Dying patients 'denied vital drugs'

INTENSIVE care patients in east Suffolk are being denied vital life-saving treatment because they live in the wrong postcode area, senior doctors have revealed.

Consultants at Ipswich Hospital say limited local funding means theirs is the only critical care unit in the region unable to administer the new "wonder drug", Xigris, used to treat severe septic shock.

They are calling for an additional £150,000 to be made available to supply the drug to 30 seriously ill patients per year. They claim using the drug could potentially save several lives every year in Ipswich.

Dr Mark Garfield, intensive care (ITC) consultant at Ipswich Hospital, said: "We are in a situation where relatives are asking us if there is anything more we can do for their loved ones. We know damn well there is but we can't prescribe it."

Xigris is the first ever drug that has been shown to combat severe sepsis, a catastrophic immune system reaction to infection which kills thousands of people each year.

Until now, critical care doctors have only been able to tackle the effects of sepsis with antibiotics or amputation.

Extensive clinical trials in the US have shown that Xigris can reduce the death rate among sepsis patients by around 6%. The Ipswich Hospital Critical Care Unit currently admits around 600 patients every year, around 200 of whom will have severe sepsis. Of those, 20-30 would be eligible to receive Xigris.

The stumbling block, as always, is the expense. Xigris costs around £5,000 per dose and some hospitals, including Ipswich, have been told there is no money available locally to fund it.

Funding is likely to be made available for Xigris when guidance for the use of the drug is issued by the National Institute of Clinical Excellence (NICE) next August.

Until then, however, health authorities will have to find the extra cash themselves. The Government has insisted that authorities may not use the fact that a particular drug is being reviewed by NICE as a reason for a "blanket refusal" to fund it.

The Primary Care Trusts responsible for setting the prescribing budget for Ipswich Hospital – Suffolk Coastal, Suffolk Central and Ipswich PCTs – have so far refused to support the use of Xigris claiming they cannot afford it.

As Xigris is given in very urgent cases, consultants say they cannot wait until the drug has been rubber stamped by NICE.

Unless funding is made available, they argue, patients will die unnecessarily.

Dr Andy Kong, another ITC consultant at Ipswich Hospital, said: "Xigris has been shown to be a very cost-effective drug. The hospital and management have worked very hard to try to secure funding for Xigris but we have reached an impasse because the PCTs say they have spent all their money.

"Fortunately, we haven't yet had any patients that needed it who have not received it but it is only a matter of time."

Ipswich has paid for three patients to receive Xigris so far, which, Dr Kong said, had been made possible through an "administrative oversight" – a case of consultants pushing the boat out to ensure the best possible health care for patients.

There is enormous frustration that their colleagues in other East Anglian Hospitals are able to use the drug.

Ipswich ITC consultant Dr Mark Dixon added: "When it comes down to it, it's a case of if you crash your car, make sure you do it the other side of Colchester."

In the future, he said, if a patient, with a Bury St Edmunds IP33 address was brought into Ipswich needing Xigris, consultants may well have to request that doctors in Bury send the drug to Ipswich in a taxi.

Paul Forden, chief Executive of Ipswich Hospital NHS Trust, said that although Xigris was recognised as an "important drug", the problem was a lack of excess money in the local health system.

He added: "What we wouldn't want to do would be to fund this drug at the expense of affecting other clinical priorities. We will continue to look very carefully to see how we could find the money to fund the drug in the future in partnership with our Primary Care Trusts".

He also referred to the fact that Xigris had not yet been ratified by NICE.

A spokesman for the East Primary Care Trusts said: "The three primary care trusts in East Suffolk work together with Ipswich Hospital on prescribing and funding decisions concerning all important new drugs which are shown to benefit patients.

"In accordance with this agreed process we have together set aside money this year for some new drugs already approved by NICE following their thorough clinical investigations.

"We understand that NICE are currently looking at Xigris. If and when they do approve its use we will make provision to fund it accordingly."

The Norfolk, Suffolk and Cambridgeshire Strategic Health Authority said it could not comment as local funding decisions were entirely in the hands of PCTs.

A clinical trial, involving 1,690 critical care patients in the US, found Xigris, which is usually given as four doses only, to be more cost-effective than medication to lower cholesterol, for example, which is taken every day over many years.

Ipswich Hospital took part in a trial using Xigris last year. Eleven patients were treated with the drug, five of whom would usually have been expected to die. In the event, only two died.

FACTFILE

XIGRIS, or Drotrecogin alfa (activated), was approved by the European Commission as effective and safe in August 2002.

Nearly 12 months later, patients are still barred from receiving it because some local health authorities have not supported its use.

Intensive care consultants have hailed the drug as revolutionary in treating critically ill patients suffering from severe sepsis – where the body's response to infection leads to major organ failure and death.

Sepsis may be triggered by trauma, surgery and burns, or illnesses such as cancer or pneumonia.

Almost 30% of all patients admitted to intensive care units will be likely to suffer from severe sepsis in the first 24 hours. Around half of those will die (Intensive Care National Audit & Research Centre figures).

Extensive clinical trials have shown Xigris can reduce death rates among sepsis patients by up to 6%.