GP targets drive up COPD prescribing
pharmafile | May 27, 2009 | News story | Sales and Marketing |Â Â COPD, NHS, qofÂ
Respiratory drugs saw the biggest growth in GP prescribing in England in 2008, thanks to new COPD targets.
The rapid growth in the therapy area is one of the few bright spots for the industry, with GP prescribing otherwise increasingly reined in by cost controls.
The growth in prescribing has been fuelled by the new COPD indicator in the Quality and Outcomes Framework (QOF) introduced in March 2008, and growing awareness of the common and debilitating condition.
The top-selling respiratory drug is GSK’s Seretide, which is licensed to treat both asthma and COPD. Seretide prescriptions surged upwards last year, reaching sales of almost £330 million in Englands primary care.
In terms of GP spending, Seretide is second only to Lipitor, and looks set to overtake it this year to become the number one product by sales.
The other major players in COPD are AstraZeneca’s Symbicort and Boehringer Ingelheim’s Spiriva.
Spiriva and Symbicort sales grew by around £20 million each, with sales of over £200 million combined.
COPD is the fifth biggest killer in the UK. It is the only major cause of death on the increase and is expected to be the third leading cause of death worldwide by 2020.
Dr Stephen Head, a Nottinghamshire-based GP confirmed the QOF indicator had had an impact on prescribing, and said practice-based commissioning has also been a factor.
“The QOF means GPs are more likely to test patients with symptoms to see if they are likely to benefit from treatment,” he said.
Practice-based commissioning, he said, also means GPs are prescribing the drugs patients would receive if they were referred to hospital.
He said the successful marketing of Seretide, Spiriva and Symbicort has also had an impact on prescribing, providing “modest but nonetheless real” evidence of reduced hospital admission rates.
The cost growth of respiratory drugs of 7.7% in 2008, compared to a 3.8% rise in prescription volumes indicates more expensive COPD drugs are being prescribed. Dr Head said this is because there is currently no generic that compares to the more expensive branded drugs.
Another reason COPD prescribing has risen is because more people are coming forward with symptoms as patients become more aware.
The British Lung Foundation (BLF) estimates there are 3 million people with COPD in the UK, but only 900,000 of these have been diagnosed.
Dr Noemi Eiser, honorary medical director at the BLF said: “This is the tip of the iceberg, and more and more of the iceberg is now emerging partly because patients are becoming more aware of COPD and its symptoms”
The charity has been working to raise public awareness of COPD, particularly in geographic areas with a high incidence of the disease, such as South Tyneside and Nottinghamshire. It has also been working with the government on the development of a COPD management strategy.
“COPD is one of the most costly diseases for the government in terms of both time off work for patients and money spent, so it is a priority,” said Eiser.
Dr Eiser says there has also been a change in attitude among GPs towards the disease, which is now seen as a condition that should be diagnosed early and managed.
Drugs bill
The COPD statistics are contained in the Department of Healths annual prescribing data release, which saw Englands GPs prescribe treatments worth a total of £8.3 billion.
Overall, prescription volumes increased 5.8%, but costs declined slightly (0.7%) showing Englands GP drugs bill to be tightly controlled even before this years PPRS-enforced price cuts.
PCTs have been clamping down on certain areas of GP prescribing in recent years, particular in cardiovascular drugs.
A Keele University study has found savings of £394 million were made in 2008 through generic prescribing.
The savings are almost doubled the £200 million a year the National Audit Office predicted could be saved through more generic prescribing in its 2007 report.
The British Generics Manufacturers Association said the savings were comparable to the £550 million savings per year required from branded drugs by the PPRS.
Around 64% of all medicines dispensed by the NHS are generics, representing 29% of the drugs bill.
Cardiovascular drugs
The Department of Health’s largest overall saving in 2008 – £278 million – was made on statins, a group of medicines that includes Pfizer’s Lipitor and AstraZeneca’s Crestor.
The drug class was one of four that the NAO identified in 2007 as offering the biggest savings opportunities, and PCTs have since been urging GPs to switch to generics.
Blockbuster cholesterol drug Lipitor is the biggest victim of PCTs aggressive cost-cutting measures.
Although still the number one prescribed drug, GP sales of Lipitor have fallen £66 million in the past two years, as PCTs have instructed GPs to switch patients to simvastatin, a cheaper generic statin. Simvastatin is now prescribed by GPs three times more than aspirin.
Another drug targeted by PCTs has been Cozaar, the most expensive blood pressure drug in the sartan class. Cozaar sales fell £26 million in 2008 as GPs favoured prescribing the cheaper candasartan, whose sales grew by £16 million in 2008 with over a third of these sales made up by Takedas Amias.
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