Rationing and deprivation: disease-modifying therapies for multiple sclerosis in the United Kingdom

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.