When producing articles for the Drug and Therapeutics Bulletin we seek comparative data on the drugs under discussion, and recommend the use of a product only if we think that on balance it offers advantages in terms of effectiveness, safety, convenience and (lastly) cost over other drugs or treatments already available. The Drug Costs symposium made it clear that the price of the drug alone indicates actual expenditure by the NHS only crudely, and that other variables (length of illness or stay in hospital, altered needs for surgery or investigations) need to be taken into account if real comparisons are to be made. The symposium also reminded prescribers that the price of branded drugs paid by the NHS depends on confidential negotiations between the Department of Health and individual drug companies through the Pharmaceutical Price Regulation Scheme (PPRS). Because negotiations are done in private it remains unclear how savings by prescribers are translated into savings to the NHS. Moreover the terms of the scheme encourage the proliferation of (‘me-too’) drugs, the setting of high prices at a drug’s launch, and the use of promotion that is aggressive.
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