The length of time it takes to deliver new drugs and treatments to patients was examined in detail during a keynote lecture at the British Cardiovascular Society conference in Manchester.
During the British Cardiovascular Society Medal Lecture 2018, Professor Martin Cowie posed the question: “From evidence to implementation: does it need to take 20 years?” At the conclusion of the lecture, Professor Cowie was presented with the British Cardiovascular Society Medal, the highest honour of the society.
Professor Cowie, consultant cardiologist at Royal Brompton Hospital and Professor of Cardiology at the National Heart & Lung Institute at Imperial College London, made the point that access to innovation for all, regardless of the ability to pay, was a key goal from the earliest years of the NHS. More recently the NHS Constitution has enshrined this, stating that “The NHS works at the limits of science – bringing the highest levels of human knowledge and skill to save lives and improve health”. However, the evidence suggests that it takes between 15 and 20 years for a new concept to move to full-scale implementation, and even then there is marked variation in adoption of new medicines, diagnostics and devices across the regions in the UK.
The modern scientific-bureaucratic approach of “Evidence-based medicine”, with a hierarchical approach to the assessment of the quality of evidence does not lead to rapid and even implementation of innovation.
A founding member and a past-chairman of the British Society for Heart Failure, Professor Cowie quoted examples of implementation of innovation from cardiology, looking at treatment of heart failure with beta-blockers, cardiac resynchronisation therapy, and the use of non-Vitamin K oral anticoagulants. It is clear that although robust evidence from randomised trials is required, it is insufficient on its own to drive rapid implementation. A positive decision from the National Institute for Health and Care Excellence (NICE) is supposedly the gateway to rapid adoption in England, but it and other organisations are concerned that the “postcode lottery” appears to be alive and well.
Professor Cowie pointed to the vision of patients, clinicians and charities being key drivers in the development, prioritisation, evaluation and adoption of innovation and how a new Accelerated Access Partnership, including NICE, will bring together key parts of the heath system to provide a single source of national-level guidance to oversee the innovation pathway and to identify where implementation has failed. The NHS Innovation Scorecard would be a key tool to flag up areas of concern, and it was likely that NICE would not only continue to produce guidance and quality standards for health and social care (and public health) but would also monitor and facilitate implementation.
Professor Cowie was optimistic that innovation would remain at the heart of the NHS, and that the postcode lottery would be under constant attack, allowing clinicians and patients access to the world’s best therapies and care no matter where they lived. Such optimism would only be realistic if all stakeholders continued to champion robust assessment, but there was more rapid and synchronised decision making by regulators and reimbursement authorities, and better working with patients and professionals in an accountable and transparent way to monitor and reward innovation and implementation.
This news story is an excerpt from material due to be published in the European Heart Journal.