Rationing and deprivation: disease-modifying therapies for multiple sclerosis in the United Kingdom
Tóm tắt
Unlike other industrialised countries, the UK deferred the routine introduction of disease-modifying therapies (DMTs) for multiple sclerosis (MS) in favour of an experiment. Between 2002 and 2005, MS sufferers were identified, were offered DMTs only if deemed suitable by their physicians, and were monitored thereafter to assess long-term outcomes. It has been demonstrated for other therapies that judgements about suitability to receive treatment are conditioned by the patient’s deprivation status. We hypothesised that this would have been the case for DMTs also. Using individual patient data for samples in Nottingham and in Glasgow, we matched patients’ postcodes of residence with deprivation scores and confirmed that patients from more deprived areas were less likely to have been prescribed DMTs. A more detailed analysis of the Nottingham data revealed two channels through which this outcome was effected. First, people from less-deprived areas were more likely to possess clinical characteristics, such as less severe disease severity and shorter duration of the disease, that enhanced their suitability for treatment. Second, the analysis of the clinical notes detailing patients’ correspondence with the medical teams suggested that less-deprived people were more able to exercise a voice capable of influencing physicians’ prescribing decisions.
Tài liệu tham khảo
Compston, A., Coles, A.: Multiple sclerosis. Lancet 372, 1502–1517 (2008)
Berger, T.: Current therapeutic recommendations in multiple sclerosis. J. Neurol. Sci. 287(Supplement 1), S37–S45 (2009)
Kobelt, G., Berg, J., Lindgren, P., Kerrigan, J., Russell, N., Nixon, R.: Costs and quality of life of multiple sclerosis in the United Kingdom. Eur. J. Health Econ. 7, S96–S104 (2006)
Richards, M.: Extent and causes of international variations in drug usage: a report for the secretary of state for health. Central Office of Information, London (2010)
Tolley, K.H., Whynes, D.K.: Interferon-β in multiple sclerosis: can we control its costs ? Pharmacoeconomics 11(3), 210–215 (1997)
Parkin, D., McNamee, P., Jacoby, A., Miller, P., Thomas, S., Bates, D.: A cost-utility analysis of interferon beta for multiple sclerosis. Health Technol. Assess. 2, 4 (1998)
Crinson, I.: The politics of regulation within the ‘modernised’ NHS: the case of beta interferon and the ‘cost-effective’ treatment of multiple sclerosis. Crit. Soc. Policy 24(1), 30–49 (2004)
Chilcott, J., McCabe, C., et al.: Modelling the cost effectiveness of interferon beta and glatiramer acetate in the management of multiple sclerosis. Br. Med. J. 326(7388), 522 (2003)
National Institute for Clinical Excellence: Beta interferon and glatiramer acetate for the treatment of multiple sclerosis: Technology Appraisal Guideline No. 32. NICE, London (2002)
Department of Health: Cost effective provision of disease modifying therapies for people with multiple sclerosis. Health Service Circular 2002/004, Leeds (2002)
Pickin, M., Cooper, C.L., et al.: The multiple sclerosis risk sharing scheme monitoring study—early results and lessons for the future. BMC Neurol. 9, 1 (2009)
Packham, C., Robinson, J., Morris, J., Richards, C., Marks, P., Gray, D.: Statin prescribing in Nottingham general practices: a cross-sectional study. J. Public Health Med. 21(1), 60–64 (1999)
Cooper, C., Blanchard, M., Selwood, A., Livingston, G.: Antidementia drugs: prescription by level of cognitive impairment or by socio-economic group ? Aging Ment. Health 14(1), 85–89 (2010)
Jack, R.H., Gulliford, M.C., Ferguson, J., Møller, H.: Explaining inequalities in access to treatment in lung cancer. J. Evaluation Clin. Pract. 12(5), 573–582 (2006)
Crawford, S.M., Sauerzapf, V., Haynes, R., Zhao, H., Forman, D., Jones, A.P.: Social and geographical factors affecting access to treatment of lung cancer. Br. J. Cancer 101, 897–901 (2009)
Noble, M., Wright, G., et al.: The English indices of deprivation 2004 (revised). Office of the Deputy Prime Minister, Wetherby (2004)
Office of the Chief Statistician: Scottish Index of Multiple Deprivation 2004: summary technical report. Scottish Executive, Edinburgh (2004)
Morgan, O., Baker, A.: Measuring deprivation in England and Wales using 2001 Carstairs scores. Health Stat. Q. 31, 28–33 (2006)
National Collaborating Centre for Chronic Conditions: Multiple sclerosis: national clinical guideline for diagnosis and management in primary and secondary care. Royal College of Physicians, London (2004)
Gallagher, T.H., Lo, B., Chesney, M., Christensen, K.: How do physicians respond to patients’ requests for costly, unindicated services ? J. Gen. Intern. Med. 12, 663–668 (1997)
Earwicker, S.C., Whynes, D.K.: General practitioners’ referral thresholds and choices of referral destination: an experimental study. Health Econ. 7(8), 711–722 (1998)
McKinlay, J.B., Ting, L., Freund, K., Moskowitz, M.: The unexpected influence of physician attributes on clinical decisions: results of an experiment. J. Health Soc. Behav. 43(1), 92–106 (2002)
Woodford, E.M., Wilson, K.A., Marriott, J.F.: Professionals’ awareness of operational antibiotic prescribing controls in UK NHS hospitals. J. Hosp. Infect. 58, 193–199 (2004)
Clifton, N.J., Raghavan, U., Birkin, J., Jones, N.S.: Prescribing antibiotics for sore throat: adherence to guidelines in patients admitted to hospital. Postgrad. Med. J. 85, 347–351 (2009)
Short, D., Frischer, M., Bashford, J., Ashcroft, D.: Why are eligible patients not prescribed aspirin in primary care? A qualitative study indicating measures for improvement. BMC Fam. Pract. 4, 9 (2003)
Heneghan, C., Perera, R., Mant, D., Glasziou, P.: Hypertension guideline recommendations in general practice: awareness, agreement, adoption, and adherence. Br. J. Gen. Pract. 57, 948–952 (2007)
Venkataraman, S., Stremersch, S.: The debate on influencing doctors’ decisions: are drug characteristics the missing link ? Manage. Sci. 53(11), 1688–1701 (2007)
Chintagunta, P.K., Jiang, R., Jin, G.Z.: Information, learning, and drug diffusion: the case of Cox-2 inhibitors. Quant. Econ. Mark. 7, 399–443 (2009)
Vosoughi, R., Freedman, M.S.: Therapy for MS. Clin. Neurol. Neurosurg. 112(5), 365–385 (2010)
Noseworthy, J.H.: Progress in determining the causes and treatment of multiple sclerosis. Nature 399(Supplement), A40–A47 (1999)
Bates, D., Isaacs, J.: Should neurologists wait and see or see and treat RRMS ? Prog. Neurol. Psychiatr. 13(5), 9–15 (2009)
Polman, C.H., Miller, D.H., McDonald, W.I., Thompson, A.J.: Treatment recommendations for interferon-b in multiple sclerosis. J. Neurol. Neurosci. Psychiatr. 67, 561–566 (1999)
Kravitz, R.L., Bell, R.A., Azari, R., Kelly-Reif, S., Krupat, E., Thom, D.H.: Direct observation of requests for clinical services in office practice. Arch. Intern. Med. 163, 1673–1681 (2003)
Little, P., Dorward, M., Warner, G., Stephens, K., Senior, J., Moore, M.: Importance of patient pressure and perceived pressure and perceived medical need for investigations, referral, and prescribing in primary care: nested observational study. Br. Med. J. 328, 444–446 (2004)
Scott, J.G., Cohen, D., DiCicco-Bloom, B., Orzano, A.J., Jaen, C.R., Crabtree, B.F.: Antibiotic use in acute respiratory infections and the ways patients pressure physicians for a prescription. J. Fam. Pract. 50(10), 853–858 (2001)
Roxburgh, R.H., Seaman, S.R., et al.: Multiple sclerosis severity score: using disability and disease duration to rate disease severity. Neurology 64(7), 1144–1151 (2005)
Pachner, A.R., Steiner, I.: The multiple sclerosis severity score (MSSS) predicts disease severity over time. J. Neurol. Sci. 278, 66–70 (2009)
Lejeune, C., Sassi, F., et al.: Socio-economic disparities in access to treatment and their impact on colorectal cancer survival. Int. J. Epidemiol. 39(3), 710–717 (2010)
Fraser, S., Bunce, C., Wormald, R., Brunner, E.: Deprivation and late presentation of glaucoma: case control study. Br. Med. J. 322, 639–643 (2001)
Paasche-Orlow, M.K., Parker, R.M., Gazmararian, J.A., Nielsen-Bohlman, L.T., Rudd, R.R.: The prevalence of limited health literacy. J. Gen. Intern. Med. 20, 175–184 (2005)
van Ryn, M., Burke, J.: The effect of patient race and socio-economic status on physicians’ perceptions of patients. Soc. Sci. Med. 50, 813–828 (2000)
Willems, S., De Maesschalck, S., Deveugele, M., Derese, A., J, D.M.: Socio-economic status of the patient and doctor–patient communication: does it make a difference? Patient Educ. Couns. 56, 139–146 (2005)
Stirling, A.M., Wilson, P., McConnachie, A.: Deprivation, psychological distress, and consultation length in general practice. Br. J. Gen. Pract. 51, 456–460 (2001)
Mercer, S.W., Watt, G.C.M.: The inverse care law: clinical primary care encounters in deprevied and affluent areas of Scotland. Ann. Fam. Med. 5, 503–510 (2007)
Dixon, A., Le Grand, J., Henderson, J., Murray, R., Poteliakhoff, E.: Is the NHS equitable ? a review of the evidence. LSE Health and Social Care Discussion Paper 11, London (2003)
Minden, S.L., Frankel, D., Hadden, L., Hoaglin, D.C.: Access to health care for people with multiple sclerosis. Multiple Scler. 13, 547–558 (2007)
Iezzoni, L.I., Ngo, L.H., Kinkel, R.P.: Working-age persons with multiple sclerosis and access to disease-modifying medications. Multiple Scler. 13, 1–11 (2007)
Minden, S., Hoaglin, D., et al.: Disease-modifying agents in the Sonya Slifka longitudinal multiple sclerosis study. Multiple Scler. 14, 640–655 (2008)
Scolding, N.: The multiple sclerosis risk sharing scheme. Br. Med. J. 340, c2882 (2010)
Kobelt, G., Berg, J., Lindgren, P., Fredrikson, S., Jonsson, B.: Costs and quality of life of patients with multiple sclerosis in Europe. J. Neurol. Neurosurg. Psychiatr. 77, 918–926 (2006)
Sharac, J., McCrone, P., Sabes-Figuera, R.: Pharmacoeconomic considerations in the treatment of multiple sclerosis. Drugs 70(13), 1677–1691 (2010)
Boggild, M., Palace, J., et al.: Multiple sclerosis risk sharing scheme: two year results of clinical cohort study with historical comparator. Br. Med. J. 339, b4677 (2009)
Raftery, J.: Costly failure of a risk sharing scheme. Br. Med. J. 340, 1282–1284 (2010)