Education And Debate

A purchaser perspective of managing new drugs: interferon beta as a case study

BMJ 1995; 311 doi: (Published 23 September 1995) Cite this as: BMJ 1995;311:796
  1. T Walley, professor of clinical pharmacologya,
  2. S Barton, senior lecturer in primary care therapeuticsa
  1. a Department of Pharmacology and Therapeutics, University of Liverpool, PO Box 147, Liverpool L69 3BX
  1. Correspondence to: Professor Walley
  • Accepted 29 June 1995

Summary points

  • Rationing drug treatment in Britain is difficult for government,health authorities,and doctors

  • Expensive drugs may consume inappropriately large amounts of NHS resources

  • Purchasers will be required to control expenditure on drugs and need to define policies to help them

Many new drugs in the future will be very expensive and have major resource implications. Given current structures and legislation covering the prescribing of drugs, there are no clear means of controlling the use of these drugs to avoid diverting money away from other health care services and into drug treatment. This paper considers what mechanisms might be used by a purchaser to manage the introduction of an expensive new drug and uses interferon beta-1b for treating multiple sclerosis as an example. The most likely mechanism is the prescribing of the drug by a general practitioner on the advice of a neurologist. This would achieve a good benefit for the resources invested but would not control total expenditure. Devolving a limited budget for the drug to a specialist centre so that neurologists may prescribe it directly would be preferable, as this would link clinical, prescribing, and budgetary responsibility. These issues need to be addressed urgently by purchasers if major disruptions of services are to be avoided.

Successive secretaries of state have declared that patients will always receive the drugs that they need, a commitment recently reaffirmed by the House of Commons Health Committee.1 “Need” is not defined in this context, and prescribing remains effectively unrationed. Nevertheless, the government attempts to control the rise in the drug bill--for the most part by persuasion of prescribers. Will a guarantee to provide all necessary drug treatment be sustainable in the future? It seems illogical that expensive drugs should not be rationed when many other NHS services are. This seems especially so when the use …

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