The success of biopharmaceuticals is producing a growing problem for public healthcare services worldwide. Newer biological therapies offer fresh hope for the treatment of many serious diseases but are much more expensive than conventional drugs. Clinicians are increasingly finding themselves torn between offering new treatments to patients and respecting the financial restrictions imposed by healthcare authorities on the basis of cost effectiveness.

In the UK, the NHS has been under pressure after the National Institute for Health and Clinical Excellence (NICE) initially recommended against funding drugs such as trastuzumab for breast cancer, erlotinib for non-small cell lung cancer, and ranibizumab for age related wet macular degeneration.1 Widespread emotive media coverage of such cases heightens public expectation that the health service will fund all drugs in all situations, regardless of cost. However, unless biological therapies can be made more affordable, Western healthcare systems face a financial crisis, exacerbated by the pressures of cuts in public spending, to survive in the current financial climate. We examine the reasons for the high costs and the possibilities for reducing them.