NHS PENNYPINCHING (1)

Short term thinking

New guidelines for saving NHS money by prescribing older, cheaper heart drugs will mean less effective care for some patients, specialists claim. Primary care trusts have been told that at least 60 per cent of prescriptions for life-saving statin drugs should be for simvastatin and pravastatin, which are out of patent and much cheaper than newer, more potent statins. The policy emerged quietly last week as part of a report from the NHS Institute for Innovation and Improvement that claimed productivity and efficiency savings could be worth 700 million pounds a year. While the report makes no mention of any new target, an accompanying document says that generic statins should represent a minimum of 60 per cent of all prescriptions. “Greater savings will be achieved for larger shifts,” it says. While primary care trusts cannot force GPs to prescribe particular drugs, they can exert considerable pressure.

Pfizer, the drug company that makes Lipitor, the statin likely to lose market share as a result of any enforced change, says that the policy risks reversing recent advances in the management of heart disease. Olivier Brandicourt, Pfizer’s managing director, said: “Not only does this represent bad medicine and a further assault on clinicians’ freedom to prescribe the most appropriate medicine for their patients, but it could also slow progress towards the Government’s own goal of significantly reducing deaths caused by coronary disease by 2010.” He is backed by heart specialists.

John Betteridge, Professor of Endocrinology and Metabolism at University College London, said: “It is crucial that the quest for savings on prescribing costs for statins should not lead to less effective care for individual patients at high risk of cardiovascular events. I fear that this may be the case.” Professor Paul Durrington, of the Cardiovascular Research Group at the University of Manchester, said: “This is essentially robbing Peter to pay Paul. “Substantial numbers of patients with above-average cholesterol levels will fail to hit the Department of Health’s own targets with generic statins and these are also the targets GPs are contracted to achieve. “Failing to achieve these targets will translate into more expensive hospitalisation and surgical intervention.”

A recent paper in the British Medical Journal suggested that, at the right dose, all statins were of more or less equal potency, and that 2 billion could be saved over five years if the NHS prescribed only simvastatin. But Pfizer cites trials in which Lipitor produced greater reductions in cholesterol levels than simvastatin. Dr Berkely Phillips, medical adviser to the company, said: “The most important thing is that we are moving to new, lower targets for cholesterol. “The current target is 5 mmol/litre of total cholesterol but the Joint British Societies — the British Cardiac Society, the British Hypertension Society, Diabetes UK, Heart UK, the Primary Care Cardiovascular Society and the Stroke Association — have recommended that the target should be 4 mmol/litre. “On 40 mg of simvastatin, a normal dose, only 33 per cent of people would reach this target. Lipitor [atorvastatin] is more potent.”

The Department of Health denied that there was any new target. A spokesman said: “This is guidance for trusts showing the potential savings that could be achieved if their GPs prescribe lower cost statins.” He added: “There is no government ‘cholesterol target’. However, under the new GP contract, doctors are rewarded for controlling the cholesterol level of patients with coronary heart disease. We are not aware of any evidence that shows the prescription of low-cost statins — in line with guidance from the National Institute for Health and Clinical Excellence — will reduce the effectiveness of this measure.”

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NHS PENNYPINCHING (2)

Is infertility not a medical problem?

British couples who have difficulty starting a family are among the least likely in Europe to receive the IVF treatment that they need. According to a new league table published yesterday, Britain came 12th out of 15 countries that provided data for 2003, with only Macedonia, Croatia and Austria performing fewer cycles of fertility treatment per head of population. Clinics in Denmark, the top-rated country, where most IVF is provided free by the State, conducted 2,031 cycles per million inhabitants, compared with 633 in Britain. France, the country most comparable in size, comes ninth, with 1,009.

In global terms, Britain finished 16th out of 34 countries. Most of the lower-ranked nations, with the exception of America, which has no reimbursed provision of IVF, are from the former Soviet bloc, the Middle East or Latin America. Israel headed the world table by a distance, with 3,263 cycles per million; IVF is available free, and without limits.

Anders Nyboe Andersen, of Copenhagen University Hospital in Denmark, who led the team that compiled the European data, said that Britain’s position came as no surprise given the low priority that funding IVF receives from the NHS. While the National Institute for Health and Clinical Excellence (NICE) has recommended that three cycles be provided free to most couples in which the woman is under 40, the Government has asked primary care trusts to pay for only one and many do not offer even this limited service.

North Lincolnshire PCT is the latest to scrap free IVF treatment because of financial deficits. Dame Suzi Leather, chairman of the Human Fertilisation and Embryology Authority, recently described access to IVF as “the No 1 problem faced by patients” and called on the Government to implement the NICE guidelines. Dr Andersen told the European Society of Human Reproduction and Embryology conference in Prague: “The main reason for Britain’s position is that (IVF) is not available from the State.”

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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