Continuing the multiple sclerosis risk sharing scheme is unjustified

BMJ 2010; 340 doi: (Published 03 June 2010) Cite this as: BMJ 2010;340:c1786
  1. Christopher McCabe, professor1,
  2. Jim Chilcott, senior research fellow2,
  3. Karl Claxton, professor3,
  4. Paul Tappenden, senior research fellow2,
  5. Cindy Cooper, senior research fellow2,
  6. Jennifer Roberts, professor4,
  7. Nicola Cooper, senior research fellow5,
  8. Keith Abrams, professor5
  1. 1Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9PL
  2. 2School of Health and Related Research, University of Sheffield, Sheffield
  3. 3Centre for Health Economics, University of York, York
  4. 4Department of Economics, University of Sheffield
  5. 5Department of Health Sciences, University of Leicester, Leicester
  1. Correspondence to: C McCabe c.mccabe{at}

    Christopher McCabe and colleagues examine the claims behind the decision not to reduce drug costs in the multiple sclerosis risk sharing scheme

    Since 2002 people in England with multiple sclerosis have been able to access disease modifying drugs through a risk sharing scheme.1 The scheme was set up after the National Institute for Health and Clinical Excellence (NICE) recommended that the drugs should not be used in the NHS because of doubts about their effectiveness and high price. It suggested instead that the Department of Health could work with the manufacturers to make the treatments available to NHS patients in a cost effective manner—that is, at a lower price.2

    Under the terms of the scheme interferon beta (Avonex, Betaseron, and Rebif) and glatiramer acetate would be made available to NHS patients in the context of a study monitoring disease progression. The data were to be reviewed at two year intervals. If the observed benefit was less than that predicted by the model NICE had commissioned from the Sheffield School of Health and Related Research (ScHARR),3 which four of us worked on, the drug price would be reduced to achieve a target cost effectiveness ratio of £36 000 (€40 000; $54 000) per quality adjusted life year (QALY).1

    Since the start of the scheme, 5583 patients meeting the Association of British Neurologist criteria have received one or more treatments, costing in the region of £350m. The first report of effectiveness was not published until last December.4 The authors of the report, which was published in the BMJ, concluded “we found no evidence that these treatments are cost effective.”4 They also state that “we cannot reliably determine whether the current pricing of these drugs represents value for money for the NHS.”4 Despite these findings, the NHS is still …

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