Considers the crucial role of private sector social entrepreneurship in the context of a state welfare system stretched beyond its means. Defines social entrepreneurship, recounts a number of key points from relevant research projects, reflects upon current developments and initiatives, describes a number of cases and uses these to draw a set of tentative conclusions about social entrepreneurs and social entrepreneurship in the context of the current government’s aim of fostering rapid growth in the sector. Concludes that while such growth is highly desirable, a number of hurdles have to be overcome.

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Objective To evaluate the cost utility of interferon beta-1b in secondary progressive multiple sclerosis. Design Population based cost utility model (healthcare perspective). Data on use of health services were obtained from case records and routine morbidity data and utility values from a EuroQol survey. Local and published costs were used. Effectiveness was modelled using data on relative risk reductions from a randomised trial of interferon beta-1b. Setting Tayside region, 1993-5. Subjects 132 ambulatory people with secondary progressive multiple sclerosis. Main outcome measures Cost per quality adjusted life year (QALY) gained. Rate of relapse and proportion becoming wheelchair dependent over three years. Results The number needed to treat for 30 months to delay time to wheelchair dependence in one person by nine months was 18 (95% confidence interval 5 to 26). For every 18 people treated for 30 months, six relapses would be prevented, gaining 0.397 discounted QALYs. The cost per QALY gained was £1 024 667 (£276 466 to £1 485 499). If treatment was restricted to patients attending neurology services, the number needed to treat was 14 (cost per QALY gained £833 514 (£161 358 to ∞)). The cost per QALY gained was not sensitive to changes in cost which took account of a societal perspective. Conclusions The cost per QALY gained from interferon beta is high because of the high drug cost and modest clinical effect. Resources could be used more efficiently elsewhere..

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