Analysis

Economics of biological therapies

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3276 (Published 21 August 2009) Cite this as: BMJ 2009;339:b3276
  1. Christopher J Kelly, medical student1,
  2. Fraz A Mir, consultant physician2
  1. 1University of Cambridge School of Clinical Medicine, Addenbrooke’s Hospital, Cambridge CB2 0QQ
  2. 2Clinical Pharmacology Unit, University of Cambridge, Addenbrooke’s Hospital
  1. Correspondence to: F A Mir fam31{at}cam.ac.uk
  • Accepted 30 June 2009

Demand for biological drugs is putting pressure on health budgets. Christopher Kelly and Fraz Mir examine why they are so expensive and what can be done to increase access

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.

Revolutionary drug treatment

Biological therapies are generally derived from living material (human, animal, or micro-organism) and have a highly complex chemical structure. Many fundamental differences exist between biological drugs and traditional “small molecule” drugs (table 1).2

View this table:
Table 1

 Comparison of classic pharmacological and clinical characteristics of traditional and biological drugs2

The US Food and Drug Administration considers biological therapies to include “virus, therapeutic serum, toxin, antitoxin, vaccine, blood, blood component or derivative, allergenic product, or analogous product, applicable to the prevention, treatment, or cure of a disease or condition of human beings.”3 Over 150 …

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