Disclaimer – The authors views are entirely her own and may not reflect the views of Abbott Diabetes Care
There’s no such thing as a free lunch. Most people with type 2 diabetes and everyone with type 1 need devices and medicines to help control their blood sugar – and those have to be paid for. I’ve worked in many countries, and it never ceases to amaze me how lucky we are in the UK to have the NHS. Even if you pay prescription charges (and people taking medicines for diabetes don’t), the NHS covers the vast majority of the cost of tablets, monitoring equipment and injections. The NHS provides regular eye screening for everyone with diabetes – one of the only countries in the world to offer this screening service for all. Nobody has to go to an NHS outpatient appointment with their cheque book handy.
80% of the NHS spending on diabetes goes on managing complications1 – and this is precisely what medicines are designed to prevent. So if a medicine will prevent those costly complications down the road, it’s a worthwhile investment. After decades with only a handful of drugs available to keep blood sugar controlled, the last few years have seen an explosion in new options. Some have fewer side effects, so more patients will stick with them; some are more effective at lowering blood sugar.
But all new drugs are bound to be more expensive than older ones. Pharmaceutical companies invest hundreds of millions of pounds to get a single medicine licensed, and the 20 year patent period, during which they have exclusive rights to produce it, helps recoup the cost of drug development
So in 2010 the Government announced a new system of ‘value based medicines’2 – they weigh up the cost of medicines against how much they improve quality of life, reduce complications or save lives. This calculation works out the ‘cost per QALY’ (Quality Adjusted Life Year). Although it has to be done at a population level – the human and financial cost to one person getting a side effect can be huge, even if it’s extremely rare – these calculations are the best way we have of deciding if medicines offer value for money. They’re about looking beyond the upfront costs and recognising that just because a drug is cheap, it won’t be cost effective if it doesn’t work well.
But people aren’t statistics – they’re people. The NHS also recognises that everyone has different risks, preferences and concerns. One person might see a side effect as unacceptable; another would say the same side effect was a small price to pay for better long term health. If you have concerns over your medicines, tell your doctor why – they’re not mind-readers, but if they know what matters to you, they just might have a better solution.
1.Diabetes UK (2014) State of the Nation: challenges for 2015 and beyond.
2.Equity and excellence: Liberating the NHS, Department of Health, Jul 2010