Stroke drug branded ‘huge financial risk’ for NHS chiefs

Approval was granted for the Pradaxa medication in Scotland last month to replace warfarin in people with an irregular heartbeat.

And while that was welcomed from a patients’ perspective, it could add more than £7 million to the health board’s annual bill.

Warfarin – which is jokingly referred to as rat poison by those who take and administer it – is a remarkably cheap drug to issue, costing only around £10 per patient every year.

However, for those with other health problems there can be a problem tolerating it, and Pradaxa has been hailed as a superior alternative. But it costs £900 a year, and if all the estimated 8000 people eligible for it in the Lothians were to receive it, the burden would be an extra £7.2 million.

NHS Lothian chief executive James Barbour, who sits on the Scottish Medicines Consortium (SMC) board, said while the drug won approval, it was not possible to continually focus resources on medication and expect other areas to survive.

He said: “I was there [when this was approved] and can assure it was given rigorous scrutiny. They were very mindful of the cost implications.”

The arrival of Pradaxa is the first time warfarin has been seriously challenged in half a century.

It is a better alternative because other treatments can be carried out alongside it, and given many who suffer an irregular heartbeat have other health complaints, it is a welcome move.

The SMC ruled Pradaxa was a “clinically and cost- effective medicine for stroke prevention”, but it is up to NHS boards how and when to administer it.

In the Lothians, it is understood it will be introduced gradually to those most at risk of a stroke, caused by the condition atrial fibrillation, which affects 80,000 people across Scotland.

Spending will be monitored closely by bosses in Edinburgh.

One senior source said: “It will be of benefit to patients, but that has to be balanced against the huge financial risk it brings.

“It’s possible money will be saved long term because of less need for check-ups and appointments, but on the balance sheet it’s not something you are looking for in this climate.”

The health board shaved more than £30 million off its budget last year, and has to find an additional £50 million before March.

NHS Lothian’s associate medical director Simon Mackenzie said: “This drug has been approved by the SMC but not by the National Institute for Clinical Excellence [in England and Wales].

“It has been very heavily promoted by companies and professionals.

“We’ve had discussion and asked to consider the place of [Pradaxa]. There is a place for it clinically – but we need to make the right judgement on this.”

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