A Price On Your Life?

Posted on: 01 September 2008 by Gareth Hargreaves

There's a price on your life. Get the wrong disease and you may simply be too expensive for the NHS to save.

That's the reality of modern healthcare. It's called rationing.

Spending on the NHS has trebled since 1997. This year it'll reach £100 million. That's £3058 every second. But even that is not enough to keep up with the rising cost of new treatments.

Sky News asked one of the UK's leading cancer specialists to calculate the impact of new drugs on the NHS, as part of a series of special programmes to be broadcast in September.

Professor Karol Sikora says that medicines likely to be available over the next year will prove so expensive that they'll cost the health service £50 billion. Half the current NHS budget.

The choice is simple. Either spend a lot more on healthcare through tax or top-up insurance, or restrict what the NHS is prepared to pay for.

The Reality Of Rationing

Increasingly the NHS is doing the latter. It is looking at the value for money of new medicines. Since the budget is limited, it seeks to spend cash on treatments that give the most bangs per buck.

sky_news_health_pillsThat's the job of the National Institute of Health and Clinical Excellence, NICE. It's the official rationing body of the NHS. And it regularly comes in for a bashing from the tabloids for denying new drugs to patients.

Avastin for bowel cancer. Sutent for kidney cancer. Aricept for Alzheimer's disease - all ruled too expensive for the NHS.

Take the first one, Avastin. It costs around £17,000. And it gives an average of 5 extra months of life.  For the patient, those extra months are priceless.  But for the guardians of the NHS purse, Avastin just isn't worth it.

Judging a drug's cost effectiveness is a complicated - and controversial - business.

Health economists look at clinical trials to see what is likely to happen if a patient is treated with the medicine - what quality of life will he or she gain and for how long?  And then they ask how much it costs to buy each QALY, or Quality Adjusted Life Year.

The figure for Avastin is over £49,000 per QALY. That's far more than the cut-off used by NICE, which is around £30,000.

So however grim the decision is for patients with bowel cancer, NICE has decided NHS funds would be better spent on something else.

The Post Code Lottery

NICE was set up by the government to stop the postcode lottery. But our investigations have shown that your access to treatment is still strongly affected by where you live.

sky_news_health_elderly_patientThe NHS in some parts of the country spends almost three times as much on cancer or heart disease as others. That's not just on drugs. But also the availability of the right doctors, radiotherapy machines and scanners.

If you live at the wrong address, it could affect your chances of survival.

And so could your age.

Astonishingly, we found evidence that you stand a much better chance of being treated properly for a heart attack if you are under 45 than if you are a pensioner.

Younger patients are more likely to be given clot-busting drugs and more likely to have surgery to unblock the arteries around the heart.

In effect, doctors are making bedside judgements on who is worth treating. Some will be acting in what they believe to be the patient's best interests. They assume that an older patient won't want such aggressive care.

But the professor who did the research says it's also possible that doctors are rationing care. If they treated all heart attack patients, the numbers would overwhelm their clinics. So instead they concentrate their efforts - ration their care - on the younger ones.

And such covert rationing doesn't stop there. In some parts of the country patients won't get hip operations if they are obese or if they smoke.

It's not official Department of Health policy. It's local primary care trusts making up their own rules on who to treat.

sky_news_health_iv_bagThe political parties run a mile from any discussion of rationing. When doctor turned independent MP Richard Taylor wanted to raise the issue in the House of Commons he was prevented from using the word “rationing” because it wasn't acceptable on the front of government business papers.

That's why we want to bring rationing out in the open. If it is inevitable, as most doctors and NHS managers believe it is, then how can it be done fairly?

Sky News will be presenting a week of special programmes called The Price of Life, starting on Sunday 7th September 2008, focussing on different areas of medicine, from cradle to grave, revealing the extent of rationing.

Should the premature baby survive at all costs? Is it worth saving the 85 year old grandfather?

We're brought up to believe that the NHS will be there for us when we need it most. But in today's health service that won't be at any price.

Thomas Moore
Sky News Health Correspondent

For more details and news from Sky News' week of programming on health care rationing visit www.skynews.com/health.

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