More MS news articles for Nov 2001

Need for cheap MS treatment leaves Milburn in a quandary: The health secretary's stipulation that the NHS use only cost-effective drugs is problematic

Nov 1, 2001
Financial Times

Both Alan Milburn, the health secretary, and the pharmaceutical companies face dilemmas in talks on how to make costly treatments for multiple sclerosis available on the National Health Service. The four companies want the NHS to use more of their product. But they need to protect their overseas markets.

Mr Milburn equally would rather be seen to be treating MS sufferers than denying them. But he cannot afford to undermine the National Institute for Clinical Excellence, the fledgling body that he set up to ensure that the NHS adopts only cost-effective treatments.

Nice's preliminary conclusion that the Beta-interferons and glatarimer acetate, the two treatments available, are not cost-effective is easily the most controversial decision it has taken to date.

And it is Nice that first suggested that the department should enter into talks with the companies to see if the cost - not the price of the drugs - can be lowered.

The companies, Schering, Serono, Biogen and Teva, will strongly resist lowering the price, which ranges from Pounds 6,650 to more than Pounds 12,000 a year for treatment. UK prices help set the price that other countries will pay.

What the government is looking for, therefore, is a package deal - a cut in the cost to the NHS while the price formally remains the same.

The difficulty with the treatments is that they work in some patients but not in others. At present, it is not possible to identify beforehand which patients will benefit. If only those who would benefit were treated, the cost to the NHS would fall. Although it would have to fall a long way for Nice, on its current criteria, to judge it cost-effective.

The health department's favoured solution is a so-called "sale or return", or "risk-sharing" approach: it would agree to treat up to 10,000 patients over a period of years. But it would pay only for those in whom the drug proved effective. That might expose data, which some health officials believe the companies already hold, showing which patients the drug works most effectively in.

The challenge for the companies is whether that is a good deal. Will a guaranteed market among a group of patients smaller than the drug is currently licensed for be worthwhile? Competition between them encourages them to take the risk. If one does take part and its prod uct becomes the NHS approved one, the others will lose out.

But there is another risk. If the project does establish that there is an identifiable sub-group of patients in whom the drug works, that finding could hit sales in other countries where the drugs are already much more widely prescribed.

An alternative might be a block contract to supply the drug to the NHS at a cost much lower than the Pounds 60m to Pounds 100m a year that it is estimated it would cost to treat all 10,000 MS sufferers. That might allow the same question - which patients does the drug really work in? - to be answered another way.

But if the cost is not a lot lower, Mr Milburn will be seen to have set up a body to help decide NHS priorities - and, then to have over-ridden its first decision.

Copyright: The Financial Times Limited