This is a post from Kate Francis on the acor list- Call me cynical but I do not worry that any pricing schemes will hurt profits or research of drug companies.

Date:    Wed, 24 Oct 2007 04:50:13 -0400
From:    Kate Francis <katemylist@YAHOO.CO.UK>
Subject: VELCADE in UK - 'Money back guarantee' plan for cancer drug

This is taken from the "Daily Telegraph" today ...
I've removed a few paras on the background of MM,
which were not of much interest.

I wonder if it could be the start of something more
widespread?  And, if so, what would be the effect on
long term research overall?

By Rebecca Smith, Medical Editor
Last Updated: 3:02am BST 24/10/2007

The drugs rationing body is expected to ratify today a
groundbreaking 'money back guarantee=92 for a cancer drug.

Makers of the drug, Velcade, for a type of fatal bone
marrow cancer, have proposed a scheme where the NHS
only pays for the drug when it works.

The health service would be refunded the cost of
treating a patient who does not respond.
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The National Institute for Health and Clinical
Excellence will say today the scheme, known as risk
sharing, is the only way it is cost effective for the
NHS to provide the drug for patients.

Each year 2,400 people die from the cancer and
although Velcade does not offer a cure it can extend
survival by on average one year.

The money back scheme will work well for Velcade
because there is an easily identifyable marker which
shows whether the drug is working for that individual.

But it could not be applied to all drugs because in
most cases it is unclear whether a patient is
responding to a drug straight away or to what extent.

Launching a consultation on the scheme in the summer
Andrew Dillon, chief excecutive of Nice, said: =93We are
aware of the challenge that the NHS faces in ensuring
that patients can access expensive, but potentially
effective, treatments for life-threatening conditions
such as cancer.

=93If the drug=92s manufacturer accepts the proposals we
are consulting on today, it will mean that when the
drug works well the NHS pays but when it doesn=92t the
manufacturer should bear the cost. All patients
suitable for treatment will get the chance to see if
the drug works well for them.=94

Velcade will now be recommended for use in patients
with multiple myeloma who have tried one other therapy
and have either already had or are unsuitable for a
bone marrow transplant.

They will receive four cycles of the medicine, after
which tests are done to measure the reduction of serum
M-protein - a marker of how much the drug is working.

If the reduction is more than 50 per cent, the patient
remains on the drug and the NHS pays the bill for the
full courses but if not, the patient stops treatment
and the drug manufacturer picks up the bill for the
medicine used thus far.

The cost of one treatment cycle with Velcade is =A33,049
and the maximum a patient would receive is eight
cycles at a total cost of =A324,396.

The drug maker, Janssen-Cilag, proposed the scheme
after initial guidance from Nice said the drug was not
cost effective to provide on the NHS at all.

Although Janssen-Cilag will accept the
recommendations, the firm has said it is
'disappointed=92 that patients who show a limited
response to the drug, defined as a reduction of
between 25 per cent and 50 per cent in the serum
M-protein, will have it withdrawn.

The Department of Health has already indicated that
the system is acceptable.