UK patients are not being given the most innovative medicines, finds ABPI report

International Comparison of Medicines Usage: Quantitative Analysis puts Britain ninth out of 13 countries

The UK uses branded medicines less per person than many other countries, and tends to use older rather than the latest medicines, according to new research published by the Association of the British Pharmaceutical Industry (ABPI). This means that fewer patients in the UK are receiving new, innovative medicines than the average in a range of comparable, developed countries.

The report, International Comparison of Medicines Usage: Quantitative Analysis, was compiled by the Office of Health Economics (OHE) and updates the 2010 Richards Report which examined the extent and causes of variations in international medicines use.

Although the UK showed an increase in usage per person for 11 of the 16 therapy classes surveyed from 2008/09, the report shows that Britain remains 9th out of 13 countries, with France maintaining its position at the top of the rankings and New Zealand at the bottom.

In seven of these 11 therapy classes (cancer medicines less than five years old, alteplase for stroke, second generation anti-psychotics, dementia, multiple sclerosis, pegylated interferons for hepatitis C and respiratory syncytial virus) the UK usage per person was below the international average for 2012/13 – this included the latest cancer medicines less than five years old and those for treating dementia, multiple sclerosis and stroke prevention.

In the remaining four of these 11 classes (cancer medicines more than 10 years old and medicines for osteoporosis, respiratory distress syndrome and wet age-related macular degeneration) UK use was higher than the international average for 2012/13, highlighting a reliance on older medicines and relatively slow uptake since 2009 of newer, more innovative medicines, particularly to treat cancer.

Overall the UK has remained static in the bottom half of the table which is disappointing

David Watson, the ABPI’s Director of Pricing and Reimbursement, said: 'While this report highlights an improvement in ranking for the use of some medicines and a decline in just a few areas, overall the UK has remained static in the bottom half of the table which is disappointing given the number of initiatives in place since 2009 to improve patient access to newer medicines.'

He said the UK’s continued use of older medicines, especially to treat cancer and diabetes, 'highlights a failing in the system to ensure that patients benefit from the new, innovative treatments the pharmaceutical industry is developing to improve patients’ health outcomes'.

'We are seeing NICE-recommended medicines facing further review, restrictions and modifications compared with NICE guidance,' he said.

'For our part, the industry has, through the 2014 Pharmaceutical Price Regulation Scheme (PPRS), agreed to keep NHS expenditure on branded medicines flat for two years and within agreed controlled growth levels for a further three years. This should enable the NHS to prescribe the newest, most effective medicines for patients and we would expect to see a rise in the per person use of some of these newer medicines in future years,' he added.

The UK’s continued use of older medicines, especially to treat cancer and diabetes, highlights a failing in the system

Watson also said that the information in this report would be used in continuing discussions between the pharmaceutical industry, the Department of Health and the NHS on how access to medicines can be increased through the commitments of the PPRS agreement.

In five of the 16 classes of drugs measured, the UK has fallen below the international average including: cancer medicines 6–10 years old, hormonal cancer medicines, thrombolytics for myocardial infarction, TNF medicines for rheumatoid arthritis and statins.

This latest analysis replicated the methods and medicines of the Richards Report and additionally included data on medicines for HIV and diabetes. UK usage of HIV medicines is in line with that of other countries, but its use of diabetes drugs is about a third of that of other countries, close to the international average for insulin, and significantly above the average for older diabetes medicines.

RAND Europe has published a complementary report examining the reasons for variations in international medicines usage, International variation in drug usage: an exploratory analysis of the ‘causes’ of variation.