Further supplementary written evidence submitted by Novartis (PHS0093)

Prevention in Cardiovascular Disease

Novartis is a leading global medicines company, which uses innovative science to create transformative treatments in areas of great medical need. This is one of three submissions from Novartis into this Inquiry, with a focus on cardiovascular disease (CVD) prevention.

CVDs are the leading cause of death globally, taking an estimated 17.9 million lives each year[i]. Early diagnosis of CVD through screening programmes is crucial to improving patient outcomes. A healthy and globally competitive Life Sciences sector is foundational to successful disease prevention. The NHS Long Term Plan (LTP) has identified CVD as the single biggest area where lives can be saved over the next 10 years and aims to prevent 150,000 heart attacks, strokes and dementia cases in this timeframe[ii]. Early identification of CVD risk factors such as cholesterol, lipoprotein(a) and other lipids is critical to the prevention of downstream complications such as heart attacks, CAD[1], stroke and heart failure.

Heart failure (HF) costs the NHS £2bn per year[iii] (2% of its total budget)[iv] with hospitalisation comprising 70% of HF cost to the NHS[v].The LTP recognises that 80% of heart failure is currently diagnosed in hospital, despite 40% of patients having symptoms that should have triggered an earlier assessment[vi]. Early diagnosis of heart failure with NTproBNP testing has been shown to significantly improve patient outcomes and reduced rates of hospitalisation. Hence NTproBNP testing should be urgently prioritised in primary care to improve tax-payer value for money.

Ensuring appropriate incentives exist to support HCPs[2] in the early detection of CVD risk factors is critical to disease prevention. The primary care Quality and Outcomes Framework (QOF) exists to improve patient care by incentivising GPs to manage a range of conditions via a points-based menu of indicators. While this approach has merit, the coverage of indicators for CVD is not comprehensive, with key measures missing for certain risk-factors that would support disease prevention e.g. LDL-c[3] and lipoprotein(a)[4]. Adding these indicators to QOF will help prevent avoidable morbidity and premature death, while providing cost-saving opportunities to the NHS (CVD costs the NHS in England £7.4bn per year[vii]).

The Life Sciences Vision aspires for the UK to possess “the most forward-thinking and prevention focused healthcare system in the world”[viii]. Despite this intent, poor levels of medicines uptake[5] and unsustainable industry payments to the VPAS[6] scheme (an outlier compared to Europe[7]) threatens our ability to prioritise disease prevention. VPAS payment rate was 15% in 2022, reaching 26.5% in 2023, with a total projected industry payment of £3.6bn[8]. High industry payments are now affecting investment decisions impacting the viability of launching new medicines in the UK. This will limit the ability of the NHS to harness innovation to deliver a prevention focused healthcare system. A sustainable VPAS agreement is urgently required to ensure vital medicines reach patients and innovation can thrive in the UK’s critical Life Science economy.

February 2023