Cut-price deals and cash-back offers …Scotland's drug care of the future

AN INNOVATIVE scheme to get new medicines to patients under cut-price deals and money-back offers from drugs companies is set to get the go-ahead in Scotland.

Until now, the NHS has been unable to consider such initiatives to increase access to expensive treatments – despite similar deals made by health watchdogs in England and Wales.

Now The Scotsman understands that drugs experts are to recommend these cost reduction schemes be considered in Scotland in a move that could see thousands more patients receiving treatments that would otherwise be deemed too expensive for the NHS.

Campaigners welcomed the move, which should increase access to costly therapies for cancer, Alzheimer's and Parkinson's.

At least five drugs in England have already been approved under the initiatives, either in final guidance or in draft form. One drug – Velcade – has been approved for many patients since October 2007 under a money-back scheme.

In other cases, the drugs approved under the deals south of the Border have already been recommended by the Scottish Medicines Consortium (SMC), raising the possibility that Scotland is paying more for treatments offered at a lower cost elsewhere in the UK.

As well as offering money back if drugs fail to work, deals have included drugs companies paying for part of the treatment or agreeing to reduce the costs to match those of other therapies.

Kate Seymour, of Macmillan Cancer Support, yesterday said the organisation welcomed backing for cut-price schemes in Scotland. She said: "Risk-sharing schemes are not a panacea for increased access to drugs, but it is one way of bringing the costs down and getting drugs to more patients.

"I don't think we could not have gone down this route. It was always just a question of how long it would take."

Andrew Powrie-Smith, director of the Association of the British Pharmaceutical Industry (ABPI) in Scotland, said it was in the interests of patients, doctors, the Scottish Government and drugs companies to get such arrangements in place quickly." he said.

"What we all want is for patients in Scotland to get access to the best medicines available."

Myeloma UK, an Edinburgh-based charity for patients with bone marrow cancer multiple myeloma, said the system of approving drugs in Scotland was in need of reform. Eric Low, the charity's chief executive, said: "After years of Scotland leading the way for approving new cancer drugs, it is now behind the rest of the UK. The Scottish Government needs to review its processes for introducing new drugs to the NHS and catch up quickly with progress made in England."

In the case of one drug for multiple myeloma – Revlimid – draft guidance from the National Institute for Health and Clinical Excellence in January recommended the treatment after drug maker Celgene proposed a scheme whereby the NHS funds the drug for the first two years and any further costs are met by the manufacturer.

But such schemes cannot be considered in Scotland under the current policy, so the drug is not recommended for NHS use.

In recent years campaigners have become increasingly concerned that many new, innovative drugs are not being given to patients because they do not meet cost-effectiveness criteria.

Drugs such as breast cancer treatment Herceptin were central to concerns that treatments that could potentially help many patients were being denied them because of the price.

An SMC spokesman said: "Guidance from the Scottish Medicines Consortium on market access schemes will be handed to the Scottish Government around Easter."

A Scottish Government spokeswoman said: "Last summer the Scottish Government asked the SMC to examine whether it would be feasible to operate 'patient access' schemes in Scotland and we expect their recommendations to be submitted to us before Easter."

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GREAT DIVIDE

VELCADE: To treat multiple myeloma. In October 2007, England approved its use in patients who have failed on one previous treatment. In Scotland, it is only recommended for use in patients who have tried at least two other treatments.

SUTENT: For kidney cancer. England changed its draft guidance this year to recommend it for some patients. The drug is not recommended in Scotland.

REVLIMID: For multiple myeloma. Draft guidance recommended the treatment in England. It is not recommended here.

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Cancer drug helped give me a better life

RON Ogilvie was diagnosed with multiple myeloma in 2000 after stumbling and breaking his leg.

He has had radiotherapy treatment and chemotherapy to send the disease into remission.

Mr Ogilvie, from Balerno, also had treatment using his own stem cells to fight the cancer in his bone marrow.

But he said a key part of his care was getting on a clinical trial of the drug Revlimid, which has not yet been approved for general use on the NHS in Scotland.

Charity Myeloma UK wants the drug to be made available under a scheme to reduce its cost to the NHS.

"I did very well when I was taking the treatment. I think it is one of those drugs you can be on long-term and not suffer too many side effects," Mr Ogilvie said.

After finishing the trial, the 62-year-old said tests revealed signs of the disease returning. He has since been on other treatments which are keeping him in remission. But Mr Ogilvie said he would like Revlimid to be available to him should he need it again in the future. "It is frustrating to think that it might not be there. These drugs should be available now for any patient who needs them."

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When it's a matter of life or death, difficult choices will just have to be made

Analysis: Lyndsay Moss

EVERYONE agrees that there is a limit to what the NHS can afford to pay when it comes to new treatments.

Without a bottomless pit of money, Scotland must explore every avenue to ensure that as many new drugs as possible make it to patients.

Many believe cost-cutting deals with the pharmaceuticals industry are the way forward, benefiting patients, who get new treatments, and also companies, who want their drugs to be used so they can claw back the millions spent in their development.

One concern about such schemes is the extra bureaucracy they will create for the NHS.

But when it comes to giving patients extra months of life, a bit of form-filling seems pretty inconsequential. Until now Scotland has been behind England in using these schemes, but with new guidance in place the nation could be the leader again with a more efficient process for approving cost-cutting deals.

In the longer term, however, this strategy alone will not solve the problem of an ever-increasing number of new drugs making their way to market with NHS funding unable to pay for them.

Difficult choices will still have to be made and patients will not always agree to them. The Scottish Government and health boards can play a part in reassuring the public about access to new treatments by making sure that they are fairly distributed across the country.

Accusations of "postcode lottery" still persist, despite the best efforts of the Scottish Medicines Consortium.

Finding ways of reducing the cost of research and clinical trials will cut the price of new drugs overall.

This is just one area we should be exploring to try to increase access further.