While the chief executive of Eli Lilly may lament the UK’s drug prices (UK is ‘worst country in Europe’ for drug prices, says Mounjaro maker, 24 September), the NHS should celebrate them. The system put in place for evaluating the cost-effectiveness of new drugs is respected the world over and is successful in applying the principle that funding a new product should not damage the NHS as a whole. This principle of cost-effectiveness has led to widespread price reductions for the NHS that has allowed the service as a whole to benefit.

The chief executive of Eli Lilly links the recent pausing or cancelling of pharmaceutical industry investments in the UK to drug pricing here, when these are down to the drug companies’ desperation to kowtow to Donald Trump.

Further to this, the talk of increasing Nice’s cost-effectiveness threshold, and even index-linking this, is a disgrace (NHS could pay 25% more for medicines under plan to end row with drugmakers and Trump, 8 October). The threshold is not a price that we should increase every year; it is a measure of opportunity cost. It measures what health improvements in the wider NHS we miss out on when we invest more in a new service or drug. If a new drug doesn’t generate more “health” than that which it displaces, the NHS as a whole is worse off. The rate of displacement doesn’t directly change with inflation. Linking the two is nonsense.
Simon Dixon
Former professor of health economics, University of Sheffield

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