I have come across something I call the ‘evidence pit’ over the last few years, but it seems to be getting worse. I am not sure whether it is driven by the NHS or the pharmaceutical industry or just a general misunderstanding. I think I know what causes it – the financial pressures in the NHS.
So the argument – here is the need, here’s a drug, here’s its license, here’s its data, this is where it fits and this is the price is lost in the fear that a new medicine is just too expensive for the NHS to bear.
So who changes the game? Who decides that the NHS can’t afford the new medicine and changes the way that the medicine is presented in the NHS? Who dreams up the positioning squeezing a new medicine into a gap in the market.
Quite honestly it hacks me off. A niche position in a group of patients or a place in a pathway that is not supported by the evidence.
Are you all mad!
How can I approve a medicine for a group of patients or a position in a pathway that are not clearly defined in the trials?
Why would you want your medicine used in a group of patients more severe than the trial and the likelihood of success is low.
Just because there is a medical treatment gap you don’t have to shoehorn a new medicine into it.
So here is how I see it.
The prescribing budget has performed well. Some good fortune and some good management. We know that some new medicines may create cost pressure and we will deal with it.
Present the medicines in line with licence and evidence – straight down the line
I like to approve medicines in line with their licence and in a group of patients compatible with those entering the clinical trials – simple
I don’t like approving medicines in positions not supported by evidence even though it may be in line with license. So to do this make sure that there is either evidence, experience or both supporting the medicine in that patient group and that place in the pathway showing effectiveness and safety and value.
Give the medicine a chance – don’t fall in the ‘evidence pit’