NHS will struggle to pay for new stroke drug, experts warn

THE NHS in Scotland is facing adding tens of millions of pounds to its medicines bill with the launch of a new blood-thinning drug, raising questions about how it will afford the huge extra costs.

Pradaxa, which helps to prevent stroke in patients with heart rhythm problems, has been hailed as a long-awaited alternative to warfarin, which can have serious side-effects and requires close monitoring.

But the older drug, also a well-known rat poison, costs just 12 a year per patient - compared with an estimated 900 for the new treatment.

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The Scottish Medicines Consortium (SMC) is due to issue guidance on Pradaxa in September and if it recommends the treatment - as is widely expected - the NHS will have to find millions more to fund it.

While the switch is expected to save money in the long-term, with fewer people suffering complications caused by warfarin, such as bleeds on the brain, in the short-term health boards may struggle with the increased costs, experts believe. Such are the cost implications of the new drug, health board officials will hold talks to discuss how the NHS will cope with its arrival.

An NHS source told The Scotsman that if tens of thousands of patients were switched to the new drug, it would cost the health service many millions of pounds - potentially taking up a large proportion of any budget uplift the NHS receives next year. "You have to ask whether anyone is planning for this and can the NHS afford it if this drug is recommended," the source said. "Anyone can do the sums. Is the NHS ready to take on the cost of even just 20,000 to 30,000 patients switching to this?"

He added: "On the one side this new drug shows how far science has come. But on the other side, can we afford this and does it mean we have to make even more savings elsewhere?"

Pradaxa, also known as dabigatran, is one of a number of new drugs expected to eventually replace warfarin, which has been in use since the 1950s.

Like warfarin, Pradaxa will be given to patients with atrial fibrillation (AF) - a condition which causes an erratic heart beat - with European approval as a treatment for this expected in the next few weeks.

AF is thought to affect 1.2 million people in the UK, suggesting at least 100,000 patients will live in Scotland. Such patients are at an increased risk of stroke and the drug helps to reduce this risk. AF is thought to be behind about 15 per cent of all strokes in the UK.

Research into Pradaxa last year showed it reduced the risk of stroke, while cutting the chance of suffering a major bleed by 20 per cent compared to warfarin.

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Warfarin requires close monitoring, costing at least 100 a year per patient. Part of the argument for approving the new drug is likely to be that it will reduce this need.However, as many patients will continue to use warfarin, such services would still need to remain in place, raising questions about how big the savings would actually be.

Dr Matt Fay, medical adviser to the Atrial Fibrillation Association (AFA), said another huge cost could be a large number of patients who currently take no blood-thinning treatments starting with the new drugs.

Health campaigners said replacements for warfarin were welcome, but that the extra costs for the NHS were a concern.

Louise Peardon, from Chest, Heart and Stroke Scotland, said: "The potential benefit of these new drugs is that they don't require the same level of monitoring as warfarin and according to the trial the blood-thinning effect is fairly stable.

"The big challenge for the NHS is the cost implication."

An SMC spokesman said: "SMC is assessing the clinical and cost-effectiveness of dabigatran in stroke prevention and we expect to publish advice in September."