Drugs advice 'will cost millions'

GPs say NHS committee's recommendations on cholesterollowering treatment
endanger moves to control costs. Nigel Hawkes reports

HEALTH authorities struggling to make ends meet say they have been given
advice by an NHS committee that could add hundreds of millions of pounds to
their bills.

If fully implemented, the Standing Medical Advisory Committee's advice on
prescribing "statins", cholesterollowering drugs, issued in August, would
cost £800 million a year. No additional money has been made available. The
potential cost is far greater than the £300 million recently extracted from
the Treasury by Frank Dobson, the Health Secretary, to help the NHS to
survive the winter.

Health authorities say the advice threatens their attempts to control
soaring drug costs. "It was neither timely, effective nor desirable," Mike
Marchment, chief executive of Warwickshire Health Authority, said. "The
committee didn't do a proper analysis, failed to present the evidence and
jeopardised the treatment of highrisk patients who really get the greatest
benefits from these drugs."

The committee recommends prescribing the drugs to one in 12 of the
population between the ages of 35 and 69 ­ roughly 1.7 million people. The
cost depends on which of the five statins available is prescribed. The most
expensive, Pravastatin, made by Squibb, costs nearly £750 a year per
patient at the highest dose rate.

Mr Marchment and colleagues wrote in the British Medical Journal earlier
this month that following the advice, using the cheaper Simvastatin made by
Merck, Sharp and Dohme, would cost the authority £8 million a year. "We are
a typical authority and our patients represent 1 per cent of the whole
population. So guessing a total of £800 million for the whole country would
not be far out."

Nick Freemantle, of the Centre for Health Economics at York University,
said that the drug itself was not unreasonably expensive, but the huge
numbers targeted by the advice mean that overall costs were high. "In
patients with angina and an elevated cholesterol level, or those who have
had a heart attack, the benefits are good. For every 150 patients treated
for one year, one death will be avoided."

But the benefits are far less clearcut and may not even exist, he said,
for those at lower risk, whom the committee also recommends should be
treated. "It is very important that the highrisk group should be on these
drugs," he said. "The danger is that they will get lost in the drive to
treat a much larger group where the benefits aren't clear."

Mr Freemantle says that this is not a sensible way to carry out health
policy. "We had doctors with their heads in their hands," he says. "They
had been desperately trying to get the drug budget into balance when along
came this advice and wrecked their efforts."

Peter Enoch, a GP from Ilkeston, Derbyshire, who chairs the committee, said
he was "aggrieved" at the criticism, as his group's intention was not to
encourage but to limit the prescribing of statins. "We were concerned that
statins were likely to take off at an alarming rate, with little advice
available to counter that of the drug companies. We were trying to
discourage them from being used indiscriminately. Our advice is that if the
funds are available, then this is the way to go about using the drugs.

"GPs should advise trying other things first ­ diet, exercise, stopping
smoking ­ and if that fails, then we outline three priority groups who
should get the drugs." Dr Enoch suggests that the committee's critics have
failed to read the accompanying documents, which make this clear.