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Letters to the Editor
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Health economics
A matter of perspective
From Mr E. Wilson
John Wilson is correct to point out the cost
of aspirin prescribing in terms of other treatments forgone (PJ, 9 December 2006, p686). Prescribing
such small quantities (28 days’ supply) for such a cheap and easily
available over-the-counter drug is not necessarily the best use of finite
NHS time and money. Or is it? It is all a matter of perspective.
What Mr Wilson does not consider is the outcomes from the alternative
uses of the £53m. A (somewhat crude) assumption that each of the
25.8 million prescriptions were for 75mg x 28 days’ supply means
2.157 million patient-years of treatment would be preventing somewhere
in the region of 3,200 heart attacks each year, or 1,000 deaths (although
all-cause mortality is not statistically significant, and there is an
increased risk of stroke and haemorrhage).1 Some of the alternative uses
of those funds include Herceptin for early stage breast cancer, Glivec
for chronic myeloid leukaemia in blast crisis, and Tarceva for non-small-cell
lung cancer.
My tentative review of the evidence suggests that £53m
in these alternative uses could prevent 110, 601 and 104 deaths, respectively
(although the quality of the data is somewhat heterogeneous).2–5 From the NHS’s perspective then, it could maximise “deaths
prevented” by taking money out of these expensive cancer drugs
and putting it into more aspirin.
So from the NHS’s point of view, it is maximising deaths prevented
by prescribing low dose aspirin in place of the anti-cancer therapies
mentioned. But this is not optimal from the point of view of the whole
of society: we would all be better off if patients bought their own aspirin,
freeing NHS resources for the next best use — which may or may
not be expensive cancer therapies. Ed Wilson
Health Economics Group
University of East Anglia School of Medicine
References
1. Bandolier. Low
dose aspirin – harm and benefits (accessed 20 December
2006).
2. Fritz P, Cabrera C, Dippon J, Gerteis A, Simon W, Aulitzky W et al.
c-erbB2 and topoisomerase II protein expression independently predict
poor survival in primary human breast cancer: a retrospective study.
Breast Cancer Research 2005;7:R374–R384.
3. Piccart-Gebhart MJ, Procter M, Leyland-Jones B, Goldhirsch A, Untch
M, Smith I et al. Trastuzumab after adjuvant chemotherapy in HER2-positive
breast cancer. New England Journal of Medicine 2005;353:1659–72.
4. Garside R, Round A, Dalziel K, Stein K, Royle P. The effectiveness
and cost-effectiveness of imatinib in chronic myeloid leukaemia: a systematic
review. Health Technology Assessment 2002;6(33).
5. Herbst RS, Prager D, Hermann R, Fehrenbacher L, Johnson BE, Sandler
A et al. TRIBUTE: a phase III trial of erlotinib hydrochloride (OSI-774)
combined with carboplatin and paclitaxel chemotherapy in advanced non-small-cell
lung cancer. Journal of Clinical Oncology 2005;23:5892–9. |
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