Tendering the UK experience

1
Tendering the UK experience

• Paula Bolton-Maggs
• Manchester UK

2
Government funding for recombinant products

• 1998 funding made available to place all
  haemophilia patients under age of 16y onto
  recombinant products
• February 2003 agreed to make an extra 88
  million available over 3 years to transfer all
  adults

3
Background

• About 5000 haemophiliacs of whom 2200 have severe
  haemophilia
• 27 comprehensive care centres and 67 smaller
  centres (94 total)
• About 700 up to aged 21 already on recombinant
  products
• DH working with UKHCDO, the haemophilia society
  and local health systems (primary care trusts) to
  agree a strategy

4
Usual practice

• Prescribing freedom
• Haemophilia centres discuss individually with
  companies their annual volumes, and negotiate a
  price
• Smaller centres disadvantaged
• Variation in the prices offered from 0.38 to
  0.60 p per unit plus 17.5 VAT (US 0.68 to 1.06)
• Advantage to have several sources of supply

5
National tendering for recombinant products

• Over a 3 year period (2003-6) at a cost of 88
  million
• 13m in 2003/4
• 21.7m in 2004/5
• 53.4m in 2005/6
• Supported by the national agency for purchase and
  supplies (PASA)

6
Working group

• Roll out to be phased by age, starting with
  youngest
• A national tender to be placed for the additional
  products to ensure best possible price for the
  NHS and consistency across the country

7
Information required

• All centres make returns to the National
  Haemophilia Database
• Known number of patients
• Known location and local health purchaser
• Known total quantity of products used
• Centres were asked what products were required on
  a patient by patient basis based on consumption
  April 2002-March 2003

8
Tendering subgroup

• Assessment of likely volumes which could be
  purchased taking into account
• The anticipated usage
• Indicative prices from drug companies
• PASA posted an invitation to tender in European
  community respond by July 1st 2003

9
Delays.

• Legal challenge 1 the roll-out based on age is
  discriminatory and contravenes NHS guidance - but
  found not to breach article 14 of the European
  Convention on Human Rights.
• Legal challenge 2 a judicial review which
  argued that the DH 1998 circular on recombinant
  for children was in breach of the disabilities
  discrimination act. Judgement 8 Dec 2003 did not
  support this.

10
Finances

• Each primary care trust would receive an
  allocated sum according to
• the number of patients
• the agreed product
• the predicted annual use
• The process would be audited every quarter

11
Method

• Companies asked to tender for sample volumes
  varying from 10 to 60 of the UK supply
• Industry representatives were interviewed by a
  tendering subgroup
• UKHCDO
• Commissioners
• PASA

12
Outcome 1

• 4 companies
• Baxter
• Bayer
• Wyeth
• Aventis/ZLB
• 2 companies prices were 1/3 less per unit (but
  linked to volume) than the others which were
  offered at the European average price
• Clinicians shown the offers and asked what they
  wanted informed they would be reimbursed up to
  the level required for their choice

13
Outcome 2

• In 1st yr 528 patients distributed between 40
  centres were allocated funding (by age, younger
  patients first wave)
• In 2nd yr 568 patients allocated funding in 45
  centres
• Included a 10 uplift for anticipated annual
  increase in demand

14
Problems

• Shortfall between volumes committed to and those
  actually purchased
• Some patients may not have used product in the
  base year
• Slow transfer of patients
• Use of wrong order number (many centres working
  with two different contract prices)

15
Progress of roll out audit report for quarters
1-3 April to December 2004
16
Progress of roll out audit report for quarters
1-3 April to December 2004
17
Future

• Continued national pricing structure?
• Currently a very precise knowledge of who lives
  where, and which local health authority is
  responsible for funding
• Revert to per capita (i.e. whole population)
  allocation of funding for haemophilia products