The UK also occupies 10th place for cancer drug usage

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UK ranks eighth out of 13 developed countries on drug usage, finds analysis

Caroline White

1 London

The United Kingdom lags behind several other developed countries in its use of drugs for dementia and cancer, but comes out near the top for its use of cardiovascular medicines, says a report.

But no consistent international pattern emerges for all the disease categories assessed, even for those countries at the top of the league table, the findings show.

The report, by Professor Mike Richards, national clinical director for cancer services, was drawn up in response to perceived concerns that UK patients were not getting the same level of access to newer drugs as their peers elsewhere and to the commitment made in the Pharmaceutical Price Regulation Scheme to develop measurable comparisons of new medicines uptake in Europe.

The analysis reviewed drug use per head of the population for seven disease categories that are costly to treat in 10 European countries of varying size, plus Australia, New Zealand, and the US.

The unweighted analysis, which spans the period from April 2008 to March 2009, ranks the UK eighth overall, behind several of its European neighbours—including Spain, France, and Denmark. The US tops the league, and New Zealand comes bottom.

The UK earns second place for its use of cardiovascular drugs-thrombolytics for heart attack and cholesterol lowering statins-the latter being prescribed almost three times as much as the international average.

But it scrapes in at 13 for drugs to treat hepatitis C and multiple sclerosis and 11 for antipsychotic and dementia drugs. It manages only 10th place in the rankings for rheumatoid arthritis drugs.

The UK also occupies 10th place for cancer drug usage-which the report analyses in more detail-rising to fifth place for hormonal cancer treatments, but dropping to 12th for drugs launched in the past five years.

Australia, which ranks fifth overall, comes 12th for its use of cancer drugs, whereas the US only manages eighth position. And Germany, which comes 11th overall, occupies third place for cancer drugs.

The report found that the causes of the variations “appear to be complex.” There seems to be little correlation between drug usage and health spend to account for the differences, it says, but health technology assessments, such as those by the UK’s National Institute for Health and Clinical Excellence, can have a substantial impact. Operational, cultural, and epidemiological factors are all likely to play a part, it says.

Professor Richards cautioned against jumping to conclusions about quality of care. “There is no right or wrong level of usage,” he said, adding that it was up to clinicians to decide on appropriate levels. “You can’t take the simplistic view,” he warned.

But the government used the report’s findings to back its announcement of a £50m fund, available from October, to enable patients to access cancer drugs more easily, including those currently deemed too expensive or used off label.

The intention is to extend the fund to £200m ({euro}240m; $313m), pending the outcome of the comprehensive spending review later this year.

But Catherine Foot, senior fellow at health think tank the King’s Fund, questioned the move.

“Undoubtedly, this will mean some patients will get access to expensive drugs who wouldn’t otherwise have done so. But it’s not revolutionary,” she said. “And it won’t give the green light to every drug available.”

She also wondered whether this was the best use of NHS money, particularly in the current climate. “To hold yourself to account by outcomes [as this government has done] raises serious questions about why you would choose to invest £50m in drugs as your greatest chance of achieving them,” she said.

Cite this as: BMJ 2010;341:c4128

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