Education And Debate

A purchaser experience of managing new expensive drugs: interferon beta

BMJ 1996; 313 doi: (Published 09 November 1996) Cite this as: BMJ 1996;313:1195
  1. E Rous, consultant in public health medicinea,
  2. A Coppel, pharmaceutical advisera,
  3. J Haworth, medical adviserb,
  4. S Noyce, pharmaceutical adviserc
  1. a Stockport Health Authority, Springwood House, Stockport SK7 5BY
  2. b East Lancashire Health Commission, 31/33 Kenyon Road, Lomeshaye Estate, Nelson BB9 5SZ
  3. c Sefton Health, Burlington House, Waterloo, Liverpool L22 0QB
  1. Correspondence to: Dr Rous.
  • Accepted 7 August 1996

Interferon beta is a new and expensive drug for treating multiple sclerosis. One published trial has shown that it reduces the exacerbation rate in patients who have relapsing-remitting disease without important disability. This paper describes the development of a strategy for purchasing the drug in one region of England before its licensing. Purchasers felt unable to decline funding for this marginally effective drug and thereby undertake explicit rationing. To ensure prescribing was within the guidelines, a vast communication network had to be sustained with managers, general practitioners, neurologists, the Multiple Sclerosis Society, and professional advisers in all the purchasing authorities. The workload involved was considerable. The dilemma of rationing in a public service with a high political profile is demonstrated.

Interferon beta represents a drug company's dream ticket—the first new product for a chronic incurable disease that is relatively common and has a variable course. This drug is one of the first of the new biotechnological treatments for multiple sclerosis, all of which are likely to be relatively expensive drugs. This paper describes the preparations undertaken by purchasing authorities in the North West region before the licensing of interferon beta. To our knowledge this is the first time such a major coordinated effort has been made by NHS purchasers to pre-empt the consequences of one drug.

Conclusions of published trial of drug

One published trial of interferon beta showed that it reduced the exacerbation rate in patients with relapsing-remitting disease.1 The study population was aged 18–50 years and without important disability. The two year data demonstrated exacerbation rates of 1.27 per patient per year in the placebo group, 1.17 in the first treatment group (1.6 MIU dose), and 0.84 in the second treatment group (8 MIU). The difference between the placebo group and the second treatment group was significant, P=0.0001. Technically, the trial demonstrated clinical …

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