Friday May 4, 2001
I am a qualified nurse who has given up work because of the onset of multiple sclerosis. Beta interferon, which I buy privately, has halted the progress of my disease. Fellow patients on the drug for much longer have had their symptoms reversed by beta interferon and their quality of life restored.
Peter Cardy of the MS Society quoted Michael Rawlins, chairman of the national institute for clinical excellence, as saying that £3,000 per annum per patient is an acceptable price for beta interferon (Drug cost dithering 'lets MS get worse', April 30). Sir Michael also made this claim at a meeting of Nice in Nottingham on March 21, when I asked him what is the cost-effective price for the drug. Patients are now very concerned because the actual cost of the drug is £10,000. With such a wide gap between the figures there is little prospect of Nice approving this treatment, so why has it extended the time it requires to appraise it? Is there political influence in the background?
Long Eaton, Notts
• Your article on our appraisal of medicines for people with multiple sclerosis is misleading in some important aspects. Although the price at which a drug is sold will influence its cost-effectiveness, at no stage has Professor Rawlins, or any other member of the institute, speculated on an appropriate cost for the beta interferons or glatiramer acetate. Drug pricing is not our responsibility.
We have clear processes for undertaking our appraisals. It allows for consultation and for appeal before guidance is issued to the NHS in England and Wales. Appeals do not delay the process, they are an integral part of the production of robust guidance; and the fact that we use an independently prepared review of the evidence should leave all those involved in our work feeling confident of its objectivity.
The evidence we use for our appraisals is critical to making an informed decision. It is for this reason that in the case of the medicines for MS, we commissioned further work on an important element of it. We are clear that the current economic models, on which we would rely to make our judgment of cost-effectiveness, are flawed and do not constitute a suitable basis to form a robust judgment. We can improve on them and we are doing so in a fully transparent manner. This work involves all consultees and we will review the results in July.
The current situation for people with MS is that health authorities in England have clear guidance from the Department of Health on the arrangements they should be making for people with this distressing condition. They have been instructed to continue with these local arrangements until Nice guidance becomes available.
Further information, together with the appeal panel's decision and minutes of committee meetings, are published on www.nice.org.uk.
Chief executive, national institute for clinical excellence