Drugs have quite rightly be subject to a lot of angst from cost-effectiveness viewpoints. The NHS is skint. Generics are cheaper than branded: some branded drugs are not well evidence based, as are some generics, and some doctors are not very good at prescribing cost effectively. I confess to being far more aware of the issues about cost effectiveness with drugs as opposed to the other medical bits and pieces that nurses are far more used to using and advising on – dressings, catheters, continence pads, etc. Many nurses can prescribe such things independently, sometimes doctors have to sign them off. Are we as concerned about the cost effectiveness of non pharmacological prescriptions as we should be? I think not. While doctors are now using to having their wrists slapped for seeing drug reps (less common now than was) the role of reps seeing nurses regarding other non-drug products has recieved far less attention. So I was interested in the latest Drugs and Therapeutics Bulletin (abstract only, but you can sign up for a trial to read the full thing) on silver dressings, which are expensive, 25 million quids worth being used in the NHS in 2006. The promise was that such dressings are useful in ‘difficult to heal’ wounds, but the DTB finds that “the routine use of silver dressings is not justified on clinical or cost effectiveness grounds…the amount spent in the NHS on silver dressings appears difficult to justify in the light of the exisiting data.”
It would be nice to see swift action following.