Introducing new cost effective treatments into the NHS. Surfactant treatment for premature babies: who cares enough to pay?

The growth in the medicines bill for innovative drugs in the United Kingdom is the lowest in Europe.' Funding new treatments within the NHS is difficult: drug budgets are overspent by significant amounts and mechanisms for obtaining new money for medical advances are simply not working.2 Unless there is a more planned approach to spending on drugs-which takes into account the introduction of new treatments-then the time lag before patients can benefit will continue to be unnecessarily long. The introduction of new treatments is not simply a matter of funding. Other issues include evidence for the effectiveness of the new treatments, the relative benefits of a new treatment against established treatments, and understanding the wider effects of the introduction of a new treatment. Taking a narrow view of the costs of treatment may mask potential cost benefits of a new treatment. The difficulties of introducing a new treatment are well illustrated by the problems experienced in securing the funding and the appropriate service structure for surfactant treatment of preterm babies with respiratory distress syndrome. replace surfactant after birth by tracheal instillation.6 Betamethasone and other gluco-corticoid drugs stimulate the synthesis of surfactant in utero and their benefits have been recognised for at least 20 years.5 The first successful trial of surfactant replacement was reported about 13 years ago.6 Several surfactant preparations are now available to treat or prevent respiratory distress syndrome. These are derived from bovine and porcine lungs-the so called natural surfactants-and from synthetic sources. Synthetic surfactants are protein free and have a slower onset of action. Randomised clinical trials At least 12 randomised clinical trials have shown the efficacy of antenatal glucocorticoids in reducing both the incidence and severity of respiratory distress syndrome and neonatal mortality.7 Surfactant treatment for respiratory distress syndrome is also a well studied intervention; over 30 randomised controlled trials involving more than 6000 babies have shown that its use increases survival and reduces the incidence of pulmonary air leaks.8 9 Respiratory distress syndrome and surfactant treatment Respiratory distress syndrome, a disorder of preterm babies, is caused by deficiency of pulmonary surfactant,3 a substance needed for adequate lung expansion after birth. About 5000 babies each year in the United Kingdom develop respiratory distress syndrome-up to two thirds of babies weighing less than 1500 g at birth.4 The mortality rate with assisted ventilation and other supportive treatment is about 25%. Babies with the syndrome have an increased …