How can we measure the health benefits of our products to help us ensure that the next generation of products is even more effective and sustainable...
Around 10% of our products and technologies contribute to improving human health and enhancing the quality of life (excluding automotive catalysts, which also provide human health benefits in addition to their positive impact on the environment). One part of Johnson Matthey's business lies in the manufacture of active pharmaceutical ingredients (APIs). They include morphine and codeine to relieve pain, platinum based anticancer compounds for chemotherapy treatments and a range of fine chemicals used by pharmaceutical companies in drug preparations.
A way of measuring the benefit of a health intervention has been devised by health professionals and is known as the 'QALY' criterion. This unit of measurement combines the length (or quantity) of life with quality of life to produce a measure called 'quality-adjusted life year' or QALY. To help classify quality of life, which is a subjective state, a questionnaire called EQ-5D is used – and was developed by an independent company to measure health and inform decision making. The EQ-5D asks patients to respond to questions on their mobility, level of pain, self-care ability and so on. These QALY calculations are then used to quantify the health benefits of a particular treatment.
Measuring the Health Benefits of APIs
For this study, Johnson Matthey selected active pharmaceutical ingredients that are used to treat illicit drug use. The company's API manufacturing businesses manufacture methadone, buprenorphine and naloxone, which are sold to customers in the pharmaceutical industry who formulate them into products to treat illicit drug use. Buprenorphine and naloxone are co-formulated into the product suboxone.
Finding the most effective way to cure illicit drug dependency will bring benefits both to individuals – who are relieved of the health destroying effects of addiction – and society which bears the economic costs. Research done in 2011 estimated that illicit drug use in the US cost the country more than $193 billion in 2007 – on a par with diabetes ($174 billion) and smoking ($157 billion) – in the health related economic costs. In low income nations, the economic burden is substantially greater. On top of this, the spread of AIDS among illicit drug users is so high that the World Health Organization buys methadone to treat patients in these nations. In Africa, which is worst hit, more than 50% of illicit drug users are HIV positive.
Methadone is purely synthetic whereas buprenorphine and naloxone are manufactured from alkaloids extracted from the opium poppy. As a result they require more complex manufacturing processes, making the end drug, suboxone, more energy intensive and more expensive to produce. So can we justify it as a sustainable alternative?
A Sustainable Alternative?
The study was hugely informative. The researchers concluded that suboxone offers a greater health benefit per kilogram of API. At the same time, it has a number of clinical benefits over methadone, as there is no dependency and, unlike methadone, suboxone can be prescribed by family doctors. Smaller doses are required per addict: a typical daily dose of methadone is 20mg, while that of Suboxone is only 8mg. As suboxone is due to come off patent shortly, prices are likely to drop and this may lead to its wider adoption, especially in Europe and developing nations, where methadone is currently preferred.
This type of research contributes to the life cycle assessment of the product. It allows the sustainability credentials of APIs and pharmaceutical products to be objectively established and enables the health and environmental impacts of a product to be evaluated side by side. More is to come, as it forms part of Johnson Matthey's ongoing programme of health benefit studies, led by its Life Cycle Experts group.