February 6th 2020
There are many reasons a treatment might not be available for patients, but this one from a recommendation by a UK National Health Service (NHS) watchdog shocked us: the £10,000 cost for the treatment is too high to make available to patients with severe depression that might benefit from it!?!?!?
Typically where things stall are not at this late stage—just before patients have access to a potentially life saving drug. Sometimes a drug is shown not to be as effective in preclinical work with animals as initially expected, or later during clinical trials in humans–evidence that our system of regulation with respect to safety and efficacy works—but that is not the case here.
We have previously written about the animal research behind the new nasal spray depression treatment containing ketamine, showing the impressive research work in rodents and primates, prior to the clinical trials in humans. All of these advances have been supported by substantial investment by the NIH and other government funding bodies leading to the new drug treatment option for clinically depressed patients. A great example of our tax dollars at work!
However, a new BBC article notes that although this fast acting ketamine-like antidepressant spray can lift mood, it has been rejected by an NHS healthcare watchdog NICE (National Institute for Health and Care and Excellence). The reason? Because of too many uncertainties between the price and the clinical benefits. Now, that’s not nice!
Many drug treatments can sometimes cost even more (hundreds of thousands) particularly for rare disorders where the manufacturer cannot benefit from cost reduction by mass producing a treatment. So £10,000 for a potentially life saving treatment for a patient that has suicidal tendencies should at the very least be an option on the table. Given the large taxpayer cost to get treatment to patients this far, the £10,000 cost for the drug is a mere drop in the bucket. There is also substantial need: see our prior post on the massive societal costs and the devastating personal impact on people suffering from depression, their friends, and families.
A slightly more compelling reason may have been that ketamine is a drug that is recreationally abused. So making it more easily available could be a societal risk to people looking to get their hands on a nasal spray that may “solve all of their societal angst and problems”. Although we don’t know how the UK or each country would regulate it, it is worth noting that each hospital/pharmacy abides by strict regulations about storing and dispensing regulated drugs.
Why should we pay attention to this British problem? Does it really affect us in other countries? Well, the UK does tend to set standards that other countries model with regards to health care. Their NHS is a government supported health care system that is less susceptible to pharmaceutical cost or pressure than other healthcare systems.
The fact that the NHS is being advised to bin this treatment at this late stage is a disturbing precedent, or at the very least we need to know more on the reasons why. Otherwise this could set a model that wipes out the tremendous benefits generated thus far by animal research that has gone into developing this treatment for depression.
It is also important to consider that the cost of new drug treatment is always initially more expensive as pharmaceutical companies seek to recoup the costs that they invested in producing the treatment. The cost usually drops substantially after initial sales. Further scientific studies could stall, such as those demonstrating among a larger population of patients whether the clinical efficacy of the drug is as good, better, or worse than the results seen in the initial clinical trials and what the longer term effects are. Lastly, further research with animals to improve this or other treatment will likely lead to even better treatment options.
Rest assured, your Speaking of Research investigative reporting team will be monitoring this development. We’ll also be doing some digging and fact checking to see exactly what lies below the surface. The cost argument does not work.
~Prof. Chris Petkov and the Speaking of Research team