The cost to the NHS of prescribing drugs for diabetes has soared to almost £1 billion annually, as the number of people diagnosed with the disease has risen sharply alongside the surge in obesity.
£956.7m was spent by NHS England on prescribed diabetes drugs last year; representing 10.6% of the cost of all prescriptions issued by NHS primary care services in 2015/16.
More is now spent on medication for type 1 and type 2 diabetes than for any other ailment.
The number of diabetics across the UK as a whole has recently risen to more than four million and has increased by 65% over the last 10 years.
Diabetes is thought to cost the NHS about £10 billion, once the cost of treatment is included.
Last year a total of 49.7m items were prescribed for diabetes, compared to 27.1m a decade years earlier.
90% of diabetics have been diagnosed with type 2 diabetes, with lifestyle factors clearly playing a massive role in this epidemic.
90% of adults with type 2 diabetes aged 16-54 years are either overweight or obese.
Helen Donovan, the Royal College of Nursing’s health professional lead, stated that cuts to nursing support for diabetics meant that some patients were not getting the help they needed to manage their illness.
“These stark figures show the need for a greater focus on preventing type 2 diabetes. Encouraging healthier lifestyles would not only save the NHS money, it would improve countless lives. This is bad for the health service’s finances but more importantly it can be devastating for patients.”
NHS Digital’s findings show that the West Midlands is the region of England with the highest proportion of people over the age of 17 who are diabetic.
The south central area has the lowest prevalence rate, at 5.6%.
And the east London borough of Newham spends proportionately more of its drugs budget than anywhere else in England on diabetes medication, at 17.9%.
North Tyneside spends the lowest, at 7.4%.
Meanwhile, the spend on medication differed widely in different parts of England.
The cost per patient treated was highest in Warwickshire North, at £415 a head, and lowest in Northumberland (£239).
62% of adults were overweight or obese in England in 2012, while 6% of people aged 17 years or older had diagnosed diabetes in England in 2013.
In England, 12.4% of people aged 18 years and over with obesity have diagnosed diabetes; five times that of people with a healthy weight.
Men with a raised waist circumference are five times more likely to have been diagnosed diabetes than those without a raised waist circumference; women are over three times more likely.
Clearly tackling obesity can play a massive role in the fight against diabetes, yet results for 2014 showed that 61.7% of adults were overweight or obese (65.3% of men and 58.1% of women).
Leading doctors have indicated that statins are being rationed by the NHS in a desperate move to reduce expenditure, despite the fact that the drugs often cost a matter of pennies.
Health watchdogs have condemned the decision to limit access to the heart-related medicine, asserting that the wider prescription of statins had been recommended in order to save lives.
However, despite criticism over what many will see as penny-pinching, it is worth remembering that statins remain something of a controversial medicine.
Many believe that simple lifestyle factors, such as increased exercise, improved diet, ceasing smoking and reducing alcohol intake, are more effective than taking the drugs in question.
The drugs, which reduce the cholesterol level of patients, cost less than 10p per patient per day, underlining the rather bizarre nature of this particular financial decision.
This latest financial move can be placed in the context of an extremely challenging healthcare climate, in which NHS trusts face massive deficits, while being tasked with achieving billions of pounds worth of efficiency savings.
But Stockport CCG has caused fury from senior doctors and from Nice, after ordering local GPs to ignore the Nice advice, instead restricting the drugs to those at greatest risk.
It seems difficult to defend the decision to limit access to statins, considering the relatively trivial amount of money involved.
Dr Andrew Green, chairman of a British Medical Association committee on prescribing, believes that funding is at the heart of the issue, and the statin prescription can be considered a mere symptom of a wider malaise.
“So many CCGs are in deficit due to under-funding, and the pressure on them to achieve financial balance is so great that we are beginning to see some very strange decisions born out of desperation.”
The CCG released a statement outlining the reasons behind the statin rationing.
“The CCG was required to make some decisions on savings to achieve financial balance and long-term financial health. The plan included a decision to not implement the NICE lipid modification guidelines for primary prevention in full.”
But Professor Mark Baker, director of the centre for clinical practice at Nice, was critical of the CCG’s decision, believing it could be a policy that ultimately indirectly kills.
“Cardiovascular disease maims and kills people through coronary heart disease, peripheral arterial disease and stroke. Together, these kill one in three of us. This decision amounts to denying patients access to the most effective means of reducing that risk. Our guidance is intended to prevent many lives being destroyed and it offers a major shift in public health outcomes at relatively low cost.”
Responding to the widespread criticism, a Department of Health spokesperson defended its health service funding, and indicated that statin rationing is not obligatory.
“Doctors should make decisions about prescribing statins based on clinical evidence – there should be no blanket restrictions. We are giving the NHS more money – £4 billion this year – to fund its own plan for the future, and it’s vital that money is spent effectively.”
Scientists from Cambridge University have discovered a number of drugs which could help with the ongoing fight against Alzheimer’s disease.
Researchers indicate that the drugs in question effectively act like statins for the brain.
Experiments were conducted on worms at the University of Cambridge, and researchers involved in the studies identified drugs which prevented the very first step towards brain cell death.
It is now hoped that it will be possible to correlate the drugs with specific stages of the Alzheimer’s condition.
Experts now consider it important for them to understand and establish precisely how the drugs could work safely in humans.
Statins are taken by people to reduce the risk of developing heart disease and the Cambridge research team says its work may have unearthed a potential “neurostatin” to ward off Alzheimer’s disease.
This new discovery would potentially be able to prevent the development of Alzheimer’s, as opposed to treating it once it has already been identified.
Writing in Science Advances, Prof Michele Vendruscolo, senior study author from the University of Cambridge, said the research team wanted to find out more about the mechanics of every stage of the disease’s development.
“The body has a variety of natural defences to protect itself against neurodegeneration, but as we age, these defences become progressively impaired and can get overwhelmed. By understanding how these natural defences work, we might be able to support them by designing drugs that behave in similar ways.”
And commenting on the issue, Dr Rosa Sancho, head of research at Alzheimer’s Research UK, was extremely enthusiastic about the potential of this new medical breakthrough.
However, Sancho also warned that the researches were nowhere near the stage of instigating clinical trials, and must first labour for many hours in an attempt to understand how the drugs can be implemented safely within the human body.
“We will now need to see whether this new preventative approach could halt the earliest biological events in Alzheimer’s and keep damage at bay in further animal and human studies. This early research in worms suggests that bexarotene could act earlier in the process to interfere with amyloid build-up.”
Similar substances to those discovered by the Cambridge researchers have already been utilised in treating other conditions.
For example, bexarotene is utilised in the treatment of cancer, and was previously found to prevent the death of brain cells in worms.
Dr Doug Brown, director of research and development at the Alzheimer’s Society, was cautiously optimistic about the finding, indicating that the notion of implementing it in humans on anything like a significant scale was still likely many years away.
Brown acknowledged that similar drugs have significant side-effects, and that considerable research would have to be undertaken before the new substances can be utilised safely.
“Bexarotene has many side-effects when used to treat lymphoma, such as skin complaints, headaches, and sickness, and we would also need to be sure that it’s safe for people with Alzheimer’s to take. We haven’t found any new drugs for dementia in over 10 years, and repurposing drugs that already work for other conditions could provide us with a shortcut to new dementia treatments.”
A committee of MPs has concluded that the Cancer Drugs Fund must be run and managed more efficiently.
The Public Accounts Committee concluded that the fund designed to provide cancer medicines to NHS patients had been ineffective since it was set up in 2010.
Perhaps the most damning conclusion made by the report is that the benefit of the fund to patients is not clear at all.
The aim of the fund, which has just celebrated its fifth birthday, was to ensure that access to cancer drugs would be routine or patients across the UK.
Some of the medicines that were purported to be available via the Cancer Drugs Fund would otherwise not be available on the NHS.
Figures do indicate that the fund has not been a complete failure.
The fund, which is expected to have cost £1.27 billion by April 2017, has helped more than 80,000 cancer patients.
But, conversely, the evidence submitted to the Public Accounts Committee indicates that the amount of money that the Cancer Drugs Fund is paying for medication can be excessive.
And the legislative and bureaucratic process involved with the Cancer Drugs Fund could be described as laborious.
Before any drugs can be given to patients on the NHS, they have to be recommended by the health watchdog, the National Institute for Health and Care Excellence (NICE), which looks at how well they work and whether they are cost-effective.
But if drugs are not recommended or have yet to be appraised by NICE, the Cancer Drugs Fund can step in and choose to fund cancer treatment.
Despite high hopes for this fund when it was initially set up, the committee of MPs unfortunately concluded that there is limited evidence that the fund is having any significant benefit for cancer patients.
It has not even been satisfactorily proven that the Cancer Drugs Fund is even extending cancer patients’ lives.
With money having been diverted from primary care, it is clear that the Cancer Drugs Fund faces major logistical and fiscal issues.
The £480 million budget set aside for the two years from 2013 to 2015 was exceeded by £167 million.
Commenting on the issue, a spokesman for NHS England acknowledged that there are serious underlying issues with the Cancer Drugs Fund, and that these must be addressed in the immediate future.
“While we welcome the committee’s support for a redesigned Cancer Drugs Fund, we hope their explicit call for cuts to cancer drugs prices charged to the fund will be borne in mind as complex decisions on its future are taken in the next few months.”
Mismanagement of the £1.3 billion Cancer Drugs Fund has led to dying patients missing out on key medication, according to information provided by MPs.
A damning report by the Public Accounts Committee indicates that the fund has been malfunctioning significantly over the last five years.
The budgeting of the organisation has clearly got out of control, and this has led to the health service paying extremely high prices for medication.
The report concluded that “there is no assurance that the Department of Health and NHS England are using their buying power effectively to pay a fair price for cancer drugs. The companies were clearly prepared to reduce their prices to help keep their drugs on the fund’s list.”
One only needs to look at the figures related to the cancer drugs fund in order to understand the extent to which it has grown beyond its original remit.
Its initial budget had been capped at £175 million per year, but this has subsequently risen to in excess of £415 million.
The report documents this, and also explains the consequences of this vast increase in expenditure.
“To help cover this overspend, NHS England had to defer some planned spending on primary care services. NHS England did not start to take action to control costs until November 2014. Since then it has reduced the number of drugs available through the fund.”
Despite the failings of the fund, the report does nonetheless conclude that 80,000 people have received medication through it since it was launched.
But the figures are extremely damning for the fund, and suggests that its future will be reviewed as a matter of urgency.
Meg Hillier MP, chair of the committee, commented that there had been fundamental economic failings within the fund during the five years that it has operated.
“Clearly they weren’t watching the money. As the costs went up they rapidly delisted, which shows a sign of lack of control. Every time they overspent and had to cut back, that affects patients. If they had managed it better there would have been more benefit for many more patients. It was chaotic.”
Hillier continued by pointing out that the fund had fundamentally failed cancer sufferers in particular.
“One of the reasons for the fund was to focus on rare cancers, but those rare cancers have lost out because more money has been spent on the bulk cancers which should have gone through [routine funding routes].”
An NHS England spokesman commented “This report comes just a day after new independent figures showing the NHS’ great success in improving cancer care and survival rates for patients across England. While we welcome the committee’s support for a redesigned cancer drugs fund, we hope their explicit call for cuts to cancer drugs prices charged to the CDF will be borne in mind as complex decisions on its future are taken in the next few months.”
Overall prescribed medication costs in the NHS total nearly £15 billion.
The NHS has fast-tracked a drug with the intention of addressing the debilitating condition of the prostate cancer.
Clinical trials indicate that docetaxel can extend the life of men are suffering with this aggressive form of cancer by more than 12 months.
Following the decision by the NHS, it is now possible for clinicians throughout the health service to prescribe this medicine immediately.
Prostate is the most common cancer in men in the UK, affecting one in eight at some point in their lives.
Over 9,000 British residents dying from prostate cancer on an annual basis.
Docetaxel could extend life for over 4,500 men every year who already have advanced cases of prostate cancer.
Angela Culhane, the chief executive of Prostate Cancer UK, believes that the decision related to this drug is excellent news for sufferers of the malignant cancer all over the UK.
“It is critical that specialists are made aware that this use of docetaxel treatment is available so that no man misses out. Earlier docetaxel must become the standard for men who can benefit from it and we will continue applying pressure until we are sure this is the case.”
In addition, Culhane also suggested that the response of the NHS in this department is indicative of the flexible approach that the health service should take to new drugs in the future.
“This fast-track response to new evidence indicates what can be achieved when there is the will in the system. It must set a precedent for other treatments that demonstrate clear clinical benefit when used in different ways.”
Jonathan Fielden, the director of specialised services at NHS England, also commented on the issue, stating that the scientific evidence supporting the prescription of this particular drug was incontestable.
“Rigorous new evidence shows that this drug brings significant benefits for patients with advanced prostate cancer. So working closely with patient groups and cancer specialists, NHS England is now pleased to be fast-tracking its wider availability.”
Prostate cancer is disproportionately present in older men, while a family history of the condition can also be a major risk factor.
It has also been shown that black men in particular suffer from prostate cancer in large numbers.
Although docetaxel is being prescribed as a medicinal drug for the first time, the substance has already been used within the NHS previously.
Docetaxel chemotherapy forms part of the routine NHS treatment for men with advanced prostate cancer.
However, this has previously only been prescribed once men have become resistant to androgen deprivation therapy.
In future, it will be possible for both the treatments to be commenced simultaneously, and NHS officials are hopeful that this will have a positive influence on treatment of prostate cancer.
The HIV-preventing drug PrEP could soon be available on the NHS, under the trade name of Truvada.
PrEP can significantly reduces the chances of people being infected with the deadly HIV virus when taken on a daily basis.
In an attempt to address the spread of AIDS in the United Kingdom, a £50 million scheme will see the new PrEP drug available to men via the NHS.
The initiative comes in the context of new research which indicates that consuming the drug could reduce the chance of new HIV infections by as much as 50 per cent.
Already the scheme has been praised by proponents of the PrEP drug, who suggest that it will be a game changer for the treatment of HIV.
New research indicates that PrEP will prevent thousands of men from contracting HIV over the next few years.
Initially, PrEP was considered somewhat controversial, but has recently become more widely accepted, and is now available in numerous jurisdictions overseas.
Although there were initial fears that PrEP could lead to homosexuals in particular taking more sexual risks, trials have indicated a superb success rate for the new medicine.
It has been demonstrated that PrEP can cut the risk of contracting HIV by around 90 per cent.
Research outlining a model of the usage of the drug has already been published in the Lancet.
And it has been calculated by the authoritative journal that infection rates of HIV could plummet by as much as 59 per cent in gay and bisexual men as a result of the PrEP NHS availability.
This was based on a projection of all gay men in the UK being offered the drug. In theory, this could lead to preventing 10,000 new diagnoses by 2020.
Narat Punyacharoensin, of the London School of Hygiene & Tropical Medicine, and the lead author of the study, commented on the issue.
“Current prevention efforts in the UK that focus on correct and consistent condom use and regular HIV testing have been falling short. Our results show that pre-exposure prophylaxis offers a major opportunity to curb new infections and could help reverse the HIV epidemic among men who have sex with men in the UK.”
The health authorities have been similarly positive about the potential of this new treatment.
A spokesman for NHS England commented: “NHS England is working with local authorities and others across the NHS to consider the clinical and cost effectiveness of providing pre-exposure prophylaxis to at-risk groups.”
A new study attempts to address concerns about the side-effects of HIV-preventing PrEP drugs – finding the drugs are as safe as Aspirin.
More people than ever are living with HIV in the UK and each year new infections occur.
Over 103,000 people are living with HIV in the UK, with 17 per cent of sufferers currently undiagnosed.
A new tuberculosis drug which is aimed specifically at children will hit the general market later this year.
The TB Alliance, a non-governmental organisation, has announced the existence of the dissolvable tablets, which features a sweet flavour intended to appeal to minors.
This tablet has been developed through a partnership between the TB Alliance, the World Health Organisation (WHO) and the US government, and is especially intended to improve drug regime adherence among children in the developing world.
Although this is not an entirely new drug, it has been produced by combining existing tuberculosis treatments such as rifampicin, isoniazid and pyrazinamide.
The drug was announced at a conference in Cape Town, South Africa, with the TB Alliance stating that it could have a particularly marked benefit for developing countries.
Doctors and parents in many developing countries rely on crushing or splitting tablets when treating children with TB, having a negative impact over the controlling of drug dosage.
This can also mean that it is difficult for caregivers to satisfactorily administer the tablet fragments over the six-month course that tends to be required.
“Since the adult tablets were fixed drug combinations it meant redesigning the tablet according to the ratios [for children],” commented James Seddon, a paediatric TB researcher at Imperial College, London.
Campaigners in the third world have already acknowledged that the new drug is a significant improvement over existing treatments.
Juliana Odindo, a Kenyan campaigner with Y+, a global network of young people with HIV, stated that “it is great news that child-friendly TB medication is finally being made available so that children do not have to gamble with their dosages like I did.”
According to estimates from the WHO, over one-million children became ill with tuberculosis during 2014, with approximately 15 per cent of these people dying from the disease.
However, only around one-third of those who catch the disease are officially diagnosed and put on treatment, according to the authoritative health organisation.
Unfortunately, tuberculosis drugs aimed at children represent a lower-volume and low-profit market, which rarely interests pharmaceutical manufacturers.
Thus, the producers of this new drug have teamed up with Unitaid, an international drug purchasing facility overseen by the WHO, in order to ensure that the product gets to market.
Evaline Kibuchi, the TB manager at the Kenya Aids NGOs Consortium, welcomed the development.
“Our grassroots activists and civil society organisations have been advocating for child-friendly TB drugs over the last year,” Kibuchi commented.
The only seeming challenge remaining for this medication is to achieve approval from Kenya’s government.
The drug is likely to be available early in 2016 should this regulatory barrier be negotiated.
A drugs company lavished “unacceptable” levels of hospitality on NHS officials from across the country according to an inquiry.
The Prescription Medicines Code of Practice Authority (PMCPA) launched an investigation after newspaper reports broke the story.
One particular board meeting, conducted in a German spa town, particularly caused concern.
Officials employed in assessing drugs for the NHS were put up in luxury hotels, and each received a payment of £1,000 from the company.
It is thought that this could have compromised their neutrality.
Commenting on the issue, the report indicated that the hotel utilised was “out of proportion to the occasion”, and that the event had been “an inducement to recommend” the company’s products.
The report noted that the “panel was especially concerned that at the end of the advisory board participants addressed what they would do differently as a result of the meeting which, in the panel’s view, demonstrated that the primary focus of the day was in providing information to and influencing participants rather than the provision of advice to the company.”
Continuing its verdict on the retreat, the report concluded that the arrangements were irregular and could have brought the NHS into disrepute.
“The time spent obtaining advice appeared to be extremely limited and further no preparation was needed. Taking all the factors into account the panel did not consider that the arrangements either for the whole day or just the afternoon were such that the UK health professionals had attended a genuine advisory board meeting. It therefore ruled a breach of the Code. The panel considered that the meeting was an inducement to recommend Stirling Anglian’s medicine. A breach of the code was ruled.”
When conducting such meetings, it is generally considered that the NHS should use no more than normal hotel facilities, in order to ensure that NHS officials are not compromised in the selection of vital medicines.
Considering the necessary links between the health service and the pharmaceutical sector, complete neutrality is essential, and such hospitality could seriously compromise this in the eyes of the general public.
In addition, the PMCPA said it was “extremely concerned” that UK health professionals had attended the meeting on the “false understanding” that it was an advisory board and that they had been paid to do so.
The overall expenditure on prescribed medicines in the NHS is expected to exceed £15 billion next year; a figure which puts the importance of this issue into perspective.
A breast cancer drug will not be routinely offered on the NHS, despite considerable negotiation from the drug manufacturer.
Kadcyla has been shown to be effective in extending the lives of breast cancer patients.
NICE has indicated that the price tag per patient, at £90,000 per individual, is not tenable.
Manufacturer Roche claims that it offered a discount; the same one it used to cut a deal with the Cancer Drugs Fund.
And it will still be possible for females in England to acquire the drug from this fund for the time being.
Kadcyla can add about six months of life to those with incurable breast cancer.
It is also utilsed to treat people with HER2-positive breast cancer that has spread to other parts of the body and cannot be surgically removed.
An undisclosed price had been agreed between the manufacturer of the drug and NHS England, with the intention of ensuring that the medicine is not taking off the Cancer Drugs Fund.
However, with the fund due to be eliminated permanently in March 2016, it seems that this treatment is about to be permanently blackballed in the United Kingdom.
The government has no intention to create a replacement to the fund at the time of writing.
Although negotiations are ongoing, charities are concerned that more breast cancer patients could miss out on getting Kadcyla in the near future if no deal is reached between those holding the purse strings of the NHS and the drug manufacturer.
Roche claims that around 800 women every year benefit from the existing medication.
But NICE believes that the price of Kadcyla is simply too high to justify its general usage compared to the clinical merits derived from it.
NICE has stated that its decision on the subject is final, although it will review the guidance if any further research becomes available.
Roche has indicated that it would be willing to return to the negotiating table with NICE.
Sally Greenbrook, of the group Breast Cancer Now, suggested that patients would ultimately suffer as a result of this decision.
“Women in England who could benefit from Kadcyla are covered – for now – by the Cancer Drugs Fund, but with just months until the new Fund is introduced, we’re yet to be convinced that the proposals will improve the outlook for breast cancer patients. We’ll do all we can to ensure that reform of the Fund leads to positive change but given that the plans include using similar thresholds to those used by NICE, and no mention of pricing negotiations, we’re concerned that the new Fund will fail to improve on the existing one and may make matters worse.”
Kadcyla is not available on the NHS in Scotland.
AstraZeneca, the UK pharmaceuticals group, has won a significant legal victory related to one of its ovarian cancer drugs.
However, in the process of the legal proceedings, AstraZeneca promised to cut the price of the drugs and fund some treatment costs going forward.
The concessions made by AstraZeneca are indicative of the financial pressures that drug manufacturers in the UK are facing.
This agreement can be placed in the context of the mounting fiscal pressure on the health system as a whole.
The National Institute for Health and Care Excellence (NICE) indicated that it was prepared to recommend olaparib — also known by its trade name Lynparza — for use by NHS England.
This was a reversal of a decision made in June to reject the drug for distribution in the United Kingdom.
However, with the authorities cautious about the consequences of the verdict, the recommendation was made with restrictions put in place as well.
These will provide guidelines with regard to which patients shall be eligible to take the ovarian cancer drug.
The verdict coincided with a separate decision to reject a push by Johnson & Johnson, the US drugmaker, to win wider access for NHS patients to a heavily promoted prostate cancer drug called abiraterone.
Both of the drugs were developed in the United Kingdom, and AstraZeneca has suggested that the legal battle the company has face is indicative of the barriers preventing homegrown innovation in the pharmaceutical field.
However, critics of the pharmaceutical industry suggest that big pharma manufacturers only have themselves to blame for the high prices that have lead to legal restrictions.
In final draft guidance, NICE recommended use of olaparib only after three or more courses of chemotherapy.
There was also an additional condition that AstraZeneca would be responsible for footing the bill for patients who remained on the drug for a period in excess of 15 months.
Lisa Anson, head of AstrAstraZenecaeneca in the UK, agreed with the ruling, but also suggested that patients in the NHS are losing out on vital treatment owing to overly restrictive conditions.
“Despite being a world leader in the discovery and development of groundbreaking medicines, the UK has the worst overall cancer outcomes in western Europe.”
It was he pointed out that Anson obviously has a vested interest in this issue.
Johnson & Johnson indicated that it was extremely disappointed by NICE’s decision not to recommend use of abiraterone.
There were 4,271 deaths from ovarian cancer in 2012 in the UK.