Sir, – Anthony Hannon (Letters, July 20th) makes an impassioned plea for the drug Skylaris to be made available to patients with Friedreich’s ataxia, but doesn’t answer the central question: is it cost-effective? –He reports the drug to be “life extending and enriching” but he doesn’t quote the evidence of the MOXIe Trial.This indicates an improvement of one or two points on the 93-point rating scale. The cost is hard to define as the drug isn’t available here, but would be in the order of €100,000 to €200,000 a year per patient.Many other patients with many other diseases might benefit from that money.Perhaps we need less passion and more clinical thought before paying huge amounts for possibly little benefit. – Yours, etc,DR COLUM FARRELLY, FRCGP,Derry.