Apr 18, 2002
From May this year (2002), patients with multiple sclerosis across the U.K. are likely to benefit from treatment with the drugs beta interferon and glatiramer acetate on the National Health Service as part of a unique "payment by results" agreement between the Department of Health and five pharmaceutical companies.
The National Institute for Clinical Excellence (NICE) published its final appraisal determination on the effectiveness of beta interferon and glatiramer acetate. NICE has found that on the basis of current prescribing mechanisms, these drugs are not cost-effective for use on the NHS.
However, in their initial findings (the Provisional Appraisal Determination, published in August 2001), NICE recommended that "...the Department of Health...and manufacturers might usefully consider what actions could be taken, jointly, to enable any of the four medicines appraised in this guidance to be secured for patients in the NHS in England and Wales, in a manner which could be considered cost-effective."
Following those considerations, the Department of Health, drug manufacturers and patient bodies have agreed on an innovative way of securing beta interferon on behalf of NHS patients. It will ensure that those patients who meet criteria devised by the Association of British Neurologists (ABN), including those with the relapsing/remitting form of MS and those with secondary progressive MS in which relapses are the dominant feature, can be prescribed these drugs on the NHS in a cost-effective way:
* Eligible patients will be called up by specialist neurologists for assessment to confirm that they meet the ABN criteria and that they will benefit from using the drugs. It is probable that most eligible patients will already be under the care of a specialist neurologist who will arrange this assessment.
* Once the patients have been assessed they will then be prescribed the drug most likely to be clinically effective for him or her.
* All patients meeting the criteria will be thoroughly assessed to establish the extent of their disability. This is necessary to provide a baseline to monitor the patient's progress with the treatment. Generally, patients will then be seen each year for a further assessment of their condition.
* Implementation of the scheme will be a major undertaking and it may take some time before all potentially eligible patients can be assessed. To help with implementation all the companies involved have agreed to help fund some of the additional specialist nurses who will be needed.
Groups of patients will be monitored over the lifetime of the scheme and costs to the NHS will be adjusted according to whether expected patient benefits are realised. Cost of treatment in a full year could be in the order of 50 million pounds sterling.
Health Authorities and Primary Care Trusts will be expected to fund these treatments out of their general allocations which are increasing in real terms by an average 7.2% next year. Funding treatments under the scheme is a statutory obligation.
"Today we can go a long way towards ending the uncertainty that has affected thousands of people with MS," said Health Secretary Alan Milburn. "For years they have suffered from the legacy of 'post code prescribing.' Beta interferon has a unique history which demands a unique solution. Uncertainty about the effectiveness of treatment for MS has led to thousands of patients missing out. Now, following advice from NICE that the government and pharmaceutical companies should find a way to make these drugs more cost-effective, a solution has been found.
"Negotiations have produced this innovative scheme involving payment by results. Patients will be monitored to see whether the drugs are working for them. Prices will be reduced if patients don't benefit as anticipated."
"Consultant neurologists will have a choice of treatments for their
patients. We are also introducing statutory obligations to ensure decisions
by neurologists are backed up with funding so that these patients get the
drugs they need." This article was prepared by Pain and Central Nervous
System Week editors from staff and other reports.
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