Survey: vets reveal the true cost of the cascade

RE: Survey: vets reveal the true cost of the cascade

David Mills — Wed, 06 Aug 2025 09:59:00 GMT

[quote userid="14047" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247578#247578"]On a very basic point the palatability is very important when it comes to compliance and reducing waste.[/quote]

Possibly.

In cats (probably the most difficult animals to medicate) only about 2/3rds finish the course of medication currently (it is probably less than this as this is a survey-based study)

https://pmc.ncbi.nlm.nih.gov/articles/PMC10812359/

So it's hardly a ringing endorsement for the status quo!

Formulations only tend to change to easier to give when they come off patent - think methimazole, clindamycin etc - so the current system doesn't work for owners. Synulox tablets still has that laughable line on the envelopes that 'even sick animals will take it as a treat' or some such nonsense.

[quote userid="14047" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247578#247578"]cost in treatment not 'given' correctly especially wrt AMR[/quote]

There are far more pressing issues with AMR than 'palatable' meds - overuse of antibiotics for non-bacterial diseases or prophylactically being the main ones that dwarf palatability as an issue.The financial cost shouldn't be significant given how much cheaper generic medications are. Arguably capsule formulations are easier than flavoured.

RE: Survey: vets reveal the true cost of the cascade

Elizabeth Molyneux — Tue, 05 Aug 2025 08:52:33 GMT

On a very basic point the palatability is very important when it comes to compliance and reducing waste. Most human drugs are not so palatable for animals. What would be the cost in treatment not 'given' correctly especially wrt AMR

RE: Survey: vets reveal the true cost of the cascade

Dinu Catilina — Mon, 04 Aug 2025 14:31:01 GMT

[quote userid="8991" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247573#247573"]It takes 30 seconds to write a prescription on a PMS and off to a pharmacy people go -[/quote]

I would love to see this. However, Sweden has exactly this system in place and their veterinary care is significantly more expensive than in the UK.

RE: Survey: vets reveal the true cost of the cascade

David Mills — Mon, 04 Aug 2025 13:44:29 GMT

[quote userid="3169" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247566#247566"]If you take the BNF prices for the study - the prices are meaningless. [/quote]

Not really - it just means your supplier is charging you X times what they would the NHS. Just the same as what vets do I suppose.

As I've said previously, these issues have been circumnavigated in other jurisdictions by removing supply of medication (other than injectables or emergency drugs) from vet practices. It takes 30 seconds to write a prescription on a PMS and off to a pharmacy people go - no pill counting (couldn't agree less with app-based counting having just seen a nurse trying to count 100 preds), no storage, minimal wastage, pharmacy supplies the human generics, prices are lower, and well the whole argument goes away really. (I'm aware this wouldn't work for farm or equine practice but they are different beasts).

The cascade isn't doing anyone any favours at all. Least of all animals and their owners. We've seen on here the amount of issues supply of medication throws up for vets. Who the hell benefits? It really isn't improved efficacy and safety!

RE: Survey: vets reveal the true cost of the cascade

Arlo Guthrie — Mon, 04 Aug 2025 13:39:27 GMT

...

[quote userid="9239" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247571#247571"]I'm sorry, I'll come across like I disagree with everything you say but I would hope you got used to it by now. [/quote]

LOL. I am not sure we are really disagreeing here.

[quote userid="9239" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247571#247571"]Unless it saves money, see the example of wearing seatbelts. [/quote]

Of course I know that value can be measured in terms of a direct reduced cost or an indirect saving.

When it comes to CPD, yes, I know that ...

[quote userid="9239" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247571#247571"]35 hours/year you can do for free without paying a penny to anyone.[/quote]

Which is why I used the opportunity cost figure. £200 per hour in what you might charge for consultations. And the reality is, most people dont do all their CPD free of charge, there will usually be some element of formal training.

Now I am not saying CPD is a bad thing. Not at all. What I am saying is that it is all pretty arbitrary. Who said 35 hours per annum? Is there any evidence that the £10K you are spending per vet per annum is delivering £10K's worth of benefit to clients or the practice in terms of enhanced safety, performance, speed etc.

Or, as you say:

[quote userid="9239" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247571#247571"]Well, it may save me 10K in costs in other ways. [/quote]

Yes, it might.

But is it?

[quote userid="9239" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247571#247571"]It pains me to defend the RCVS [/quote]

I am not attacking the RCVS, so no need to defend it!

I am just challenging / debating whether there has been sufficient focus on the cost of regulation by the regulators.

RE: Survey: vets reveal the true cost of the cascade

Dinu Catilina — Mon, 04 Aug 2025 12:59:23 GMT

I'm sorry, I'll come across like I disagree with everything you say but I would hope you got used to it by now.

[quote userid="2100" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247569#247569"]

But it is a fact, rather than an opinion, that implementing regulation at any level costs money.

[/quote]

Unless it saves money, see the example of wearing seatbelts.

[quote userid="2100" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247569#247569"]

If the RCVS decrees you do 35 hours CPD a year, what is the opportunity cost of that? (how much money you would have earned in 35 hours?) £7K? And if you then spend what, another 3K on formal CPD courses, we're up to 10K a head per annum.

I would say that is a significant additional cost, and whilst most would probably say CPD is a good thing, the question is whether it is delivering £10k of benefit per vet per annum to clients?

[/quote]

35 hours/year you can do for free without paying a penny to anyone. Yes, it is still 35 hours which you could take out from work, we give 5 cpd days/year. I am yet to see an excellent vet who does little CPD but it is selection bias so maybe you are right.

[quote userid="2100" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247569#247569"]the question is whether it is delivering £10k of benefit per vet per annum to clients? [/quote]

Well, it may save me 10K in costs in other ways.

It pains me to defend the RCVS but they're not at fault for everything. Just most things.

RE: Survey: vets reveal the true cost of the cascade

Arlo Guthrie — Mon, 04 Aug 2025 12:42:40 GMT

[quote userid="9239" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247568#247568"]I for one think that it's not the RCVS that drove costs up[/quote]

I wasnt blaming increasing costs on the RCVS.

But it is a fact, rather than an opinion, that implementing regulation at any level costs money.

I would say that is a significant additional cost, and whilst most would probably say CPD is a good thing, the question is whether it is delivering £10k of benefit per vet per annum to clients?

You are right, precious little evidence of the degree to which various factors have contributed to rising costs.

But regardless, it must surely make sense for regulators to deliver demonstrable value for those on whose behalf they regulate.

RE: Survey: vets reveal the true cost of the cascade

Dinu Catilina — Mon, 04 Aug 2025 12:08:21 GMT

The problem here is that we all have opinions and none have evidence. I for one think that it's not the RCVS that drove costs up. I don't believe it's regulation that produced the gold standard but the profession and those who think that we work in health care when in truth we work in livestock management.

RE: Survey: vets reveal the true cost of the cascade

Arlo Guthrie — Mon, 04 Aug 2025 12:00:30 GMT

[quote userid="9239" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247563#247563"]I don't know about Michael but I am not saying we should keep the cascade, I'm only saying that it won't save as much money as you think it will. [/quote]

I get that and understand that not all of the saving would necessarily be passed on to owners.

BUT

I think there is a bigger point at stake here.

I think that for many years now, regulation has been driven to some degree by the same 'gold standard' ideology that has driven clinical care.

I don't think there has been much focus on the cost of regulation, and in particular, trying to make sure that rules deliver value in some way.

I think if a rule dictates that veterinary licensed drugs must be used in companion animals, fine, but there needs to be evidence that it will bring improvements in efficacy or safety.

With novel treatments, the benefit of veterinary licensing is clear, to make sure that they have been tested for safety and efficacy.

But for preexisting human use drugs which have been used in animals for yonks, and were tested on animals to get a human license, where is the evidence of any benefit whatsoever?

I think the same thinking needs to apply to things like the PSS scheme and CPD requirements, both of which appear to be ideologically driven, rather than evidence-based requirements. In other words, CPD requirements are driven by the belief that: "You'd want to know your vet had kept up to date".

Er maybe.

But if the cost of that was adding significantly to my bill, and there was no evidence that it made my vet any better at their job over the practise they get every day?

Then maybe not!

So the bigger point is that perhaps by making an example of the impact of ideologically driven regulation, this might serve to make regulators become more cost-conscious overall.

So far, I see the RCVS talking at length about contextual care being the solution to spiralling costs, but no evidence thus far of what it is doing to reduce the impact of its regulation on veterinary costs.

RE: Survey: vets reveal the true cost of the cascade

Michael Woodhouse — Mon, 04 Aug 2025 11:44:56 GMT

[quote userid="9239" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247565#247565"]Box of 100 from Veenak is 7 pounds. Box of 100 from Covetrus is 40 pounds. Neither licenced. [/quote]

But, wait, BNF says 100 are only £1.53.

If you take the BNF prices for the study - the prices are meaningless.

RE: Survey: vets reveal the true cost of the cascade

Dinu Catilina — Mon, 04 Aug 2025 11:02:42 GMT

Sorry to bring in another random anecdotal example but I'll give the price of gabapentin as an example why ONLY removing the cascade will not make things easier or simpler. Box of 100 from Veenak is 7 pounds. Box of 100 from Covetrus is 40 pounds. Neither licenced.

RE: Survey: vets reveal the true cost of the cascade

Michael Woodhouse — Mon, 04 Aug 2025 10:32:52 GMT

[quote userid="2100" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247562#247562"]

I also don't understand the maths of your argument, but I see David Mills has beaten me to it:

[/quote]

I think my point is - veterinary practice is expensive to run and not massively profitable. If the cascade was abolished tomorrow and I went to human generics with a 50% mark up, then I expect I'd be bankrupt by Christmas. I'd be happy if we didn't have the cascade, but I'd have to look very carefully at pricing of meds, and other costs would have to rise - probably a mix of increased percentage mark up, increased dispensing fee, increase on consult fee. It is nowhere near as simple as buying things for a fraction of the cost and selling them for a fraction of the cost, the gain to the client would be very minimal in most cases.

[quote userid="8991" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247561#247561"]They're excessive and a hidden cost. In some cases they allow practices to claim they don't mark up medicines.[/quote]

This is all a part of the same argument. If I was pricing up an operation I would include allowances for the consumables used (gloves, drapes, sterilisation) and disposal of waste in the cost. For that reason, I do see it as right to cover as much of the dispensing costs through the sale of medicines either through mark up or through dispensing fees. Whilst a percentage mark up on list price is far from perfect, it serves as a 'fair' starting point and really only leaves a 33% margin on the product, which I don't think is excessive. I've considered a fixed fee mark up (akin to a prescription fee) so that long term or expensive meds are cheaper, but your eye or ear treatment becomes much more expensive. The reason I don't do it, is that the loss to me is greater when something expensive goes to waste.

[quote userid="8991" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247561#247561"]As for counting tablets - no longer necessary (look at apps like Pill Eye)[/quote]

It still takes just as much time as using a pill counter, just differently.

[quote userid="8991" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247561#247561"]Stock wastage in this day and age shouldn't be high (except injectables) - but I appreciate it can be. Have you ever wondered why vet drugs come in boxes of 50-100? Who needs 100 Rilexine on the shelf at any one time? [/quote]

I do my best to minimise wastage but it happens. It can't just be me who suddenly ends up with all the big dogs on pimobendan dying and stock going out of date? Someone helpfully orders in some long term meds and dog PTS. Want to put a dog on something and it doesn't suit it? Random referral vets wanting me to dispense 5 omperazole when it comes in 100's...... Vets leave who liked a particular drug and no one else uses it? I do agree that smaller pack sizes may help, but then you have increased pack costs (but lower dispensing costs). Much easier to pack human antibiotics in typical courses than for our patients.

RE: Survey: vets reveal the true cost of the cascade

Dinu Catilina — Mon, 04 Aug 2025 10:20:38 GMT

[quote userid="2100" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247562#247562"]

You seem to be arguing it is fine for there to be vet licensed drugs which cost 20 times (or more) as much as the human version, without offering any additional safety or efficacy benefit, because it is subsidising your business.

Really? You really think that is a fair justification for the additional costs of vet licensing?

[/quote]

I don't know about Michael but I am not saying we should keep the cascade, I'm only saying that it won't save as much money as you think it will.

[quote userid="2100" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247562#247562"]I think drug mark-ups are an opaque way of doing business which lines you up for criticism from cash-strapped clients (not to mention the fact that they have caused vets to undersell the value of their time and experience).[/quote]

100% correct.

[quote userid="8991" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247561#247561"]I'm confused by these statements as they imply you need to make an absolute sum - which doesn't make sense. The vet licensed drugs cost more - 20x in some (most?) cases. You could still make your £20-30 but it be cheaper for the owner.[/quote]

I think it is an absolute sum with some variations. If drug costs are about 20% of the costs of running a business, part of those drugs have no off licence alternative which makes me think that in total we save about 10-15% of the total bill, not more. Again, it's not good the drugs subsidise fees but it is happening.

RE: Survey: vets reveal the true cost of the cascade

Arlo Guthrie — Mon, 04 Aug 2025 09:45:08 GMT

[quote userid="3169" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247560#247560"]My point being, that the owner can't have them for £57 less as I need to make back the ~£30 somewhere.[/quote]

I'm really struggling with your argument Michael Woodhouse

Really? You really think that is a fair justification for the additional costs of vet licensing?

I think drug mark-ups are an opaque way of doing business which lines you up for criticism from cash-strapped clients (not to mention the fact that they have caused vets to undersell the value of their time and experience).

Either way, you didn't have the markup on vet-licensed drugs before the EU directive and cascade. How did you survive then?

I also don't understand the maths of your argument, but I see David Mills has beaten me to it:

RE: Survey: vets reveal the true cost of the cascade

David Mills — Mon, 04 Aug 2025 09:30:15 GMT

[quote userid="3169" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247560#247560"]I need to make back the ~£30 somewhere[/quote][quote userid="9239" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247559#247559"]We still have to make the same money somehow.[/quote]

I'm confused by these statements as they imply you need to make an absolute sum - which doesn't make sense. The vet licensed drugs cost more - 20x in some (most?) cases. You could still make your £20-30 but it be cheaper for the owner.

[quote userid="3169" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247560#247560"]What have you got against dispensing fee[/quote]

They're excessive and a hidden cost. In some cases they allow practices to claim they don't mark up medicines.

Paper bag 33p? Wow.

Stock wastage in this day and age shouldn't be high (except injectables) - but I appreciate it can be. Have you ever wondered why vet drugs come in boxes of 50-100? Who needs 100 Rilexine on the shelf at any one time?

As for counting tablets - no longer necessary (look at apps like Pill Eye)

Training staff on dispensary - less than a day.

The 'physical cost' of dispensing? Really? It is part of their job, no? You don't charge clients for phone calls as well do you?

It sounds almost like you're bemoaning business costs. I find it very odd.

[quote userid="3169" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247560#247560"]How do you propose I cover all those costs? [/quote]

Push for a better pharma system would be a start. Reduce your drug costs by 10-20x. How does that sound?

RE: Survey: vets reveal the true cost of the cascade

Michael Woodhouse — Sun, 03 Aug 2025 22:19:03 GMT

[quote userid="8991" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247540#247540"]But in first opinion the majority of work is consults and meds - of which drugs make up a significant cost. Pyoderma? Cephalexin dog tablets £60+, human equivalent £3. That £60 is often more than the professional time. Some of it is nonsense add-ons like dispensing fees (should be scrapped), but to an owner that could be a weekly shop the £57 difference.[/quote]

My point being, that the owner can't have them for £57 less as I need to make back the ~£30 somewhere. So that is out of the window. Happy if we could use whatever we saw fit and no cascade, but as I say - I'd protect my margins and reduce the overall cost to the owner. I still need whatever the margin was on the vet licensed medicine.

What have you got against dispensing fees? a paper bag to put the drugs in (admittedly personalised and the large size as we use them for farm dispensing also) costs me 33p. I spend literally thousands of pounds per year on bags, bottles, tablet pots and dispensing envelopes. I have returned pharmaceuticals to dispose of and broached bottles that pass their broach date or drugs going OOD. I wouldn't like to try and add up the labour cost for reception, nursing and vet staff in physical dispensing, stock control, ordering, trying to source replacements for out of stock items. Generating SICs. Not to mention waste disposal of the boxes and packaging. Training new and existing staff. Ordering from 4 or 5 different places each week (the vet wholesalers unlikely to supply the tablets at £3.....).

How do you propose I cover all those costs? The £5 dispensing fee and 50% mark up on the Ceporex (your £60 to the owner is £20 to me). I'm sitting here considering putting dispensing fees up, significantly, tomorrow........

RE: Survey: vets reveal the true cost of the cascade

Dinu Catilina — Fri, 01 Aug 2025 19:26:23 GMT

[quote userid="8991" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247540#247540"]I disagree for the vast majority of the profession. [/quote]

Fair comment, I don't know how most of the profession works, I have a very limited view from my own business and our clients.

[quote userid="8991" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247540#247540"]

Sure, if your main source of income is TPLOs etc or surgery generally then drug cost is small compared to procedure fees.

But in first opinion the majority of work is consults and meds - of which drugs make up a significant cost. Pyoderma? Cephalexin dog tablets £60+, human equivalent £3. That £60 is often more than the professional time. Some of it is nonsense add-ons like dispensing fees (should be scrapped), but to an owner that could be a weekly shop the £57 difference.

[/quote]

Surgeries are, from my observation, the biggest bills. TPLO, spinal, gall bladders, whatever, they tend to come in a big lump and it's the most common source of grumbles from owners. Again, in my limited experience. Yes, antibiotics can be 60 pounds but with a reasonable consultation fee of 40-50 and some steroids they will not break the bank.

I also don't believe that if we can sell cepahlexin for 3 pounds the owner will save 57 pounds. The owner will most likely save 10-15 pounds and the rest of the money (which the practice would have had back through discounts and rebates) will be paid through an increased consultation fee. We still have to make the same money somehow.

Just to be clear, I believe the cascade should be scrapped. I also think drugs should be bought online and from pharmacies and vets should sell their skills and not drugs. I just don't believe that it will save any money for the client. I don't believe that the cascade has an inflationary effect on the veterinary costs.

Just a random anecdotal example from today. Bitch came in for caesarean, we are about 950-1050 pounds in normal hours and to me it's quick and easy money. Quoted at another local practice, not OOH, not a specialist centre, just regular grunts like us between 2500 and 3000 pounds. That's 100 pounds worth of drugs in there.

RE: Survey: vets reveal the true cost of the cascade

Ben Walker — Mon, 28 Jul 2025 19:48:46 GMT

[quote userid="8991" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247540#247540"]Level the playing field. You can stock the human varieties and sell them for whatever you want.[/quote]

Would a mechanism to provide incentives for human generic manufacturers to apply for veterinary authorisation achieve the same aims without overhauling the licensing process or the cascade?

RE: Survey: vets reveal the true cost of the cascade

David Mills — Mon, 28 Jul 2025 16:51:51 GMT

[quote userid="9239" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247538#247538"]looking at a 4500 pounds cruciate bill the cost of the drugs is pretty low and it's the same for a lot of things.[/quote]

I disagree for the vast majority of the profession.

Sure, if your main source of income is TPLOs etc or surgery generally then drug cost is small compared to procedure fees.

No one said anything about mark up or prescription costs? We are talking about the higher cost of veterinary medicines and the uneven monopoly currently in place for vets, owners and everyone else.

Level the playing field. You can stock the human varieties and sell them for whatever you want. At the moment there is a lack of choice or competition on medicines because of the requirement to use the vet licensed ones. So vets are screwed on price and owners pay for that (+ mark up). What I suspect would happen is the vet licensed ones would magically come down in price to close to the human ones (or they'd just stop making them). Regardless you could supply them direct to owners at a price point that pays for storage and availability.You'd still have the novel therapies - in fact that would be the money-spinner for pharma now, so more products, win-win.

RE: Survey: vets reveal the true cost of the cascade

Arlo Guthrie — Mon, 28 Jul 2025 15:16:45 GMT

[quote userid="9239" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247538#247538"]Decreasing the price of some tablets will make zero difference when the cost of running a practice, paying the staff and delivering "gold standard" care is sky rocketing. [/quote]

Well, in this survey, vets reported that clients were very often finding vet-licensed versions unaffordable. So it may make zero difference to the cost of running a practice or paying the staff, but that wasn't the point. The point is that it could make a big difference to clients.

I think there is another important aspect, which is the signal it would send to the profession if the regulator were to allow vets to prescribe human licensed drugs (which had been in veterinary use before the cascade) in preference to vet licensed ones when the vet ones have no appreciable benefit over the human ones, and are much more expensive.

Firstly, it brings a bit of pragmatism to regulation, and secondly it shows an acceptance by the regulator that costs ARE important (and that it needs to do its bit to keep them in check).

The VMD seems ideologically wedded to the idea of vet-licensed versions of human drugs, at any cost, and despite there being no evidence of any benefit for the increased cost.

RE: Survey: vets reveal the true cost of the cascade

Dinu Catilina — Mon, 28 Jul 2025 13:50:13 GMT

[quote userid="2100" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247537#247537"]

Dinu Catilina I am not sure I quite understand your logic here. I mean, if owners had a bottomless pit of money, then yeah, sure, what is a few pennies here or there. But they don't. They only have finite resources. So if drugs cost more, that means there is less room for vets to charge for their time.

Then there's the old adage, which I think is nevertheless true: "look after the pennies and the pounds will look after themselves."

[/quote]

I am probably wrong then but the way I see it, looking at a 4500 pounds cruciate bill the cost of the drugs is pretty low and it's the same for a lot of things. Decreasing the price of some tablets will make zero difference when the cost of running a practice, paying the staff and delivering "gold standard" care is sky rocketing.

RE: Survey: vets reveal the true cost of the cascade

Arlo Guthrie — Mon, 28 Jul 2025 10:03:29 GMT

[quote userid="9239" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247535#247535"]Yes, same thoughts here. All these talks about the cascade and about the price of drugs or markups are, to me, irrelevant. If I need to take 100000/month to break even then it doesn't really matter where the money comes from. [/quote]

Then there's the old adage, which I think is nevertheless true: "look after the pennies and the pounds will look after themselves."

And finally, but I think most importantly, is that surely regulation should deliver value?

In other words, if regulation pushes up prices, then we (by which I mean everyone, but especially vets on behalf of their clients), should demand that it delivers value: that if vet licensed lactulose costs 22x as much as human licensed lactulose, then it had better deliver 22x value (which could be measured in terms of efficacy, convenience or safety).

[quote userid="3169" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247531#247531"]Ok, what would YOU like to see from this? Do you live in a panacea where the little old lady can have the human antibiotic at 5p a tablet with no mark up, prescription costs etc? Do you think that would be a universally good thing in terms of animal welfare, client satisfaction, good antibiotic stewardship, practice management, business profitability, your salary review etc?[/quote]

I am not sure I understand how veterinary licensing of antibiotics has any bearing on antibiotic stewardship? Surely that is only about limiting antibiotic prescriptions - it makes no difference whether you're prescribing a vet or a human version of the same antibiotic.

Cheaper human-licensed drugs a good thing in terms of animal welfare? There's no evidence for them being a bad thing for welfare, from a clinical perspective. But there is some evidence now for more expensive vet licensed drugs being bad for welfare because some people cant afford them.

Is there evidence that vet licensed lactulose has brought any benefits in terms of client satisfaction, or practice management, or business profitability or salary reviews? I think not!

It is important to stress again that this paper is not making a case against all vet licensed drugs. Of course it makes sense to establish clinical and safety standards for novel drugs.

We're talking very specifically about retro licensing human drugs that have been used safely for sometimes decades, with little appreciable benefit to the animal or the owner.

RE: Survey: vets reveal the true cost of the cascade

Beats — Sat, 26 Jul 2025 22:45:20 GMT

Michael, I suspect that if your pricing was rolled out across the country, things would get cheaper at the majority of veterinary clinics for the majority of pet owners (though without a reduction in costs this may result in some business difficulties for those clinics).

I suspect the same with the pricing structure where I work.

Considered as a separate point, however, the cascade does however affect prescribing decisions and there is no logic to tying vets' hands like this. If you wish to prescribe cat licensed lactulose no-one has an issue with that, but many vets have an issue with the suggestion that they should not prescribe the same sugar stuff poured out of a large bottle if they would prefer to.

Most cases of heart failure with me get furosemide and pimobendan in the cheapest form I can supply it. If an ACEi was a negligible additional cost, then most would get that too. Cheap human ACEi would be a negligible cost, but it is suggested that I should not use this - not that I should make a fully informed educated decision on whether I think this would be a useful thing to do, but I am incapable to think rationally myself and thus must be told what to do. I do not profit more by not prescribing human ACEi to these cases, as I am not prescribing (generally) an alternative vet-licensed ACEi (due to cost) - there would be no financial hit to the business in me handing out some additional tablets costing pennies if I thought that was a worthwhile activity to be doing.

My final point would be that even if you don't think the practicalities of the restrictions on medicine choice to vet licensed ones actually do you any harm (either because you think they are sufficiently competitively priced or you are happy to argue in favour of any decisions which you make to bypass them as required), what about the theoretical principle?

Someone thinks that you either lack the integrity to make decisions regarding the medicines you supply to pets rationally, or thinks that you are not capable of the higher level of thought that they possess: so you must be legally restricted in what you can do. For emphasis: someone thinks they know more than Michael about what medicines you should choose to stock and prescribe to pets under your care. I'm surprised if this doesn't offend you, but if so consider that there are lots of other vets that think they know better than those telling them what they should do and would like to return to being in charge of they medicine decision making freely from quangos. We are not eating dogs and cats, so there is no real rational reason for this beyond EU bureaucracy gone mad.

While there may be no present aspects of the cascade diktat which upset you re your prescribing choices for pets, if you were to learn that the same logic was to be applied to other aspects of your practice, I would say you would resent it.

Imagine a new diktat that in order for everything to be better vets will have to purchase only specific vet licensed pieces of diagnostic equipment. Would that not irk you?

Or we could restrict you to only surgical procedures which have been approved by the new veterinary surgery directorate. You pay a small fee each time you spay a bitch to a kindly surgeon who has gone to the effort of licensing a bitch spay procedure. This has gone through rigorous approval and been shown to be safe. What do you mean you don't want to tie 2 ligatures around each horn now? No going back ta making your own decisions on treatments that worked fine for you for years - we have licensed ones now! (Oh, and I hope that is a dog licensed suture you are using - but we don't even need new legislation for me to start licensing those I reckon they fit the bill under current VMR most likely... alongside oxygen and other treats ripe for commercial picking).

RE: Survey: vets reveal the true cost of the cascade

Dinu Catilina — Sat, 26 Jul 2025 19:08:26 GMT

[quote userid="3169" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247531#247531"]Hypothetically, if the CMA insisted that we had to write a free prescription and the owner can go to Boots for the 5p antibiotics, everything else will have to get a lot more expensive, if you want me to stay in business. It's delightful saying we should charge properly for our time and not need to make anything on drugs, but I believe a more balanced pricing structure is more fair on average and keeps the overall cost of veterinary care affordable. Yes, your amoxicillin may be a few pence more than online/bnf whatever, but I'll still see your sick dog at midnight for a hundred pounds or so. The argument for Vets Now and other OOH providers charging the high fees is the lack of cross subsidy, if we really want to protect animal welfare then maybe a lot of cross subsidies would be best. I googled a typical Vets Now consult fee and get £324.50 - licensed amoxicillin at 12x the cost isn't a drop in the ocean......[/quote]

Yes, same thoughts here. All these talks about the cascade and about the price of drugs or markups are, to me, irrelevant. If I need to take 100000/month to break even then it doesn't really matter where the money comes from. If we make less money on drugs we will increase the fees and the final result will be the same. It might actually be worse to the client in the long run depending on what they bring their pet in for. We need to look at the cost of veterinary care overall and changing little bits here and there will have very little influence.

RE: Survey: vets reveal the true cost of the cascade

Michael Woodhouse — Fri, 25 Jul 2025 23:11:18 GMT

[quote userid="8991" url="~/f/non-clinical-questions/31201/survey-vets-reveal-the-true-cost-of-the-cascade/247520#247520"]Again this has absolutely nothing to do what you buy it for. What do you sell them for to the owners? Because everything else is moot if the owner cannot afford medication. [/quote]

Ok, what would YOU like to see from this? Do you live in a panacea where the little old lady can have the human antibiotic at 5p a tablet with no mark up, prescription costs etc? Do you think that would be a universally good thing in terms of animal welfare, client satisfaction, good antibiotic stewardship, practice management, business profitability, your salary review etc?

I'm a Yorkshireman, I like it when things get cheaper. If I can get a drug cheaper I reduce the cost to the client, but I am running a business at the same time. My staff need paying, the bills increase all the time. For drugs that are for one-off or short term use (I'd consider the earlier example of maropitant or a course of antibiotics in this way) I would generally maintain my margin and I would, lazily, mark up on list price. So your £100 bottle of Cerenia plus 50% is £150/20ml. If a generic comes along costing me £50 I'd maintain the margin and sell for £100/20ml. I do take all discounts and my net net price into account so that I generally make the same, but no more.

It is quite significant if the difference is 5p to 60p on an antibiotic tablet, but then how much difference is 90p versus 50p on an antibiotic tablet really going to make to an owner - in the grand scheme of things? With ongoing meds I take a more pragmatic view of what is available, what is a 'fair' margin, what the alternatives cost, what it would cost online plus a prescription fee. I'm also, generally, happier to agree a bespoke price to match online cost plus a prescription fee, rather than waste time writing prescriptions (and can usually make slightly more money, too).

Hypothetically, if the CMA insisted that we had to write a free prescription and the owner can go to Boots for the 5p antibiotics, everything else will have to get a lot more expensive, if you want me to stay in business. It's delightful saying we should charge properly for our time and not need to make anything on drugs, but I believe a more balanced pricing structure is more fair on average and keeps the overall cost of veterinary care affordable. Yes, your amoxicillin may be a few pence more than online/bnf whatever, but I'll still see your sick dog at midnight for a hundred pounds or so. The argument for Vets Now and other OOH providers charging the high fees is the lack of cross subsidy, if we really want to protect animal welfare then maybe a lot of cross subsidies would be best. I googled a typical Vets Now consult fee and get £324.50 - licensed amoxicillin at 12x the cost isn't a drop in the ocean......