drugs.

At present, patients wanting these treatments have to go through a board's procedure for so-called "exceptional prescribing", which would look at whether there was a special case for that patient.

Hilary Jackson, Cancer Research UK's policy manager, said the charity knew access to certain cancer treatments continued to vary across the country.

"This is unfair and distressing for patients who are left not knowing whether the treatment their doctor has recommended will be available."

A Scottish Government spokeswoman said they were reviewing processes for introducing new drugs.

&#149 The debate "The Future of Cancer Treatment: Can We Afford it?" will take place on Monday 13 April at Informatics, University of Edinburgh, 6-7pm.

'Postcode roulette' over cancer treatment

FOR Jim Reap, a health board's decision not to fund a treatment that could give him extra months of life left his family devastated.

"The doctors said, 'this is what you need, but we can't give it to you'," he said. "I felt a wee bit abandoned by the NHS."

But, thanks to the mammoth fundraising efforts of colleagues, friends and family, the 52-year-old is now receiving the drug, Sutent.

Mr Reap, of Falkirk, was diagnosed with kidney cancer in March last year.

To start with, drugs helped stop the cancer growing. When this treatment failed to knock back the disease, his doctors said Sutent could help him. But Sutent is not approved for use on the NHS.

The father-of-two and his wife, Louise, 43, a midwife, decided to appeal to NHS Greater Glasgow and Clyde, where he was receiving treatment, and NHS Forth Valley, their home health board, to try to get Sutent. But their appeal was rejected, leaving the family no choice but to pay for the drug themselves.

"My wife and I felt that we had no option but to go down that route," he said. "I had been told that the cancer was aggressive and I did not think that I had any choice. We just had to do it."

The first treatment with Sutent, which costs 3,400 for a six-week cycle, was given to Mr Reap at a reduced cost by the drugs company. But the couple soon realised that their savings would not go very far if they continued with the treatment.

It was then that his colleagues at Falkirk Council started a fundraising appeal that went on to raise more than 20,000 from a raffle and other donations and events.

Mr Reap said that the treatment has made him feel and look better, and he believes it is working. He is upset that he has had to resort to fundraising to pay for Sutent, which could finally be approved for use on the NHS next month, although three other kidney treatments probably will not be.

"It makes me very angry and particularly it makes by wife angry," Mr Reap said. "It is a complete postcode roulette if you are given these drugs. Because of what happened I was without any treatment for two months."