First of all, I wish all our readers a Happy New Year. I hope that the holiday season was pleasant and enjoyable for all.
One of my tasks at this time of year is to identify the clinical and financial implications of the introduction of new drugs for my hospital over the next few years. Our planning cycle in the UK is moving to a 3–4-year cycle from our present year-on-year system. Although highly sensible, the process is now much more complex. Much of the information for medicines development is not in the public domain. No-one knows what the costs of an as yet unlicensed or marketed medicine is likely to be in three or four years’ time. Also, the full clinical knowledge is not available to predict how many patients are likely to benefit from these new drugs. A third unknown is the impact on practitioners: will it take up more pharmacy time? Will it save nurses’ time? As a result, much of the effort has gone into looking at the next 12 months.
Three things struck me as I pulled together all the data and information to provide the hospital executive with a useable summary. First, the potential cost was quite staggering. If every patient in our hospital’s catchment area were to be diagnosed and then treated with these new drugs at optimal dose, then the extra costs would run into millions of euros for the hospital. In primary care the costs are much greater. This pattern must be repeated across many nations, and funding healthcare developments is a challenge not only for healthcare professionals, but also for governments – politicians and civil servants alike.
The second was the fact that not only did many have unfamiliar (and frequently unpronounceable) names, but also many were completely new drug entities, or drugs with new and novel modes of action, or existing drugs being used for completely different indications. A short list includes pimecrolimus, anakinra, rutuximab, pegylated interferon, etanercept, alemtuzumab, ximelagatran, fondaparinux, levosimendan and my favourite in the unpronounceable league, drotrecogin. The pharmaceutical industry is being truly innovative. However, it leaves us with a massive challenge. How do we get our knowledge base (and that of our staff and colleagues) up to an acceptable level when there is all this new knowledge for us to assimilate? A major task, and hopefully one that HPE can help address.
The third was that many of these new drugs were exactly that – new treatments that would be used in addition to existing treatments. Alternatively, they were very much more complex to provide than existing treatments. This means the time taken to provide them is greater. We will need more pharmacy staff to procure, prepare, dispense and manage these medicines, and in many circumstances more nurses to administer and monitor them. When we are negotiating with the funding bodies we must ensure that these important elements of improving healthcare are not forgotten.
Chris Cairns, Consultant Editor