London Respiratory Team Medicines Management Workstream Dr Vince

London Respiratory Team Medicines Management Workstream Dr Vince Mak October 2010 Improving the experience of all Londoners with COPD and minimising the impact of the disease

London Respiratory Team Objectives Ensure Optimal drug therapy for COPD patients Optimise use of prescribed therapy Minimise waste – Maximise value Minimise variation Improving the experience of all Londoners with COPD and minimising the impact of the disease

Cost of Respiratory Medication in England London Respiratory Team Source: NHS Information Centre Improving the experience of all Londoners with COPD and minimising the impact of the disease

Volume of prescriptions is low London Respiratory Team Source: NHS Information Centre Improving the experience of all Londoners with COPD and minimising the impact of the disease

Cost per item is high London Respiratory Team Source: NHS Information Centre Improving the experience of all Londoners with COPD and minimising the impact of the disease

Respiratory Medications are costly London Respiratory Team Seretide (all) is the most expensive drug in UK (£ 344 million/yr) Seretide 250 Evohaler is the most expensive individual item for NHS (£ 165 million/yr) – second is atorvastatin Symbicort 200 is 5 th most expensive item for NHS (£ 80 million/yr) Source: www. drugtariff. co. uk Sourced Aug 2010 Improving the experience of all Londoners with COPD and minimising the impact of the disease

Seretide by device London Respiratory Team Improving the experience of all Londoners with COPD and minimising the impact of the disease

London Respiratory Team COPD vs Asthma Improving the experience of all Londoners with COPD and minimising the impact of the disease

Tiotropium prescriptions in London Respiratory Team Source: EPACT Jun 2010 Improving the experience of all Londoners with COPD and minimising the impact of the disease

Seretide prescription in London Respiratory Team Source: EPACT Jun 2010 Improving the experience of all Londoners with COPD and minimising the impact of the disease

Tiotropium as COPD surrogate marker London Respiratory Team Total spend on Tiotropium in London for 1 year (2009/10) was approx £ 10. 5 million At on average £ 35/item = 300, 000 units dispensed in London Total spend on Seretide 250 evohaler for same period was roughly £ 16 million At average of £ 60/item = 266, 666 units dispensed ? How much Seretide 250 may be accounted for by prescribing for COPD. Improving the experience of all Londoners with COPD and minimising the impact of the disease

Optimise therapy London Respiratory Team Ensure all patients with COPD are on the appropriate therapy for the stage of their disease – New NICE guidance 2010 Improving the experience of all Londoners with COPD and minimising the impact of the disease

Optimise use of medicines London Respiratory Team Ensure all patients with COPD are using an appropriate inhaler device (spacer or DPI) Ensure compliance Ensure correct technique Ensuring safety (steroid cards for high dose ICS/combinations) Improving the experience of all Londoners with COPD and minimising the impact of the disease

Minimise waste – Maximise value London Respiratory Team Awareness of high cost of medications (healthcare professionals and patients) If medications appropriate - use of cost effective evidence based option (e. g. Plain prednisolone vs EC – potential £ 2 million saving per year in London) Ensure compliance Avoid duplicate prescribing Improving the experience of all Londoners with COPD and minimising the impact of the disease

Minimise variation London Respiratory Team Data suggests that across London after allowing for prevalence of COPD – there is large variation in: – – Use of high dose inhaled steroids alone Use of tiotropium Use of combination therapy Choice of combination therapy Improving the experience of all Londoners with COPD and minimising the impact of the disease

Next Steps London Respiratory Team Understand the data Understand the causes of variation Find and promote examples of good practice (work with LIP and QIPP programs) Disseminate information to healthcare professionals, patient groups, carers and patients Improving the experience of all Londoners with COPD and minimising the impact of the disease