The UK's pharmaceutical industry has been complaining about getting the shorter end of the stick when it comes to medicine purchasing by the NHS. The never-ending tension lies in getting the best value for taxpayers, yet allowing sufficient incentives for drug companies to continue doing business in the UK.

The Association of the British Pharmaceutical Industry (ABPI) has said that the government has been too strict with NHS spending, denying patients access to life-changing medicines. In addition, the National Institute for Health and Care Excellence (NICE) has also been rejecting some drugs that are available in other health systems.

Most recently, the recent decision by NHS England to put a cap on budgets for new drugs - even if they are approved by NICE - has angered the industry further. NHS England claimed the right to review any medicine or drug that has more than £20 million spending and bar further funding.

Future UK government warned to pay attention to complaints

The industry has issued a warning to the next UK government, to act on their concerns or lose out on further investment, letting the economy take a hit.

Affected companies have already been questioning why drug trials should be conducted in the UK - which NHS patients benefit from - when there is no guarantee that the finished products will reach the shelves.

More interestingly, the ABPI has advocated a hike in total UK health spending as a percentage of the economy to the average in leading industrialised nations. This would mean £20 billion a year extra funding.

Unsurprisingly, critics say that the calls for increase in NHS funding by pharma companies are driven by self-interest. The big pharmaceutical companies responded that curbs on NHS spending have left some drugs unaffordable, therefore are unavailable to patients.

Average survival benefit less than 14 weeks

In 2011, then Prime Minister David Cameron set up the Cancer Drugs Fund in an attempt to address the problem. The initiative allowed NHS patients in England to access drugs rejected by NICE.

But a recent major analysis by King's College London and the London School of Hygiene and Tropical Medicine showed that the move was just a "quick-fix" election promise that wasted more than £1 billion and left patients dying in agony.

Pledging to spend £200 million, Cameron said that the fund would help bring British survival rates in line with the best in Europe. Now, experts revealed that just one in five of the medicines offered by the now reformed scheme actually benefitted cancer patients, branding the initiative a "political failure across the board".

Only 38% of the drugs provided by the fund had undergone adequate clinical trials before being used, and the average overall survival benefit was just 3.2 months. Some medicines were even too toxic for some patients, forcing them to abandon the treatment.

Their conclusions were based on 29 drugs approved for use by the fund in January 2015. The ABPI was quick to dismiss the report as "sensationalist and misleading".

Policies need to be thought out much more clearly

But Professor Richard Sullivan, director of the Institute of Cancer Policy at King's was adamant and said that the performance of the fund, which cost £1.27 billion over the past six years, demonstrated the folly of announcing policy "on the hoof".

“It was easy to present this as a major win for the NHS by saying 'look at all these additional patients who are going to have access to drugs'," he said. “But it was not a properly thought-out policy. People became politically and intellectually lazy, but the money kept flowing.”

The CDF was initially closed from March 2016 onwards, but due to complaints by the pharma companies, the fund has since been taken under the wing of NICE at the end of July 2016. But Professor Sullivan said the fund has been unfair to non-cancer NHS patients, blaming cancer charities, as well as fellow academics for failing to scrutinise the alleged benefits of the fund.

Dr Kapil Dhingra, associate editor of Annals of Oncology, the journal in which the study was published, agreed and wrote in an accompanying editorial that there is "the continuing need for a thoughtful analysis and discussion of the key drivers of the cost and designing necessary improvements to ensure that society as a whole can benefit from the investments that it is making in biomedical innovation." MIMS

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