Study warns US-UK drug deal could strain NHS funding

Research published in the British Medical Journal says a US-UK pharmaceutical agreement could lead to 229,000 excess deaths by 2036 if higher drug spending is funded from existing NHS budgets. The finding matters because the deal links tariff relief for UK life sciences exports to a sharp rise in NHS spending on new branded medicines.

The agreement, signed on December 1, saw the United States commit not to place tariffs on UK pharmaceutical and medical technology exports for three years, according to Al Jazeera. In return, the British government agreed to raise NHS spending on new US medicines from 0.3 percent of GDP in 2026 to at least 0.6 percent by 2036, lifting overall medicines spending from 10 percent to 12 percent of the NHS budget.

The UK government has defended the arrangement. Science Minister Patrick Vallance said in April that it would give NHS patients access to “life-changing new medicines” and help Britain’s life sciences sector by making the UK the first country to secure a zero percent US pharmaceutical tariff, according to Al Jazeera.

BMJ study points to opportunity costs

The BMJ research says the spending pledge could carry heavy health costs if ministers do not provide extra money for the NHS. The study argues that funding more new branded medicines from within the existing health budget would mean less money for other forms of care.

Samuel Cross, a University of Liverpool professor of pharmacology and therapeutics and a co-author of the report, told Al Jazeera the agreement benefits drug companies at the expense of NHS patients. He said the central issue is opportunity cost: a fixed health budget means money directed to one priority is taken from another.

According to the study, meeting the targets under economic forecasts from the Office for Budget Responsibility would require the NHS to spend an extra £1.3bn a year by 2028, or about £25m a week. By 2036, the additional annual cost would rise to £8.8bn, or roughly £170m a week, with total extra spending reaching about £44.7bn by the end of that year.

The study also said the burden could extend beyond the NHS. Its modelling of English local authority data found that every £1bn redirected by the NHS to fund the deal would raise publicly funded adult social care costs by £118m, because of higher morbidity and mortality.

Patients most at risk

The BMJ researchers estimated that the direct effect of reduced available NHS spending could result in about 229,000 excess deaths by 2036. If the knock-on effect on adult social care is included, the estimate rises to 291,000 excess deaths, according to the report.

The study said the largest death tolls would be expected among patients with cardiovascular, respiratory, gastrointestinal and cancer conditions. It also pointed to wider quality-of-life losses for people with neurological, endocrine, musculoskeletal and mental health conditions.

The report said these effects were foreseeable because the NHS is already under pressure and has unmet need in areas where care can be highly cost-effective. It also said government assurances that frontline services would be protected do not remove the funding problem, because the NHS would have to pay for the deal from allocations set before the agreement was reached.

The BMJ authors questioned whether the arrangement would spur pharmaceutical innovation in the UK. They said the UK accounts for a relatively small share of the global medicines market and cited limited evidence that domestic UK pricing has a material effect on global investment decisions.

Cross told Al Jazeera the government should publish an impact assessment so the public can judge the value of the agreement. The report’s conclusion is that any health gains from new medicines must be weighed against the care that would be displaced elsewhere in the NHS.

This story draws on original reporting from Al Jazeera.