Tuesday, August 07, 2007

Don't get arthritis in Britain

Thousands of arthritis sufferers will be denied treatment with proven benefits by a decision not to pay for a new drug. Guidance issued by the National Institute for Health and Clinical Excellence (NICE), the watchdog that controls access to drugs on the NHS, will recommend today that the drug does not represent value for money, although it has been shown to improve dramatically the severest symptoms of arthritis in almost half of patients.

The draft ruling comes on the day that Alan Johnson, the Health Secretary, will announce that he is tearing up a price-fixing agreement with pharmaceutical companies in an attempt to reduce unneccessary waste of drug funds. The Times has learnt that the Health Secretary has decided to take on pharmaceutical giants as the NHS’s 8 billion pound annual drugs bill comes under pressure from expensive new medicines.

Abatacept, which has the brand name Orencia, is the latest of a new generation of drugs to be blocked by NICE on the ground that it is not cost-effective. About 400,000 people in the UK have rheumatoid arthritis, of whom a tenth (40,000) have a severe form. Many benefit from a class of drugs called anti-TNFs but about a third do not. This group, of around 12,000 patients, could potentially benefit from new drugs such as abatacept. Its manufacturer, Bristol Myers Squibb, estimated in its application to NICE that around 3,500 patients a year would benefit. Published data shows that in trials abatacept produced a 50 per cent reduction in symptoms in about 40 per cent of the patients who used it in conjunction with an older drug, methotrexate.

The cost would be about 9,300 a year for an average patient, but all would be sufferers who had already been treated unsuccessfully with anti-TNF drugs, which are equally expensive. Those who gained no benefit would have been taken off the drug swiftly. The NICE decision was described by patient groups as devastating. Ailsa Bosworth, chief executive of the National Rheumatoid Arthritis Society (NRAS), said: “This is extremely bad news for people living with severe rheumatoid arthritis. “Denying patients the option of abatacept leaves some of them with the unacceptable choices of being put back on to treatments they have already failed on, palliative care or taking large doses of steroids, which have unacceptable side-effects over the long term.”

The NICE ruling will be open to consultation, and final guidance is not expected until the end of the year. A spokesman said: “Having examined cost-effectiveness analyses on the drug against a range of comparators, the committee concluded that abatacept could not be considered a cost-effective use of NHS resources.” The problems of balancing drug costs against benefits have led a growing number of patients who are denied treatments to resort to legal action.

The Government hopes to free more money for treatments by renegotiating the five-year profit control agreement that it signed with drug companies just two years ago. The move comes after a report by the Office of Fair Trading recommended that the NHS move to a new system that matched the price it pays for drugs to how effective they are, after finding widespread evidence of overcharging.

Some of the most inflated prices are for treatments for blood pressure, cholesterol and stomach acid, which are prescribed to millions of patients a year. Although some cost ten times as much as alternatives they offer little or no extra benefit, the report found. It concluded: “We have identified hundreds of millions of pounds of expenditure per year that could be used more cost-effectively under value-based pricing, allowing patients greater access to drugs and other healthcare benefits they are currently being denied.” Representatives of pharmaceutical firms were warned by Mr Johnson that he was intending to tear up the agreement. A statement from the Department of Health will seek to strike a conciliatory tone, emphasising the contribution made by drugs giants to the economy and in developing new medicines.

Nevertheless, the drugs industry is likely to fiercely resist attempts to renegotiate the price regulation scheme. In the wake of the competition watchdog’s report this year Richard Barker, the director-general of the Association of the British Pharmaceutical Industry, said: “The UK gets its life- improving and life-saving medicines at a fair and reasonable price.” A Department of Health official told The Times that Mr Johnson could not ignore the findings of an independent watchdog after a thorough 18-month investigation that compared the prices paid in Britain with those paid abroad. He added that the Health Secretary had not yet decided whether to accept the recommendations in full.


Moronic NHS salary management

A DAMNING official report to be published this week will show doctors are working significantly fewer hours for more pay. The GPs' Workload Survey, the first such study for 15 years, has found that after the introduction of a new contract three years ago, doctors are working on average about 15% fewer hours. During the same period pay has risen by nearly a quarter. The report is likely to generate a backlash among nurses, who the study found are taking up much of the slack.

Gordon Brown is set to accelerate moves to force GPs to open weekend surgeries and to hold more early morning and late evening sessions. The report will show that although GPs tend to spend longer with each patient, it is nurses who are filling in on many occasions.

Another finding is that almost one-third of GPs, who earn an average of more than 100,000 pounds a year, are working part-time. The public is becoming increasingly concerned that GPs have received such large pay increases while many patients still struggle to book advance appointments and are unable to consult a family doctor out of hours. Some doctors have argued that the pay rises are to the detriment of patient care because they permit GPs to work fewer hours.

The figures will strengthen Brown's determination to make GP appointments more convenient for patients. The prime minister is understood to be concerned that patients are currently forced to take half a day off work to attend a GP surgery. Businesses say they lose 3.5m working days a year because of doctors' appointments.

A government survey found that a quarter of patients still cannot book an appointment more than two days in advance. Katherine Murphy of the Patients Association, said: "The huge pay rises they are now getting have not been reflected in the care patients are receiving.


That wonderful government "planning" again

Delay in autopsy reports on SIDS in Australia

DISTRAUGHT parents of children who have died from Sudden Infant Death Syndrome are waiting up to a year for final autopsy reports due to a chronic shortage of forensic pathologists. The shortage is also causing increasing delays for relatives waiting for adult autopsy results through the coroner's court system.

Doctors specialising in SIDS say the situation is causing anguish for parents who desperately need emotional closure after a child's death. But they would speak only anonymously because their area of highly specialised work depends entirely on state and federal funding.

The latest figures from the Royal College of Pathologists Australasia show there is one pathologist for every 15,500 Australians. The situation for child forensic pathologists is much worse: 10-12 pathologists for the entire population. About 30 per cent of these pathologists are aged 60 and over. To train a pathologist takes five years on top of a regular medical degree and one year's hospital experience.

Professor Roger Byard of the University of Adelaide told The Sunday Mail: "There just aren't enough pathologists, full stop. It's a workforce issue that's only going to get worse." Dr Debra Graves, CEO of the Royal College of Pathologists, describes the situation as "woeful". She said a 2003 Australian Medical Workforce Advisory Committee report, signed off by both state and federal health ministers at the time, recommended an extra 500 training positions over five years. But to date only 80 positions have been created, well short of the 400 traineeships that should have been in place by the beginning of 2007. According to College data, the Commonwealth has committed to funding an extra 30 positions in the private sector.

But it is the states that are dragging the chain. To date Queensland has committed to 21 positions, the ACT two, Western Australia 11, South Australia two, Tasmania one, and Victoria and New South Wales six each. The number of SIDS deaths in Australia has fallen from 500 a year to around 100 annually since the "safe sleeping" campaign began in 1991.


Australia: Queensland hospitals stretched to limit

A moronic government was not prepared for an upsurge of winter flu -- more of that wonderful government "planning"

With a burning forehead from a raging fever and his tiny chest heaving with every cough, Tyson Penrose slumped into his dad's lap. As exhausted Matthew Penrose, of Petrie, tried to make himself comfortable on the cold steel seat, he wrapped his arms around his sickly 11-month-old son and waited . . . and waited. "We were told there would be a two-hour wait when we got here," Mr Penrose said as he took his late-night place among the scores of other anxious parents who cradled their sick babies in the emergency room of Royal Brisbane Children's Hospital. By midnight, the wait time was nearly three hours. By then the children were drained by their illness and exhaustion, their desperate parents willing to do anything to get their kids better again.

The hospital staff are understanding of each parent's plight, those in the wait room said, but they are chronically undermanned and the flood of patients sickened by the current flu outbreak appears overwhelming. And this is a scene repeated in emergency rooms and hospital wards across the state as Queensland plunges into its worst flu crisis in six years.

Influenza A killed a four-year-old boy at Mater Children's Hospital last week and nurses yesterday flew home yesterday with 48 children stricken with the influenza A virus during a school trip to Canberra. The Year 7 students from Marymount College on the Gold Coast were required to wear face masks as they boarded a bus in Canberra which left for Sydney airport early yesterday morning. Two of their classmates remained in hospital in Canberra, but are reported to be satisfactory.

At the Gold Coast Hospital 23 children have been diagnosed with suspected Influenza A virus in the past two weeks, 10 of them requiring admission. That's five times the number of flu cases among children in the same period last year, a trend doctors say is occurring across the state. "It's strikingly unusual. I assume it has something to do with a change in the strain (of the virus)," said Professor John Gerrard, the Gold Coast Hospital's director of medicine.

Dr Steve Hambleton, a GP spokesman for the Australian Medical Association, agrees the current strain of influenza is unusually virulent. "It also spreads very easily. The virus can actually be transmitted within two hours of shaking hands with an infected person," he said.

The flu crisis is taking a staggering toll across the state. A Queensland Health source told The Sunday Mail that on Monday the state had run out of intensive care beds, coronary care beds and higher dependency beds - although a spokeswoman for Queensland Health disputed that. Queensland Nurses Union secretary Gay Hawksworth said critically ill patients were being dumped on trolleys in hospital corridors because there were no beds.



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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