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Saturday 31 January 2015

Trying To Put A Price On Life:

I wonder how anyone can hope to accurately put a price on someone else's life, let alone make a deliberate choice between who should live and who should die, a moral conundrum that would almost surely challenge the wisdom of Solomon himself.
I only ask the question having watched a news item regarding a young female patient who needed a particular drug to treat her life-threatening condition and who had previously been receiving supplies of the vital medicine from the drug manufacturers free of charge. However, because the manufacturers were seemingly unable to keep supplying the drug for free, at least on an ongoing basis, the girl's family had approached the NHS, to see if they would pay for the drug once the free supplies had come to an end. It transpired that the annual cost of the treatment to the national health service would be between £150,000 and £200,000 a year, although it wasn't immediately clear from the report, whether or not, or indeed by how much the continued provision of the drug would actually extend the young lady's life. Ultimately though, it was clear that if one assumed that the annual cost to the NHS would be closer to £200,000 than not, then for every five years that the girl's treatment was funded by the public health service, it was likely to cost British taxpayers the best part of a million pounds.
Now that isn't to suggest that the young lady in question, or indeed any of her fellow sufferers shouldn't be able to have such treatments, it is merely a recounting of that particular news report and an illustration of the sorts of wider individual financial costs that our health services face on an almost daily basis. Clearly for the family and friends of those suffering from life-threatening diseases, you simply cannot put a monetary value on the life of a loved one, but like it not, the reality is that in a situation where health budgets are severely constrained, one person's gain is almost always another person's loss.
This particular young girl's situation got me to wondering about how our society balances such vital needs, because whether we like it not, with a finite amount of resources to pay for life-saving drugs and treatments, essentially people's lives and their deaths can become something of a lottery, irrespective of their age, their gender, their race, or their religion, but instead having more to do with where they live or whether or not their drug or treatment has actually been approved by the National Institute of Clinical Excellence (NICE).
A newspaper article in the Guardian reports that the NHS has recently agreed a financial cap on the cost of drugs and treatments supplied to our health services amounting to £12 billion per year, with a further £2 billion set aside for additional generic and out-of-patent drugs, which are generally far cheaper and much more widely available. In theory, this means that the maximum amount that can be spent on various drug treatments from all of the various international pharmaceutical companies is £14 billion per year, which is still a massive amount of money and a significant proportion of the entire NHS budget. According to the same report though, any financial cost for NHS drug supplies, over and above the agreed £12 billion cap would subsequently be borne by the pharmaceutical companies themselves, thus ensuring that the national health service wouldn't and couldn't overspend on its drug's costs.
The only problem is however, is that as medicine advances; and medical researchers begin to tackle some of the more serious and complicated diseases, so the cost of the resulting drug treatments become prohibitively expensive. It was truly shocking to read of one particular drug, Soliris, which is reputed to cost in excess of £350,000 per year, per patient; and that could potentially be prescribed for each of them over a 25 year period, bringing its overall cost to around £10 million per person. According to the same report, approximately 200 people in the UK might benefit from being prescribed Soliris, making a potential overall spend of around £2 billion. Several newspapers at home and abroad have reported that this particular drug is the most expensive medicine ever prescribed by the NHS; and perhaps illustrates the sorts of financial pressures that our health services are suffering now; and will no doubt continue to do so well into the future.
At about the same time that NICE has approved the use of Soliris for a couple of hundred patients in the UK, they have also announced the cessation of public funding for at least 25 other separate cancer fighting drugs, which were previously being prescribed for up to eight thousand seriously, or terminally ill patients who were said to be suffering from either bowel or breast cancer. Quite how government and the health authorities manage to justify such a seemingly inequitable situation remains unclear, but what seems apparent is that hundreds, if not thousands of cancer patients will now run the risk of an early death, whilst a couple of hundred others may well have their lives extended at a considerable cost to the taxpayer. Again, in an ideal world no-one would have to make such arbitrary choices, but from a purely pragmatic point of view the cost of preserving a few hundred lives, at the cost of a few thousand others doesn't seem to be moral, equitable or indeed sustainable.
Any argument over the provision of Soliris is not an entirely isolated case. Only recently the European Drug Agency, the EDA, has granted a licence for another cancer drug called Vervoy, which has been specifically designed to fight malignant melanomas, one of the most common and destructive forms of the disease. In their turn NICE have approved its use for UK sufferers, at an average cost of £90,000 for a single course of four injections, which studies suggest will extend the lives of around 45% of those patients who receive the drug by 12 months on average. Approximately 25% of sufferers who are given the drug will survive for around two years. According to the manufacturers themselves, the annual cost of the drug to the NHS would be an estimated £30-37.5 million; and for that sum of money approximately 4-500 patients would gain a substantive benefit.
Now in itself £90,000 may not seem to be a great deal of money in the great scheme of things, but when one considers that roughly half of those receiving the treatment will die within 12 months anyway, it starts to put things into some sort of meaningful perspective. After all, if a patient gains an additional 12 months of life for £90,000, is that better value for money than the patient who only lives for six months, or three months, or shouldn't value for money come into it at all? And if something as base as value for money shouldn't be a consideration, then exactly what criteria should be applied to prescribing such vital life saving drugs? Do we just keep dipping into our finite pot of healthcare money until it's exhausted, on a first come, first served basis? Do we allow governments or health authorities to decide who and what our healthcare budgets are spent on, thereby handing them the power of life and death over us? Or do we keep on increasing the healthcare budgets, to match the ever increasing costs of newly developed drugs and treatments, drawing much needed monies away from other areas of vital public expenditure, such as education, defence and welfare, or any of the other social safety nets that we now take for granted?
Even though the estimated £2 billion cost of the drug Soliris is potentially spread over the period of 25 years, is any single person's life worth £10 million, while someone else's is worth £90,000 and yet another's is deemed to be a waste of public money? Are the elderly, the one's who have generally paid more into our national healthcare system, more or less valuable than the youngsters who have not? Is the rich man, or the educated man, any more valuable than his counterpart who is poor and uneducated? Should our healthcare system remain a lottery, decided upon by faceless bureaucrats and health professionals, or do we need to start putting a reasonable price on an individuals life and simply accept that we're all going to die at some point, it's just that some will do so, sooner rather than later.           

1 comment:

Chris Gifford said...

I completely agree with you dear, great information you have shared.

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