Value-based assessment for medicines - prescribing in the 'new' NHS

In case you hadn't noticed, people are finding money tight these days - and the NHS is no exception. Value is very much the buzz word in the NHS, but rest assured that this doesn't necessarily mean lower-quality care.


In case you hadn't noticed, people are finding money tight these days - and the NHS is no exception.

When I became a GP rather more years ago that I care to think about, almost all my time was spent treating illness. Over the last couple of decades, the emphasis has moved to a fairly even split of treating and preventing illness. Many of the patients I see these days are there for conditions they'd never know they had if I hadn't diagnosed them, like high blood pressure or raised cholesterol. But in the last few years doctors have had to watch the NHS's pennies with an ever more careful eye. These days it's all about 'value-based assessment' for medicines - and the National Institute for Health and Care Excellence (NICE) plays a key role. Value is very much the buzz word in the NHS, but rest assured that this doesn't necessarily mean lower-quality care.

NICE or nasty?

NICE weighs up all the evidence for medicines or medical conditions. It advises on which treatments provide the highest quality of care for individual patients, and which offer the best value for money. If NICE gives a thumbs-up to a medicine, it automatically becomes available on the NHS - although whether it's suitable for any particular person is still down to their doctor's discretion. If it says a medicine isn't good value for money for the NHS, it becomes hard to get on the NHS except in very special cases. It's a tough job and some of its decisions aren't popular - but there's limited money in the NHS pot and they're trying to distribute it as fairly as possible

What does 'value-based assessment' mean?

A medicine that costs pennies but doesn't work well can be less cost-effective than an expensive one that produces dramatic results. Value-based assessment of medicines compares how much it costs to save a life or improve quality of life by a set amount, using different medicines. NICE uses a term called a 'QALY' - Quality Adjusted Life Year - to compare the benefit to patients from medicines used for widely differing conditions. This takes into account both how much (and whether) a medicine will increase life expectancy, and how much it will improve quality of life of the patients who take it. Obviously this has to be done at a population level - even if 99% of people benefit from a medicine, one person could get a side effect which can drastically affect their quality of life and can occasionally even be fatal. The rate and severity of side effects are taken into account too.

What's in a name? 'Generic' medicines

When a medicine is first registered, it's given a name. This is often long and unpronounceable (even by doctors!) but may be chosen to show it's part of a 'family'. For instance, the 'statin' medicines all lower cholesterol in a similar way, so they're called simva-statin, atorva-statin, rosuva-statin etc.

But new medicines also get a 'brand' name which shows they're made by the company that first developed them. Once drugs are off patent, other companies can make the same medicine (under the same strict quality standards). So 'generic' tablets will look different but the active ingredients are the same as the 'branded' version.

Why do new drugs cost so much?

It costs hundreds of millions of pounds to get a medicine from laboratory to pharmacy shelves. Drug companies have exclusive rights to produce their own medicine for up to 20 years, which helps recoup the cost of developing them.

Let's stick with statins - will a swap hurt?

If you have type 2 diabetes, heart disease or a history of stroke you're almost certainly taking one. If you have high cholesterol and other risk factors (smoking, getting older, high blood pressure etc) your doctor may recommend one.

Twenty years ago, all statins were expensive. These days, some have come off patent and cost 10 or 20 times less than others. Your doctor may recommend changing you to a less expensive one. That doesn't necessarily mean it will be less effective - a blood test will tell - but different side effects are possible and should be reported.

What should you ask your doctor?

If your doctor suggests you change tablets:

- Ask them to check your records to make sure you haven't taken the cheaper one in the past and swapped because it wasn't controlling your symptoms

- Check if there are any new drug interactions which might affect other medicines you're taking

- Ask about differences between your old medicine and the new one. They might look different (colour, shape etc) but have the same ingredients.

With thanks to 'My Weekly' magazine where this article was originally published.

Dr Sarah is unable to provide medical advice or respond directly to questions concerning your health. If you have health concerns we recommend contacting your GP.