NHS MS scheme ‘a costly failure’
Researchers say the ‘risk sharing’ arrangement between the NHS and drugs companies for some multiple sclerosis treatments should be stopped.
4th June 2010 - The scheme used to fund some MS treatments in the UK is a “costly failure” and should be halted, according to research and analysis for bmj.com.
A leading MS charity agrees the scheme is flawed.
The “risk sharing” deal between the NHS and drugs companies was put in place in 2002 after the regulator, the National Institute for Health & Clinical Excellence, decided that disease-modifying drugs interferon beta and glatiramer acetate were not cost effective.
The agreement meant the government agreed to provide these treatments on the NHS while research was carried out on their long term cost effectiveness. The NHS would pay less if patients were not benefiting from the treatments.
In 2009, the first analysis of the data showed that patient outcomes were much worse than predicted. However, the scheme’s scientific advisory group decided it was too early to reduce prices without further information.
The authors of the research argue that the biggest losers are other NHS patients who would otherwise have benefited from the estimated £50 million a year spent on the scheme.
They say that if an assessment had been carried out after the first two years, the NHS would have saved around £250m.
Christopher McCabe, a health economist at the University of Leeds, raises concerns about the independence of the advisory group, which includes representatives from the drug companies, patient groups, doctors and the Department of Health.
James Raftery, Professor of health technology assessment at Southampton University, questions the overall governance of the scheme. He says it was good news for the drug companies, who sold at nearly full price to the NHS.
Raftery calls the scheme a “a costly failure”, writing that, “Monitoring and evaluation of outcomes in future patient access schemes must be independent of the companies involved. Transparency is essential, involving annual reports, access to data, and rights to publish. Any of these might have helped avoid the current fiasco.”
Support for the scheme
Not everyone is as critical. In an accompanying commentary, Alastair Compston, Professor of Neurology at the University of Cambridge argues that the scheme has benefited patients. He does, however, acknowledge that the governance was inadequate and that its terms of reference were not delivered. Compston also warns that attempts to force the drug companies to repay costs would be likely to trigger complex legal arguments.
In an editorial, Neil Scolding, Professor of Clinical Neurosciences at the University of Bristol and Frenchay Hospital, describes the scheme as a clever achievement, which despite being flawed, has had unintended beneficial consequences.
He argues that it has lead to an extremely successful network for specialist multiple sclerosis care in the UK and that the drugs prescribed will have prevented thousands of relapses.