James Raftery, professor of health technology assessment

Wessex Institute, School of Medicine, University of Southampton, Southampton SO167NS, raftery@soton.ac.uk

BMJ 2010; 340:c1672 doi: 10.1136/bmj.c1672 (Published 3 June 2010) Cite this as: BMJ 2010; 340:c1672

The NHS is paying for thousands of patients with multiple sclerosis to
receive drugs that monitoring data suggest are not effective. James Raftery examines what went wrong with the access scheme that facilitated their use

The largest and most ambitious patient access scheme, the UK multiple
sclerosis risk sharing scheme, was set up in 2002 after the National

Institute for Health and Clinical Excellence (NICE) recommended against

use of interferon beta and glatiramer acetate.

1 Under the scheme patients were closely monitored to confirm the cost
effectiveness of the drugs, with an agreement that prices would be

reduced if patient outcomes were worse than predicted.

2 The first report on the scheme in 2009 showed patient outcomes were much worse than predicted but judged that it was premature to reduce prices.

3 Why did this happen and what can we do to prevent it recurring?

Development of patient access schemes

The high prices charged for many new drugs have led to many health systems
requiring proof of cost effectiveness before they are funded. However,

decisions often have to be made with limited information: licensing

trials are typically short term and of little value for assessing cost

effectiveness. Once licensed, drug prices are listed at prices that

seldom change. Patient access schemes have developed whereby agreements

are made with the manufacturer to vary drug prices according to

factors such as the number of patients treated or doses used, the

response of the patient, or longer term patient outcomes.

The 2009 Pharmaceutical Price Regulation Scheme, which governs drug
pricing, outlined two types of access scheme: those based on finance

and those based on outcomes (table?).4 Schemes based on finance involve

either changes in list price or discounts linked to the number of

patients or doses or to patient responses. Schemes based on responses

can … Source: http://www.bmj.com/content/340/bmj.c1672.short

Full article: http://www.bmj.com/content/340/bmj.c1672.full

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