Risk-sharing agreements that assess innovative drugs based on long-term cost effectiveness may not be helping governments save money, a new study suggests. “In the short term, it's been to [industry's] advantage,” says lead investigator Mike Boggild, a neurologist at The Walton Centre in Liverpool. In 2002, the UK government entered a 'risk-sharing' agreement over five multiple sclerosis drugs that the UK's National Institute for Health and Clinical Excellence (NICE) had deemed too expensive. NICE reversed its decision after drug makers dropped their prices and agreed to reimburse government if the drugs did not prove cost effective in the long term. The study results based on two-years' data suggest that the drugs are not cost effective, although Boggild warns it is too early to draw firm conclusions. “The cost effectiveness of the drugs can go in either direction, depending on which assumptions we use,” he says. This type of scheme is inherently difficult to run, adds Jon Nicholl, director of the Medical Care Research Unit at Sheffield University, UK, because stakeholders have conflicting interests: the state wants to reduce costs, whereas industry wants to maximize profits. A different approach, in which firms refund treatment costs for nonresponsive patients, may be a better way to improve cost effectiveness, he says.