Christopher McCabe: What lessons can we learn from this?

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Medicines to treat MS, developed in the 1990s, were an early example of the new biotechnology drugs, synthesised in the laboratory. Hundreds are now coming on to the market at prices that make those charged for the MS drugs look pretty small beer. Instead of £10,000 a patient a year we are looking at £25,000 up to £60,000 or more.

So we are going to have to manage these drugs and these prices in a way that protects the NHS because, once spent, this is money that cannot be used for other people's healthcare. And that's the problem. This is the point that is often missed – every £1,000 spent on a new drug is £1,000 not available to provide other drugs or services for other patients – a nurse or equipment for an MS patient, for example.We made mistakes with the patient access scheme for MS drugs so we need to ask what lessons we should learn for the future. First, the governance of these schemes has to ensure the assessment is completely independent of any stakeholder with a vested interest in finding for or against the drug. Second, the time delay from the start of the study to the assessment has to be kept as short as possible. And third, the assessment has to be as simple as possible, using routine collected data where that is available.

Good governance requires that those charged with delivering these schemes are demonstrably free of conflicts of interest. Without such independence, hard decisions, such as recommending a price reduction or closure of the scheme, are unlikley to be made.

Professor Christopher McCabe is head of the academic unit of health economics at the University of Leeds

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