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adverse drug reactions--frequency

Drug News--disappointing

From the Guardian News service at

http://www.guardian.co.uk/society/2008/apr/03/nhs.drugsandalcohol 

This article appeared in the Guardian on page 11 of the UK news section. 

 

Adverse drug reactions cost NHS 4bn

 

Sarah Boseley, Health editor, The Guardian, April 3, 2008

The NHS is spending nearly 2bn a year treating patients who have had an adverse reaction to drugs prescribed for them by doctors, according to new figures from the centre-left thinktank Compass.

The amount of money spent on hospital care for those given the wrong medicine or who have reacted badly to a drug could pay for 10,000 new midwives or easily cover the estimated cost of combating MRSA infections, says Compass.

The health minister Dawn Primarolo confirmed to the organisation that 6.5% of hospital admissions are a result of an adverse reaction. Total admissions in 2006 were 16 million, which means that 1,040,000 patients were there as a result of the drugs they were prescribed.

Compass bases its calculation on an average stay of eight days in hospital at a cost of 228 a day. That puts the annual NHS bill at 1,896,960,000 just for those admitted with ill-effects. It does not include those patients who had a bad reaction to their medicines while they were in hospital. If that cost were added in, the bill would top 4bn.

The new figures, which are substantially higher than any previous estimates, have been compiled as part of an investigation into the pharmaceutical industry, its relationship to public health and regulation. "It is increasingly apparent that the lack of effective regulation is costing the taxpayer, and in some cases is causing unnecessary suffering," said Zoe Gannon, who is leading the Compass investigation.

Scandals such as that over the arthritis painkiller Vioxx, which caused heart attacks, and the antidepressant Seroxat, which was found to increase the risk of suicidal thinking in young people, suggest that industry could do more, she said.

"The industry knew about these adverse drug reactions and chose not to accept the responsibility because its ultimate goal is to make a profit," she said. "From our perspective this 1.9bn figure is not completely reducible - we are going to have to accept some adverse drug reactions - but the sheer size of this figure is enormous. It is all about getting a balance between risk and benefit and we feel that the balance is wrong."

Drug companies have huge profit margins, she said - in excess of 14.3% against a business average of 4.6%. Yet the number of genuinely innovative medicines - as opposed to copies of those already on the market - is decreasing.

"The pharmaceutical industry has the upper hand in terms of research and development investment and is always promising the latest miracle drug but too often failing to deliver,"she added.

"Now is the time for a debate about costs and policies about which drugs the healthcare service can afford as people are paying infinitely higher prices - the drugs bill to the NHS now stands at 11bn - for increasingly marginal rewards and higher risk from adverse drug reactions."

Compass's investigation will question whether it is appropriate for the Department of Health to take the lead in relations with the pharmaceutical industry. It will also be calling for a review of progress since the 2005 report of the health select committee. Compass aims to publish its own report in the autumn.

another Guardian article:
 

Home diabetes kits waste 100m a year, says research

 

Friday April 18, 2008

 

The NHS is wasting more than 100m a year by helping people with diabetes to monitor their condition at home because it only serves to make them anxious, researchers will say today.

For 10 years, doctors have argued over whether blood-glucose monitoring at home is useful for people with type 2 diabetes, the form of the disease often linked to obesity, which is soaring in the UK.

Those with type 2 diabetes are not dependent on insulin injections and can take various measures to help themselves, such as sticking to a careful diet, watching their weight and exercising. Home blood-glucose monitoring, involving a small finger-prick to obtain a drop of blood and a test kit, was introduced to allow people to check on how well they were doing.

Self-monitoring is generally agreed to work for people who are insulin-dependent. But two studies published today in the British Medical Journal reveal a different picture for those who are not.

One of the studies, by Maurice O'Kane and colleagues at Altnagelvin Area hospital , Londonderry, randomly assigned 184 diabetes patients either to self-monitoring or to no monitoring for a year.

The researchers say they were "unable to identify any significant effect of self-monitoring" on glucose levels, the use of medication or hypoglycaemic attacks. Furthermore, they say, the self-monitoring group scored 6% higher on a rating scale designed to assess depression and had "a trend towards increased anxiety".

They suggest this negative effect "might relate less to feelings of powerlessness in the face of high blood-glucose readings than to the enforced discipline of regular monitoring without any tangible gain".

The second study, by Judit Simon and colleagues at Oxford University, looked at cost-effectiveness in a group of 453 patients, randomised to self-monitor or not. They found self monitoring cost up to 92 per patient more than standard care.

In 2004, 1.5 million people in the UK had type 2 diabetes, and the bill for self-monitoring is in excess of 100m a year, the researchers say, and yet it is not cost-effective. The self-monitoring groups did not do better and they "showed reductions in quality of life". The study, they say, "provides no convincing evidence for routinely recommending self-monitoring to patients with non-insulin treated type 2 diabetes".

In an editorial, Martin Gulliford, professor of public health at King's College London, said the 100m cost represented "a substantial opportunity" to invest in other ways of helping people with type 2 diabetes. But the patients' organisation Diabetes UK appeared unconvinced. "Short-term cost savings made by reducing the number of people self-monitoring could be dangerous for the individual and lead to higher costs for the NHS in the long term," warned care adviser Libby Dowling.

A spokesman for the Department of Health said: "Self-monitoring cannot be looked at in isolation."

 

 

Those who have a financial interest in the outcome manipulate the results