Brexit: The future of healthcare in Europe

The United Kingdom (UK) has been one of the leaders in the use of health technology assessment (HTA) within the European Union (EU). With the impending departure of the UK from the EU in 2019, will the influence of its approaches be diminished?

In the last Sir John Monash Lecture of 2017, Professor Michael Drummond sheds light on this situation through his talk on ‘Financial sustainability of health care in Europe: Brexit boom or Brexit bust?’ which gave an assessment of the contribution of HTA and economic evaluation to the financial stability of health care in Europe and speculate on whether Brexit will affect this contribution going forward.

“Some of the beneficial changes from conducting HTA is recognising the need for more relevant end points in clinical trials and that clinical and cost-effectiveness vary by sub-groups. Also, methods of evidence-synthesis in terms of cost-effectiveness has improved a lot. There is an increased transparency when we talk about economic assessments,” Professor Drummond said.

For example, The National Institute for Health and Care Excellence’s (NICE) research on the guidance on new cancer drugs was interested to find out if NICE imposed any restrictions over the restrictions imposed by the license given by EU medicine agencies. If there were no restrictions, it would mean NICE recommends the drug could be used within the terms of its license.

“In just over 50% of cases, NICE didn’t impose any restrictions. In 15% of cases, it shouldn’t be used and another 30% said the drug should be used but not for all patients ‒ because we didn’t think it was especially value for money,” Professor Drummond said.

“So you can see that HTA typically does impose a few restrictions. It tries to distinguish drugs which are good value for money and those which aren’t. That is one way of trying to deal with the pressures on financial budgets of the health care system,” he added.

However last year, the British people were presented with two contrasting views of the future of the country ‒ the ‘Brexiteer’ and ‘Remainer’ view.

The ‘Brexiteer’ view sees the UK being free from the ‘shackles’ of the EU, and hence free to make its own way in the world. Being free from British objections, the EU can continue on the path of close political and economic union.

Meanwhile, the ‘Remainer’ view sees that after leaving the world’s largest free trade block, the UK will find it difficult and time consuming to strike new trade deals. And without British pragmatism, the EU might struggle in resolving political and economic issues.

“Until now, the British has been strong players in the use of HTA, but what would be the impact on the British contribution to HTA in Europe? One is loss of resources and the other is the loss of influence.

“Funding from the EU currently accounts for 17% of research contracts held by British universities. But more importantly, the EU has contributed to a lot of growth (75%) in research expenditure. Also if you look at the UK academic workforce, 16% come from EU countries.

“The other thing is the Marie Curie scheme where you can apply to EU for a grant that will enable you to conduct research in any European country. It is a way of funding mobility of researchers. There are 28 countries in the EU competing for bright young researchers and the UK has attracted 25%,” Professor Drummond said.

In terms of influence, following the end of the European Network for Health Technology Assessment (EUnetHTA) joint action, the EU has said that the outcome is that they would establish a central capacity for HTA. However if they established something else, the UK will not be able to participate.

The favoured UK approach to economic evaluation using quality-adjusted life-years (QALYs) with transparency and stakeholder engagement may be in decline. The way HTA will be practised is going to shift based on the British influence in the future.

What does this all mean? “If you look at the impact of Brexit on HTA, it is more likely to be ‘Brexit bust’ rather than ‘Brexit boom’, especially in the short-term. Going back to the conflicting visions of what Brexit means, I think the ‘Remainer’ view is a better prediction of what is likely to happen in the next 15 years or so. The ‘Brexiteer’ view predicts what happens in the really long-term,” Professor Drummond said.

He concluded that the impact of Brexit on the UK has been estimated to be substantial, up to a reduction in 4% of GDP, approximately 50% of the amount of GDP currently devoted to health care in the UK.