A new report from the Office of Health Economics (OHE)— commissioned by the Association of the British Pharmaceutical Industry (ABPI) — has revealed what health leaders believe to be the ten most important medicines in NHS history.
Top 10
In the year that the NHS celebrates its 70th anniversary, this consulting report lists ten medicines deemed to be the most important, in terms of health and economic benefits and impact on the healthcare environment, from a review of literature and evidence base and interviews with experts.
The ten medicines are:
Chlorpromazine— this antipsychotic was launched in 1953 and first used in the NHS in 1954. Primarily used in the treatment of schizophrenia it has been identified as a ‘Medical Milestone’ by readers of the British Journal of Medicine (BMJ) and is listed on the WHO Model List of Essential Medicines.
Polio vaccine— one of two vaccines on the list and launched in 1955. Full extension of the poliomyelitis vaccination programme enabled a rapid decline in the number of deaths related to polio, now eradicated in the UK. Additionally, it is predicted that this vaccine has saved 10,000 lives between 1958 and 2018.
Oral contraceptives— these pills were the first medicinal products that were taken by healthy subjects on a daily basis and have been described as being a likely cause to the reduction of preterm delivery and stillbirths as the number of teenagers giving birth has declined steadily since 1970.
Second to fourth generation penicillins— even though there are current concerns about antimicrobial resistance (AMR) and the overuse of antibacterial agents, antibiotics are undoubtedly important. With those interviewed for the report citing multiple ways these medicines have improved mortality and morbidity associated with infections.
Beta blockers— these were developed in the 1960s by Sir James Black and the first of its kind — propranolol — is included on the WHO’s List of Essential Medicines. The report authors found strong evidence that those receiving beta blockers experience a relative risk reduction in mortality of around 35% and absolute difference in mortality rates of around 5%.
Beta2 agonists— asthma was a cause of death for three people in every 100,000 in the mid 1960s. This mortality rate was dramatically reduced within a decade, which is partly attributed to the introduction of salbutamol, the original beta2 agonist.
Tamoxifen— this was cited by some of those interviewed for the report as a key development in breast cancer care with major health impact. Tamoxifen was first available in the UK in 1972 and from a synthesis of trial data it has been demonstrated to safely reduce 15-year risk of breast cancer recurrence and death.
Immunosuppressants— the first, azathioprine, was used to facilitate organ transplant procedures in the 1960s. A breakthrough for modern transplant surgery came in 1983 with the introduction of cyclosporine, which is now used in place of azathioprine. These agents were cited as having the potential to reduce the burden on the health service as they reduce the rate of transplant rejection.
HIV/AIDS antiretrovirals— pointing to the first, zidovudine, among others, those interviewed for the report stated that these treatments have prevented an acquired immune deficiency syndrome (AIDS) pandemic that had the potential to overwhelm the NHS.
MMR vaccine— before its introduction in the UK in 1988 there were still a large number of cases of measles and several deaths due to the infection, despite there being a measles vaccine (introduced in 1968). However, six years after the MMR vaccine was used, in 1994, the number of deaths caused by measles was reduced to zero and by 2015 the number of cases of measles had fallen to below 1,200.
Speaking about the research, Dr Sheuli Porkess, deputy scientific officer at the ABPI, said: “The discovery of ground-breaking medicines and their introduction in to the NHS had been transformational for patients. For 70 years, our industry — working alongside the NHS — has seen life-threatening diseases eradicated or become manageable conditions, including cancers, heart disease and HIV.
“In 70 years-time I hope we will be celebrating how advances in exciting new research in genetics, artificial intelligence and personalised medicines have helped to cure and treat many more complex diseases.”
Report author, Paula Lorgelly, added: “The milestone of the NHS turning 70 provides an opportunity for us to consider the impact of medicines to the success of the NHS.
“As well as identifying a short list of influential and often overlooked medicines, we also identified factors that aided their impact. These included the value of innovation, complementarity and scientific spillovers, substitution, the evidence base, aiding understanding, active collaboration and supportive health policy. These factors are important to consider to ensure new and future medicine developments continue to deliver impact to the NHS.”