Mixed picture on postcode prescribing
pharmafile | January 28, 2011 | News story | Sales and Marketing | NHS reforms, PCTs, SHAs, postcode prescribing
There are high levels of variation between Strategic Health Authorities and Primacy Care Trusts in the uptake of new drugs, according to a joint pharma-government report.
Use of NICE-appraised medicines in the NHS in England – 2009, Experimental statistics considered 47 new medicines in 18 groups, relating to 29 technology appraisals.
However, it did not take into account 16 cancer, Alzheimer’s and anti-TNF drugs, including Abbott’s Humira, Novartis’ Glivec and Johnson & Johnson’s Remicade, because they are supplied direct for home care use, making the data difficult to obtain.
The data, published by the NHS Information Centre, is the work of its Metrics Working Group, which includes representatives from the DH, NICE and the ABPI. The study compares predicted and observed use of new NICE-approved medicines in the NHS across England.
The UK pharma industry body the ABPI has its findings showed “stark regional variation in patient access to NICE-approved drugs”.
It highlighted the insulin products glargine and detemir, which showed observed usage from PCTs ranged from 65% less than predicted by NICE to 95% higher.
This is at odds with the SHA level, where observed use of the drugs was on average 12% higher than predicted.
The ABPI also looked at the collective use of six osteoporosis drugs, including Merck’s Fosamax, Warner Chilcott’s Actonel and Lilly’s Evista.
The report showed that at the PCT level, the lowest uptake was 79% less than expected and the highest was 632% higher than predicted. At the SHA level, it was between 12% and 57% higher than predicted.
Director general of the ABPI Dr Richard Barker said: “What is clear from this data is that you need to look at a local level to see what medicines patients are really getting access to.
“With some of the medicines at national or SHA level usage data looks fine but the picture looks quite different at the PCT level.”
The predictions are based on regional population size but not on the differences in treatment requirements.
The report itself says that in interpreting these figures, it is important to note that predicted and observed use may differ for a variety of reasons and should not be assumed to definitely indicate either ‘under’ or ‘over’ prescribing.
Looking in detail at the report, many drugs were prescribed at higher levels for SHAs than predicted by the population size.
This includes Novartis’ Lucentis, indicated for wet age-related AMD and prescribed at double the predicted rate across the 10 Strategic Health Authorities in England.
The joint study by the ABPI, NICE and the Department of Health was one of the arrangements to come from the 2009 PPRS agreement and was undertaken to assess the problems of so-called ‘postcode prescribing’.
A primary function of NICE is to create a uniform approach in the access to medicines at PCT level and this report is the second of its kind to assess whether Trusts are adhering to NICE’s recommendations.
Reforms aim to end postcode prescribing
There are currently 152 regional PCTs and 10 SHAs in England that are responsible for patients’ access to drugs and control the majority of the £104 billion NHS budget.
The government is planning to change this system by replacing PCTs and SHAs with regional GP consortia in 2013 as outlined in its recent Health and Social Care Bill.
It is also currently consulting on a new drug pricing system, value-based pricing, that will allow government bodies to directly negotiate with pharma on price and remove NICE’s formal powers to recommend or not recommend a drug for the NHS.
The measures in the Health and Social Care Bill will vastly change the environment in which the report was first conducted, and health secretary Andrew Lansley said this week that his reforms would ensure an end to postcode prescribing.
Ben Adams
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