FT.com - NHS 'risk-sharing' drug pilot scheme branded a fiasco

A pioneering scheme in which pharmaceutical companies were to cut the price of an expensive multiple sclerosis drug if it did not work has proved "a fiasco" and "a costly failure", leading health economists said yesterday.

The failure has implications for other so-called "patient access" or "risk-sharing" schemes in the NHS, they said.

Under these, drug companies which believe their treatments work after the National Institute of Clinical Excellence (Nice), has judged them not cost effective, take some of the financial risk in supplying the drugs to the NHS. The schemes vary considerably. But they can include discounts and/or price reductions if the drug does not perform as claimed. Around a dozen such schemes are running in the NHS.

Under the multiple sclerosis scheme - the first to be set up in the UK in 2002 - the NHS agreed to pay four drug companies the roughly £8,000 a year cost of providing Beta-interferon and glatiramer acetate to MS patients. The proviso, however, was that the price would be reduced if the drugs failed to prevent progression of the disease.

Some 5,000 patients were recruited. But far from slowing the disease, progression was faster in the patients who had the drugs than in untreated patients - although the comparison was with a large, past group of untreated Canadian patients.

The results were so poor that "the manufacturers would need to pay the NHS to use the drugs to make them cost effective", Christopher McCabe, professor of health economics at Leeds university, says in the British Medical Journal.

Yet their price has not been cut after the group monitoring the scheme said that would be premature. The monitoring group, however, consisted of the manufacturers, patients, clinicians and the Department of Health, all of whom "have a vested interest" in the scheme continuing, Professor McCabe said.

The scheme has cost around £50m a year - equivalent to almost 10,000 hip replacements, or a fifth of the annual cost of running a district general hospital. It was slow to get off the ground, with academic and ethical disputes over how results were to be monitored. But if it had been stopped two years in, "the NHS could already have saved up to £250m", Professor McCabe says.

James Raftery, professor of health technology assessment at Southampton university, says in an accompanying article the scheme has been a "fiasco" and possibly the most expensive health study "anywhere, ever".

via ft.com

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