Saturday, June 29, 2002
Four Tayside patients with multiple sclerosis, who paid for expensive drug treatments, are to get a refund, writes Marjory Inglis, medical reporter.
And unless an extra consultant neurologist is employed locally, it will take up to seven years to assess all local sufferers for suitability to receive the drugs now to be more widely available on the NHS.
Local health chiefs today debated the implications of a Scottish Executive decision to make Beta Interferon and another expensive drug available to a larger group of MS patients, without providing any extra resources to local health boards.
Until now Tayside has limited the number of people receiving the drugs on the NHS to between eight and 10 patients a year, containing the costs to around £80,000 per annum. Four patients chose to pay for their own drugs after the NHS locally declined to pay.
Treatment for MS until now has largely depended on where a patient lives and what their local health authority offers - the so-called "postcode lottery". Grampian, a comparable region to Tayside in terms of size and urban/rural mix, was said to spend around £500,000 a year on the drugs that in the past have been deemed too expensive for the benefits gained. They are not a cure but can relieve symptoms.
However, NHS Tayside’s finance and resources committee heard today that implementing new guidance from the Scottish Executive Health Department that would make the drugs available to a larger number of patients would have massive financial implications.
And, once again, health chiefs faced making difficult choices regarding what projects they must delay or abandon meantime in order to fund the consequences of the new guidelines.
Chairman Murray Petrie said one of the difficulties confronting his colleagues was they had no accurate idea of the total number who would be suitable to receive the drug and therefore could not accurately predict the impact on budgets. But they were in agreement that the sums involved would be vast and the cost could exceed £2.4m a year.
Mr David Carson, NHS Tayside’s head of financial performance management, said the Executive estimated between 12.5% and 15% of MS patients would meet the requirements for receiving the drugs, meaning 125 patients eligible in Tayside at a cost of £680,000 per annum. But local specialist advice was that up to 30% of patients would be eligible and the Executive had vastly underestimated the cost of the drugs.
Mr Carson said there would be a need for extra staff to conduct assessments, including a consultant neurologist, two specialist nurses and secretarial support on top of additional drug costs.
There had been central negotiations between the drug companies and the Executive Health Department, but it had now been left to individual health authorities to negotiate with the drug companies in a "risk sharing" arrangement that would adjust the price of drugs according to effectiveness. Members were clearly frustrated no central solution had been found and decided to instruct officials to start negotiations with other health authorities, with a view to a combined approach to talks with drug firms.
Mr Carson said that under the new guidance, four "self funders" would be reimbursed for the cost of the drugs, with effect from February 7 2002. Discussions with a locally-based neurologist had revealed that just assessing all MS patients in Tayside with current staffing would take seven years.
Mr Petrie said neurologists were a "scarce resource" in Scotland and there was a need to increase the assessments for suitability for the MS drugs without impacting on work with their other patients.