Disease Modifying Therapies for Multiple Sclerosis

The issue of prescribing Disease Modifying Therapies (DMTs) to patients with relapsing-remitting and secondary progressive Multiple Sclerosis (MS) was recently raised with members of the Health and Social Services Committee. My officials and I are aware that at present there are difficulties providing DMTs to newly diagnosed MS patients and we are taking action to help resolve this situation.  

MS is a demyelinating disease of the central nervous system. It is the most frequent cause of neurological disability in young adults, and it is characterised by chronic relapse and disease progression. There is currently no effective cure for MS. A group of drugs (Beta Interferon and Glatiramer Acetate) known as the Disease Modifying Therapies are used to help reduce the number and severity of relapses and slow disease progression.

In 2002 the National Institute for Clinical Excellence (NICE) concluded that on the balance of clinical and cost effectiveness, neither Beta Interferon nor Glatriamer Acetate could be recommended for the treatment of Multiple Sclerosis in the NHS in England and Wales. The MS Risk Sharing Scheme was however established in 2002 following an invitation by NICE for the Department of Health, the Welsh Assembly Government and manufacturers to consider what actions could be taken to enable DMTs for MS to be provided in a more cost effective way and appraised over a 10-year period.

The Assembly Government has invested in the infrastructure for the MS Risk Sharing Scheme in Wales since 2002 and has put arrangements in place to support the provision of DMTs to patients with MS who meet the eligibility criteria established by the Association of British Neurologists (ABN).
My officials and I are aware of the increasing demands for DMTs for MS across Wales and during the financial year 2005-6, Health Commission Wales (HCW) invested £2.5 million in DMTs and the infrastructure necessary for the care and monitoring of MS patients using these drugs.
Despite this investment the demands for DMTs have continued to rise and I am aware that a number of patients have been unable to commence therapy due to pressures on current resources at the three prescribing centres set up to treat Welsh MS patients.  In light of this, financial allocations for 2006/07 will be considered within the overall allocation to HCW and in the commissioning plans currently being developed.  

We are taking a number of steps to help resolve these issues while continuing to support the provision of DMTs to patients that have commenced treatment under the guidance of the MS Risk Sharing. My officials are: -

• Making plans to undertake a review of current practice in Wales to assess the treatment of MS patients against the criteria of the ABN.
• Addressing the epidemiology and prevalence of MS to help gain a greater understanding of future trends to support key commissioning decision
• Reviewing the latest evidence and research findings
• Liaising with the other UK health departments to discuss a joint review of the MS Risk Sharing Scheme to help ensure an equitable, appropriate and sustainable approach for the provision of DMTs in the longer term.

We will also be assessing the outcomes of the interim report of the national MS Risk Sharing Scheme, due in autumn 2006, to inform the way forward for the future management of services for MS.