I just wonder how much the NHS is spending on ablations and what the success rate over 5 years is?
It seems to me that at least 3 ablation operations are necessary in most cases to achieve any degree of success.
But when I receive my monthly medication, it is always a generic brand.
How are major first line drug companies supposed to invest in novel drugs for AF, when they only have a short window before their discovery becomes an open market for cheap copies?
Interesting view. Obviously drug companies need to make profit, which often seems to be a dirty word these days, in order to invest in R&R AND the NHS needs to be cost aware which is a difficult balance when resources are so low. I don't get how you comparing ablation with the drugs? Seems like comparing apples and pears. Nhs is publicly funded whilst the drug company is profit making companies. Isn't the drug issue to do with patents and trademarks? They are limited for a time period, say 20 years exclusive rights of manufacture, when it expires any company may produce so then there is more competition and prices reduce. Think of the row Tesco caused with the drug companies when they started putting their own brand on paracetamol a way back. Surely that is in the interest of the NHS? As to comparing that with ablations you are making a value judgement that somehow there is a cause and effect, don't get it, sorry.
An interesting post ! I have asked for the generic meds several times only to be told there's absolutely no difference between any med bearing the same name. Now I know from experience that is NOT true! I have been on total thyroid replacement for almost 30 years and can tell within a couple of days if there is any difference!
I tend to agree that you can not compare the two cases. Having said that let us just look at what has happened over the last few years.
To start with the treatment of AF is very new science. Ablation has only been around for about 20 years and common for less than ten. Long term data is still hard to find but as a three times ablatee I can say that any time spent in NSR without drugs is wonderful and I am now coming close to six years AF free although to be fair I do get some other mild arrhythmias from time to time..
Now lets look at drugs. Yes pharma companies spend huge sums looking for new drugs many of which are found by accident (note viagra) but also think how many drugs used in the treatment of AF have been found in the last few years. O K there are now three new oral anticoagulants as well as our old friend warfarin and yes these are expensive so not common at the moment. They also have no antidote which would put me off them unless warfarin was contraindicated for me.
The only new rhythm control drug I can think of is Multaq (dronedarone) from Sanofi Aventis which was heralded with much fanfare when it was authorised by NICE. I did some radio interviews and helped in a film about AF made by the company at the time and we all thought it was going to be the holy grail for sufferers of AF but even when doctors were able to prescribe it many people found it did not help them as much as had been hoped and I have not seen anybody on here recently taking it. There was also a problem over liver function which had to be addressed with regular testing and sadly I think the drug has fallen out of favour amongst cardiologists. Will this stop drug companies from still looking. No not your nelly as they say. .
At last years conference we were told that early intervention by ablation had the best outcome long term even if multiple procedures were required but as yet I have not seen any cost/results data.. One can assume that a single ablation could cost say £10k and maybe (I'm guessing here) the drug bill for a patient on multiple drugs could be say £500 per annum. If you are are looking at simple economics then does that make sense?.. Probably not until you consider the quality of life aspect. Many patients feel pretty awful on the party bag of drugs they take and some worse than due to the condition whilst most successful ablatees regain a good QOL and are able to return to their former way of life. Many people left on often unsuitable drug regimes are unable to work and become dependent on the state loosing independence and living standards along the way. You really can't put a price on that.
In concluding my comments, no you can't compare the two regimes but I know where my vote goes..
Discuss.
Bob
Hi Gerryatriq
The drug companies get 15 years exclusivity once they patent a new drug, so for example Viagra was launched (in the UK) in 1998 and the license expired last year 2013. All of the NOACs will still be exclusive, which is why the price is so high.
But consider that the usual markup is around 2000% to 3000% of material costs, if they get a big selling drug then even with the R & D costs their profits are huge. Agreed they have hits and misses but such is business.
A new drug for AFib which truly gave rhythm control without side effects, would be a very big seller and a very big money spinner.
Ian
hi all.
What I was trying to tease out was a combination of talking points.
It is fairly well understood that if AF is chronic/permanent then there is little point in trying ablation. Additionally,ablation success, would appear to be a combination of `expertise` of the operator, and type of AF.
The best 5 year results I have seen would suggest a 50-60% positive outcome, and that with probably multiple attempts., all at £10K a time, so possibly up to £30K. And even then 40-50% would have a negative result.
Given that people like myself with chronic AF are not given a chance of ablation (rightly of course), I wonder to what extent drug companies might shy away from investing in R and D for possible better drugs than currently available, given that ablations are taking more and more NHS money.
Of course I do realise that without trial and error we will not know if ablations are the holy grail, but I wonder how many people would opt for ablation given that there was a drug that would equal the likely long term outcome of ablation.
Just wanted to make the point that I had "permanent" AF, i.e. 24/7, you could not get a normal ECG out of me at all, just pages and pages of the same chaos. My EP told me that because it was 24/7 it would be easy to fix, and others have said the same. He was right and my first ablation was a 100% and immediate success for 8 years.
I think, but don't know, that it's more to do with how long you've been permanent but that really is just a guess.
Koll
Costing an ablation in a state run health service is very difficult.
Firstly there is the one large cost for purchasing the equipment, but the running costs, power used,service maintenance costs etc will not be very much.and it would make make sense to use the equipment fully to justify it's cost.
The cost for supplying surgeons,technicians,nurses wages.
However if patients are kept well and prevented from becoming stroke victims unable to look ofter them selves then I think the cost of £10k per ablation is money well spent.
The charges patents at private hospital have to cover purchase/running cost for equipment,surgeons,nursing staff,hospital use etc and off course a profit for share holders.
I suspect figures like £10k per ablation are what an ablation at a private hospital charge to make an operation profitable.
In Mexico I was given a "ball park" figure of about US$16,000
Hi Gerryatriq now that you have clarified what you were getting at I appreciate the debate more. I still hold by my original post that it is difficult to compare ablation / drug therapies and their efficacy long term and as Bob and others have said there are lots of contributory costs we need to consider to arrive at a meaningful cost to the state over a lifetime.
I had my 2nd ablation Wednesday, my EP believed that the ablated line had recovered, which was indeed the case. I also have AFlutter but he was unable to continue to ablate my right atria as he touched the AV node which stopped my heart and I awoke to find a nurse jumping on my chest, luckily it was very short and started again and I got into a NSR quickly. It was my choice to have ablation in the hope that I can be drug free and it was at no cost to the NHS, whereas all the drugs I take are.
A large percentage of my family work in the NHS and from the talk around the table I get the impression that the NHS is no longer the great institution we would want it to be. There are areas of superlative treatment and others which are pretty rotten (eg posts on this forum). It is my view that If we want a more consistent service with more therapy options then we need to consider how we are going to pay for it as only a truly well resourced NHS is going to be able to offer that. That means higher taxes. I personally would also want a much more holistic approach with much better support and advice for sufferers. I don't think there is nearly enough 'low cost' supportive options considered such as dietary advice, relaxation classes, exercise groups etc.
I find NHS staff, on the whole, a very caring and attentive lot who are mostly overworked and under appreciated, especially by a segment of the public who abuse them, (having had a few A&E admissions I have witnessed this several times) don't know just how lucky to have a medical service and tend to self inflict quite a lot of their ailments on themselves.
Maybe we should all be told, in detail, just how much our treatment for the year has cost the NHS? (Am about to duck in preparation for the onslaught!)
I very much agree with you. My last visit to A&E took place in the early hour of a Sunday morning. I was really shocked by how full (and I do mean full!) A&E was with drunken people who had for example broken a hand due to punching a wall or had a broken nose because they were so drunk they had fallen down. One was even complaining of a bad headache and was eventually send home with paracetamol to sleep it off! Many of these drunken people were loud and abusive to both staff and other visitors making it a very intimidating environment to be in.
Maybe if we were told how much our treatments cost the NHS we would be more proactive and take more responsibility for our own health & well being and look after ourselves better.
Interesting re-reading this Kazz as I wrote it 4 years ago!
Then I would say the NHS was in the acute ward - now I just think it will probably be terminal - except for immediately life threatening emergencies.
Most of my family and friends in the NHS are now just counting down the days until retirement.
I think it is very, very sad.
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