How much should you make from saving a human life?

Like me you are probably not a regular reader of Blooda medical journal dedicated to the diseases of the red stuff – but perhaps you should make an exception for a recent article. It is easily accessible to everyone, there is minimal jargon, and it is powerful stuff. It is written by over 100 senior medics, including some from the UK, but also USA, europe, latin america, …., pretty much the whole world.

In the article the authors discuss the drug sold in the UK as Gleevec. This drug is used (in combination with others) to treat a form of cancer of the blood called chronic myelogenous leukemia (CML). Gleevec has contributed to increasing the fraction of people alive 10 years after diagnosis from 20% to 80%. A remarkable, life saving, achievment. And one driven in part by the profit motive, it was developed by the pharmaceutical company Novartis.

However, the authors are, although polite and measured, clearly angry about the fact that in the USA the drug did cost $30,000 for a year’s treatment in 2001, and now costs $90,000 (£58,000) a year. Over the last 12 years production of Gleevec has greatly increased, but any economies of scale in the drug’s production are clearly not getting passed on.

It seems quite hard to get figures for how much the NHS pays for a one-year’s supply of Gleevec but a NICE (National Institute for Health and Care Excellence) press release on another drug quoted £40,000 at the higher dose level. It looks like the NHS is getting better value for us taxpayers, than the US system is. But £40,000 is still a lot of taxpayers money. And successor drugs are even more expensive, the article quotes a figure of $138,000 per year. That’s a lot.

As the article powerfully argues, it is difficult to see how the price of Gleevec is justified. Developing a drug is expensive, but it has been selling in large amounts for over a decade. These costs have been recovered. It seems very unlikely that it costs £40,000 to make enough for one year of doses. If the 800 mg mentioned in the NICE press release is per day this is only 300 g.

Here in the UK, the NHS kind of shields us from this cost, unlike in the USA when drug payments lead to many people declaring bankruptcy, but we taxpayers are paying for this. Although I am a higher rate taxpayer, it takes two and a bit of me just to buy enough drug to keep one CML sufferer alive.