Counterproductive NHS pennypinching

When you've got an army of clerks to feed day in and day out, you cannot do your best for the patients

The Department of Health may have saved more than $36 million a year by choosing a cervical cancer vaccine that does not protect against genital warts. The decision to use GlaxoSmithKline's Cervarix rather than Merck's Gardasil for the vaccination campaign for 12-year-old girls was announced last month. It was criticised by experts who said that Gardasil was a better vaccine. Dr Colm O'Mahony, a consultant in sexual health at Chester Foundation Trust, said: "All the clinical evidence pointed to Gardasil and instead they have chosen a vaccine suitable for the Third World."

A new analysis published in the British Medical Journal says that a vaccine that does not protect against genital warts needs to be $26-$42 cheaper per dose to be as cost-effective. The study, by health economists at the Health Protection Agency, used the economic model employed in the tendering process. The agreed price is confidential, but if the department saved less than this it made a poor choice.

In an editorial accompanying the study, Professor Jane Kim, from the Harvard School of Public Health, said that the Department of Health seemed willing to forgo health benefits in return for the lower cost of Cervarix. "Assuming 80 per cent coverage of current 12-year-old girls in the UK with the full three-dose vaccine series, this price differential translates to savings of $23 million to $37.2 million from the vaccine price alone in the first year of the programme."

A spokeswoman for GlaxoSmithKline said that the Health Protection Agency's model assumed that the human papilloma virus (HPV) vaccines were equal in quality and duration of protection against HPV strains 16 and 18. It also assumed that protection must last ten years or longer. There were no data for either vaccine over such a long period, but data on GlaxoSmithKline's vaccine had demonstrated prevention of pre-cancerous lesions and strong immune response for 6.4 years. "This is the longest duration of protection reported for any vaccine against HPV 16 and 18," she said.

Natika Halil, director of information at the FPA, said the charity was disappointed that Gardasil had not been chosen. Choosing Cervarix, she said, "has cost the UK a rare opportunity to protect an entire generation of its young women against genital warts. "Genital warts is very common, easily transmitted, but can be stubborn to treat and young women are in a high risk group for this infection. We reiterate our disappointment that Gardasil wasn't chosen. "Genital warts has its own financial cost to the NHS which spends $44 million a year treating it, so it will be interesting to see how this has been factored into the cost analysis."

Lisa Power, of the Terrence Higgins Trust, said: "The Government has made a decision which appears to be cost-effective but not health-effective. They think it's cheaper to let people get genital warts and treat them than to prevent them. The cost of human misery has not been considered."

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