[syhprum (OP)]

Occasionally NICE will prescribe a course treatment costing up to £200.000.00 if the patient dies before completing the course are the left over pills of any value and can they be put to any use ?

[Bored chemist]

Essentially no.
Because the QA process would be void.
You would need to test the pills before you could re-use them

[SeanB]

As well a lot of those expensive medications are custom made, either being made using DNA from the patient, or are nuclear medications with a shelf life measured in days. Thus if they are left over they generally go either to a medical incinerator, or into a low level waste repository, stored till they decay to a low level, then incinerated. The expensive ones that are neither are often hospital only, and thus dispensed daily, so the left overs simply stay in the pharmacy, till they either get used, or, more likely, expire and are destroyed with the other expired stock, unless they get a shelf life extension.

[Bored chemist]

It's important to recognise that, in many cases, the very high cost isn't a manufacturing cost; it's to cover the cost of R&D. (And advertising- but that's a different story.)

[alancalverd]

Not entirely an unconnected story in a market economy!

Assuming the stuff works on rats, you have to test for toxicity and maximum tolerable dose in fit humans, which can take a year at least, then for efficacy on real patients (which can take a very long time if it's a rare disease), submit your manufacturing process to official scrutiny, then prove it is at least as good as or substantially safer than the market leader (to get a US licence), set up your worldwide postmarket surveillance program, ....and now you can design the packaging and brief your sales force or open negotiations with NICE and its overseas equivalents for public supply.

In the intervening 5 years or so you are paying interest or dividends on the capital you used to develop the molecule in the first place, and reorganising your production and distribution facilities to scale up for the mass market or rapid bespoke production, all in the hope that the firm next door doesn't have a better product.....

The question over the £200k product is whether you will actually make a profit from 10 or 1000 patients per year, or whether it is just good for company image.