Alopecia Areta Barbae

BEND NO RESULTS IN THE ASSESSMENT OF RISK SHARING

Article published in medical journals
26/01/2010
When you set a fixed price for a new drug-funded public health insurance, all the risk posed by uncertainty about the effectiveness and costs of treatment lies in the Insurance: more or less effective, or not produce expected savings in other resources, all spending is in charge of insurance.
venture contracts are designed to distribute the risk between the insurer and the pharmaceutical industry where there is high uncertainty about the effectiveness of treatment or the cost per year of life gained (quality-adjusted cost-effectiveness): the price of medicine is not fixed but is variable and subject to some measure of the expected results.
In February 2002 the British NHS, after an unfavorable report from NICE, agreed to include within coverage of the treatment of multiple sclerosis with beta interferon (Avonex, Betaferon and Rebif) and glatiramer acetate (Copaxone) conditional on a joint venture contract.
The agreement for the treatment of multiple sclerosis has many characteristics that are far from what could be a typical pattern of risk sharing: patients should continue treatment for an unusually long, ten years. The treatment is funded by the NHS until it considers that it is effective. The price paid will decrease if not met improvement targets set until this price is equivalent to a maximum cost-effectiveness of 36,000 pounds per year of life adjusted for quality.
A preliminary assessment at 2 years of initiation of treatment recently published in the British Medical Journal indicates that there is no improvement in the effectiveness (delay in disease progression) of patients treated with the drugs under contract venture . Possibly, the longer-term evaluations will be less sensitive to short-term changes in disease and important methodological issues must be resolved highlighted in this first evaluation.

So, if these results are maintained in the longer term, the absence of incremental effectiveness is sufficient to make decisions without taking into account incremental cost. Despite the study's scientific advisory board considers it premature to take decisions on prices before they have longer-term results, holding the preliminary results for further analysis, following the logic of the agreement, the entire financial risk could reach lie with the pharmaceutical companies.

This preliminary assessment and highlights, as one might predict, the difficulties in assessing an agreement of this kind that looks more like a large clinical trial on its effectiveness to a financing agreement of drugs.

A treatment for a disease whose effects can only be long-term monitoring and which can not have a control group is not exactly the best candidate for a joint venture contract. It seems advisable, therefore, very limited use and more appropriate conditions of such contracts.