london respiratory team understanding respiratory spend and increasing value: inhalers and nicotine...
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London Respiratory Team
Understanding respiratory spend and increasing value:
Inhalers and nicotine replacement therapy
Responsible Respiratory Prescribing
Dr Louise Restrick on behalf of the London Respiratory Team
London Respiratory Team
Right Care Respiratory Prescribing
NICE 2010‘Ensure all patients with COPD are on the appropriate therapy for the severity of, and symptoms from, their disease.’
‘Offer nicotine replacement therapy, varenicline or bupropion (unless contraindicated) combined with a support programme to optimise quit rates… to all people with COPD who still smoke at every opportunity.’
Improving the experience of all Londoners with COPD and minimising the impact of the disease
London Respiratory Team
Total cost of Respiratory Medication by BNF Chapters 2008 and 2009 for England £ millions
Source: NHS Information Centre
~£1 billion on respiratory medication not including
antibiotics…
Improving the experience of all Londoners with COPD and minimising the impact of the disease
London Respiratory Team
Volume of Respiratory Medication by BNF Chapters 2008 and 2009 for England Number of prescriptions (millions)
Source: NHS Information Centre
but a relatively low volume of respiratory prescriptions ...
Improving the experience of all Londoners with COPD and minimising the impact of the disease
London Respiratory Team
Item cost of Respiratory Medication by BNF Chapters 2008 and 2009 in England
Average net ingredient cost per prescription item £
Source: NHS Information Centre
Respiratory items are the most expensive category of item
prescribed .....
…… inhalers
Improving the experience of all Londoners with COPD and minimising the impact of the disease
London Respiratory Team
NHS budget & respiratory meds
Source: NHS Information Centre
Seretide (all) is the most expensive drug
Seretide 250 Evohaler is the most expensive individual item (second is atorvastatin)
Symbicort 200 is 5th most expensive item
Of the top 5 costliest drugs to the NHS currently 3 are inhalers
Improving the experience of all Londoners with COPD and minimising the impact of the disease
London Respiratory Team
Long-term effectiveness & cost-effectiveness of smoking cessation interventions in patients with COPD
1 year abstinence %
QALY£
Usual care 1.4
Minimal counselling 2.6 14,735
Intensive counselling 6 7,149
Intensive counselling + pharmacotherapy
12.3 2,092
Tiotropium £7,112/QUALYEur J Health Econ. 2007; 8(2): 123135
Hoogendoorn M, Feenstra TL, Hoogenveen RT, Rutten-van Mo¨lken MPMHThorax 2010: 65:711-718
Pulmonary Rehabilitation £2,000-8,000/QALY
Improving the experience of all Londoners with COPD and minimising the impact of the disease
London Respiratory Team
Smoking prevalence in COPD
At best one in four Londoners with COPD are still smokers….
Improving the experience of all Londoners with COPD and minimising the impact of the disease
London Respiratory Team
Smoking prevalence in COPD
Improving the experience of all Londoners with COPD and minimising the impact of the disease
London Respiratory Team
Smoking prevalence in COPD
London Respiratory Team
Best value from inhaled therapy
Right care prescribing
Smokers offered support to stop smoking and prescribed NRT therapy each time inhalers prescribed…..
Use NICE criteria No new inhaler without patient-centred
education, training and review Mechanisms for reducing duplicate
prescribing? Steroid cards for high dose ICS/combinations
London Respiratory Team
Best value from inhaled therapy
Working with patients …
Support and pharmacotherapy to stop smoking
Each patient has and uses inhaler devices that work for them
MDI with spacer or DPI right technique for drug delivery into the lung inhaler regime as prescribed for evidence-based
benefit
London Respiratory Team
Responsible Respiratory PrescribingAre we providing Right Care?
Clinical Lead Responsible Respiratory Prescribing, Dr Vince Mak, Respiratory Physician
Clinical Lead Quit Smoking as treatment for COPD, Dr Noel Baxter GP
Are commissioners, prescribers and patients getting best value from our inhaler spend?
Do we have and use integrated quit smoking systems so that our respiratory patients have the best chances of quitting smoking?