Friday, 28 March 2014

Cheap Drugs can we afford to develop them? or Can we afford not to develop them?

#MSResearch Do we want cheap drugs?

We have been talking about the cost of drugs in the US, but we can also bring it back to the UK. 

The occasion is a recent trial of Simvastatin in progressive MS, which costs £1-2 per month; that's £12-24 per year for an MS treatment!  The nearest ‘big pharma’ kid on the block with regard to treating progressive MS is Gilenya, whose trial finishes in 2014. This drug costs £14,000 per year give or take a few thousand quid. In the States multiply this by two (yep, ProfG is right about the US paying more for their drugs).

So if we say 10% of MSers have progressive MS, okay it will be more, then with 10,000 progressive MSers in the UK, drug costs would be about £200,000 p.a. (statins) versus about £140,000,000 (big pharma) per year. 

Lets say 30 years on drug is £4,200,000,000 (pharma) versus £6,000,000 (Simvastatin).

So for the government to fund an academic clinical trial costs say £1,500,000 (it costs pharma a lot more because their staff are being paid), that means about £3,000,000 for two trials, plus a few hundred thousand for the licensing. Even if we add £100,000 p.a. for keeping the licence there is considerable saving to the NHS – spend about £15 million to save over £4 billion. 

Maybe George Osborne, Ed Balls, and the other Cronies need to digest these figures and then maybe they will do something about them?  Maybe GPs in charge of the money will see the value of prescribing something that does not cost the earth. 

Now, we don't know whether Gilenya will work, and also we don't know how well it could work compared to Simvastatin. If Gilenya is much better, the cost savings go out of the window based on efficacy, so let's hope it's great.  However, we don't really know yet whether Simvastatin will work either as no more then phase II studies have been done.  More studies are needed. 

Will they be done? 

Big Pharma assume, and they’re probably right, that academia will not come through with the goods......after all they haven't so far and big pharma don't see any "disruptive Influences" (common board room language) on the horizon to inhibit their 20+ billion dollar market.

If simvastatin does come to the market at a cost of £2 a month, there will be no more investment by big pharma developing better drugs for progressive MS. Because if they can only charge £2 a month there will be no interest.  If the drugs work better they still will only be able to charge an increment.  
This is called Pharmacoeconomics.
Putting progressive MS to one side for the moment, what about a case where we know of cheap drugs that work in people with RRMS as well as anything that Big Pharma have to offer?  

Which drugs are we talking about?  There are a number, some could be developed quicker than others.

For one example you (or the NHS) would have to spend about £2,000 a life time (in fact more likely close to £1,000 only) per person compared to £320,000 - £560,000 (£8-14,000 p.a. for current DMT x 40 years).  

So now doing the sums with 100,000 MSers and every one of DMT that is £56,000,000,000 versus £200,000,000 for a £1-3 million outlay to get the drug licensed.

Is there a will to take on Big Pharma? Or are all Neuros in the pockets of Big Pharma?

What effect would this have on Big Pharma’s interest in MS?  

But what would be the effect on all of us if we don’t do it?  Will the NHS survive? Unfortunately, I think this one may be easier to answer!


  1. What about the EAMS scheme you brought up last week? The cost for a Phase II clinical trial is much lower and can be afforded by charitable societies. Simvastatin could already be used if thie EAMS takes it into consideration....

    1. The fast track is to help companies get information so they give companies the option of putting people on drug who would not be eligible for the trial or maybe the trial is full and they pay for a drug and collect data.

      Now in case of simvastatin it is not a company doing the studies so (a) Who is going into a trial and get a chance of placebo if they know they can wait and get drug and (b) who is going to pay for the drug? Ok it is only a few quid, but then who is going to pay for the register to collect the data.It is not a case of eating a few fried eggs to get your cholersterol up so you can get a statin and the dose is high and also how are you going to get the evidence that it really works

      There could be a solution

  2. Looking back on your comments on ofatumumab of 29.1.14, it would seem Big phama don't want to develop induction therapies, rather maintenance therapies that will keep the cash cow going for years. NICE will become more and more of a gatekeeper- they only give the go ahead to one in three drugs put before them now as it is. NICE is proposing to change the criteria on which it decides a drug's availability, which may restrict the access to drugs for terminally ill patients. Maybe it will help access to MS patients as it will assess the burden of illness on an individual as well as the wider impact on society, but I wouldn't hold my breath.

    1. I agree on your assessment of my take of ofatumumab I guess it will not be an induction therapy because the company's role is to make money for their shareholders. Should we aim to generate induction therapies if companies don't want to go down that route?

      so what you think about a cheap induction therapy?

  3. Remember the lessons from your board game MouseDoctor: drug development has a very low success rate

  4. I agree, does that mean we should not try? The question I pose is can an academic get round the board ever? If you work out that there is no way you can get round the board then there is no point starting.

    However being an optimist I am guessing there I away way round and I can see enties out there that have been round the block already.


  5. P.S.
    I have been speaking to ProfG about this and he suggests the figure for progressive MSers will be nearer 60,000 so in my analogy it is £1,200,000 verses £740,000,000 per year so
    £3,600,000 verses £22,200,000,000 over 30 years. So again for about £15,000,000 you could save £22 billion

