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Leela Barham is a freelance health economist and policy expert. She has published in peer-reviewed journals and presented at national and international conferences. She has provided advice to the Department of Health and Social Care on policy on pricing of branded medicines to inform the negotiation of a successor to the UK’s Pharmaceutical Price Regulation Scheme (PPRS), the Voluntary Scheme for Branded Medicines Pricing and Access (VPAS), as well as worked with patient groups, the NHS, pharmaceutical companies and many others internationally on the economics of healthcare and pharmaceuticals. Contact Leela on email@example.com
That the UK's NHS has struck a deal for a national roll-out of Bexsero, GSK's vaccine for Meningitis B in infants, is good, but it needs to do better, writes Leela Barham.
GlaxoSmithKline (GSK) and the UK National Health Service (NHS) have struck a deal for a national roll out of Bexsero, a vaccine for Meningitis B in infants. Meningitis B is a bacterial infection that can affect children often under the age of one, as well as teenagers. It affects just short of 2,000 babies and teenagers in the UK every year. That a deal has been agreed is good news for the many babies and parents who will have less to fear from Meningitis B, but campaigners have rightly questioned just why it has taken so long. It’s also offended some as the delay in the NHS making it available has meant over those with money to spare have been able to protect their babies – those without the cash have had to go without.
It’s taken a long time - however you break it down - for this agreement to be reached. It’ll perhaps be September 2015 when the first babies will be vaccinated; more than two years after Bexsero was licensed in Europe.
The Bexsero deal timeline
It’s worth noting that delay has come from both sides. For example, it was some six months before the Department of Health and Public Health England even sat down to talk with the manufacturer once the JCVI recommended use in infants. It was another six months before a deal was struck. At the same time GSK only took over Novartis’ vaccines business recently, including the Men B vaccine. Speculation, but sorting this transaction out may have slowed things down.
A good deal?
So has the government got a good deal after such a long wrangle? They’ve definitely secured a hefty discount on the list price, reportedly at £75 ($112) per dose. The deal is apparently for £19 ($28). However, modeling has put a cost effective price at £3 ($4.5) or perhaps £4 ($6) per dose. That was against a pretty stringent £20,000 ($30,000) cost per Quality Adjusted Life Year (QALY) (why not £30,000 applied to other medicines, especially when we’re talking about babies?). So the NHS is still far away from the price that has been suggested in modeling to be cost effective. But don’t forget, the true value of nationwide vaccination is uncertain – maybe we should pay more if it turns out the vaccine performs better and protects more than 73% of babies against infection that it’s currently believed to do or it protects against another strain as suggested by some medics - and we need to balance value for the NHS with innovation and the benefits it brings to patients.
The budget impact for the NHS could be perhaps £16 million ($24m) a year. That’s not that much, you might think, especially when the national roll out could prevent the loss of perhaps 180 lives and 500 permanent disabilities. Campaigners say that the cost of treating just one child needing long-term care could be in the region £3 million.
But the NHS has been facing in recent years it’s toughest financial position. Gone are the days of receiving significant growth in funding well over inflation. Now it’s barely keeping up and has only just managed to be receive real terms increase at less than one per cent in recent years. We’re at a point where something like 4 out of 5 hospitals are in deficit and not all the political parties -currently jostling for position in the run up to the General Election in May - are willing to commit to the £8bn that the head of the NHS, Simon Stevens, says it needs.
The cost of delay
That there is a need to push for value for money is clear, but so too is the need to do so quickly when campaigners suggest that the cost of delay has been real harm to infants. Meningitis B is fatal in about 1 in 10 cases and 1 in 4 of those who contract the infection and survive, can experience long-term effects; deafness, epilepsy, learning difficulties and amputation. That a deal has been struck is good; the UK has a history of striking reasonable deals with pharma, but we need to do better. Faster appraisal (should it really have taken 4 years for a final recommendation from the experts?), earlier dialogue (starting before licensing perhaps?), and reasonableness on all sides must be a focus.