NEW THERAPEUTIC PRODUCTS AND DIFFICULT DECISIONS - THE CASE OF RECOMBINANT FACTOR-VIII IN THE MANAGEMENT OF HEMOPHILIA-A

New and expensive therapeutic products can place great pressure on hea lth care purchasers. Often, evidence to support the inclusion of such products in the purchasing process is lacking or confusing, yet demand can be organized and forceful. In this paper we use the example of th e introduction of recombinant factor VIII (rFVIII) in the management o f haemophilia A, to highlight some problems purchasers face in decidin g whether to fund its use. The introduction of rFVIII involves substan tial extra funding requirements and the benefits afforded by its use a re unclear. Although a case can be made for the use of rFVIII on the g rounds of subjective future theoretical risks and intangible benefits, the purchasers of health care are charged with maximizing the present and obtainable benefits of the community at large, given finite resou rces. Guidelines produced by the United Kingdom Haemophilia Centre Dir ectors Organization state rFVIII to be its treatment of choice for all haemophilia A patients, but offer no insight into the benefits attain able through the use of rFVIII, in terms of health outcomes. We report summary findings of Purchaser Intelligence Groups examining the use o f rFVIII and offer comment on the problems associated with the impleme ntation of therapeutic products such as rFVIII.