Sunday, 28 October 2012

Big Pharma and price hikes: not NICE

Having a long-term illness affects your life, and your concerns, in lots of ways. For once, I'm not talking about the symptoms, about pain, fatigue, or whatever characterises your particular flavour of poorliness. I want to write about the medications many of us need, and how we, and our doctors, are held to ransom by the pharmaceutical companies - "Big Pharma" - that manufacture them.

Epanutin is one brand name of a drug called phenytoin, which reduces the risk of seizures for people with epilepsy. It's used less than it used to be, but it's still taken by around 100,000 people in the UK. The cost of this was around £2 million a year.

The rights to manufacture Epanutin have recently been sold by Pfizer, to UK firm Flynn Pharma. They've repackaged it and increased the bill by a staggering 2330% to £46.6 million. All that has changed is the packaging: the capsules themselves are identical.

Because phenytoin is a relatively old drug, it's out of patent and any drug company can make it. So the NHS can just switch to another supplier, right? Sadly, wrong. Pfizer, and now Flynn, are virtually the only manufacturers of the capsules. Phenytoin is also available as a syrup and as tablets, but there's a problem. People with epilepsy tend to be extremely sensitive to levels of their medication in their blood, so they and their doctors are reluctant to switch from the Epanutin capsules. As a result, there's virtually no competition to make another version of phenytoin, and Flynn pretty much have a monopoly.

Result: Flynn basically have the NHS over a barrel. Because Epanutin is a standard treatment for epilepsy, it's more or less 100% sure that the NHS will go on funding it.

That's a standard treatment. What's the situation with newer medications?

Alemtuzumab, or Campath, is currently licensed for use in leukaemia. Neurologists have also been prescribing it off label for aggressive multiple sclerosis since a large, encouraging trial in 1998 and subsequent published trials showing it as superior to other MS treatments.

It's also considerably cheaper than other MS treatments, at around £2,500 a year per person. Or it was. The manufacturers, Genzyme, have applied for a license for Campath for the treatment of MS, and are expected to relaunch it at up to 20 times its current price. They have also withdrawn it from off-label use for MS pending approval, on the grounds that "any adverse event outside a clinical trial … may complicate the regulatory process".

When a medication is licensed for use in the UK, it then has to be reviewed by the National Institute of Health and Clinical Excellence (NICE). NICE has the difficult task of deciding which treatments should be funded by the NHS, to share out the limited amount of cash available. Should it approve the use of an operation that costs, say, £20,000 per person, or a medication for a completely different condition that can treat 50 people for the same amount? What if the operation saves lives, while the medication is for something far less serious?

So, assuming Campath is licensed for use with MS, NICE will have to decide whether the NHS should fund it. If it was still cheaper than existing treatments, with better results, it would be a no-brainer (though of course the risk of side-effects also comes into the equation). But it looks like it's going to cost far more than that.

We've all seen stories in the newspapers about people denied treatments by NICE, often for cancer. Is Campath going to be another such? MS is progressive: people denied Campath would be at risk of severe disability as a result. And if Campath is approved, what else will be denied?

These are two examples of big hikes in price. I have no doubt there are others. What these pharmaceutical companies are doing is certainly not illegal, but is it moral? These are existing drugs. There are no additional research and development costs to recoup.

Big Pharma. Getting bigger every day, and at the expense of sick and disabled people.

1 comment: