Transcript Stoke-on-Trent (2014/15)

Current Prescribing Trends
CCG
Total Cost
2013/14
Total Items
2013/14
Total Cost
2014/15
Total Items
2014/15
% Growth
in Cost
Stoke-on-Trent
£3,501,381
261,712
£3,791,344
273,258
8%
North Staffs
£2,496,073
172,374
£2,699,642
177,478
8%
England Total
£622,417,673
37,792,688
£669,032,451
39,415,271
7%
Figures taken from PrescQIPP Drugs used for diabetes snapshot 2014/15 – April to
January
Growth by BNF chapter – Actual Growth Cost
Top 6 BNF chapters (highest to lowest growth cost):
Stoke-on-Trent
North Staffs
Endocrine System
Endocrine System
Nutrition and Blood
Nutrition and Blood
Respiratory System
Stoma Appliances
Gastro-Intestinal System
Gastro-Intestinal System
Appliances
Appliances
Stoma Appliances
Immunological Products &
Vaccines
Endocrine System Growth
Actual growth April to February 13/14 vs 14/15
CCG
Actual Actual
Growth Growth
Items
Cost
%
%
Difference in cost
Growth Growth per item
Items
Cost
Stoke-onTrent
18,568
£491,356 3.61%
9.38%
£0.57 - Endocrine
£0.55 - Diabetes
North
Staffs
8,605
£367,165 2.29%
9.48%
£0.72 - Endocrine
£0.77 - Diabetes
Top 10 Diabetes Drugs/Reagents by Cost
Stoke-on-Trent (2014/15)
Drug/Reagent
Cost
BGTS
£646K
Metformin HCl
£614K
Insulin glargine
£404K
Sitagliptin
£365K
Biphasic insulin aspart
£312K
Exenatide
North Staffs (2014/15)
No. of Items
Drug/Reagent
37,247 BGTS
Cost
No. of Items
£497K
26,075
128,930 Metformin HCl
£436K
81,543
8,178 Insulin glargine
£377K
7,400
£274K
7,769
7,324 Biphasic insulin aspart
£195K
4,410
£266K
3,401 Insulin aspart
£191K
4,996
Insulin aspart
£255K
6,420 Gliclazide
£132K
35,946
Liraglutide
£233K
2,011 Exenatide
£125K
1,578
Gliclazide
£215K
60,236 Liraglutide
£106K
982
Linagliptin
£132K
£100K
1,801
11,621 Sitagliptin
4,276 Insulin detemir
Main areas of concern
Stoke-on-Trent
• 2,000% (£18,500) increase in insulin degludec
• 250% (£5,600) increase in combination product
sitagliptin/metformin (Janumet)
North Staffs
• 365% (£10,000) increase in insulin degludec
• 11% (£10,000) increase in liraglutide
Main areas of improvement
Stoke-on-Trent
• Decreased spend on non-formulary drugs
• Decreased spend on BGTS
• Decreased spend for 3 combination products
North Staffs
• Decreased spend on non-formulary drugs
• Decreased spend for 3 combination products
North Staffordshire Joint Formulary
AIMS:
• To promote safe, effective and economic
prescribing in both primary and secondary care
• Help to ensure seamless prescribing, thereby
reducing possible errors and confusion
• Each section approved by the North Staffordshire
and Stoke-on-Trent Area Prescribing Committee
Medicines are categorised according to a traffic light system
The formulary can be found at: http://www.stokeccg.nhs.uk/joint-formulary
GLP-1 mimetic prescribing and
ESCAs
• 1st line – Byetta (exenatide twice daily)
• 2nd line – Bydureon (exenatide once weekly)
• 3rd line – Victoza (liraglutide once daily)
Essential Shared Care Agreements (ESCAs) set out
specialist, GP and patient responsibilities and are
required due to the amber 1 classification of GLP1s
on the formulary
GLP-1 mimetic prescribing and
ESCAs
7 GP practices in Stoke are taking part in the GLP1 LIS
service
Prescribing needs to be in line with NICE guidance
• Triple therapy – 1.0% reduction in HbA1c and 3%
reduction in weight 6 months after initiation
• Dual therapy – 1.0% reduction in HbA1c 6 months
after initiation
Guidelines for diabetes
• Management of adults with diabetes mellitus –
Guidelines for clinical care
• At-a-glance guide for self monitoring blood glucose
(SMBG) in diabetes
• Patient guide for self monitoring of blood glucose (SMBG)
in diabetes
• At-a-glance guide for treatment with a 3rd line oral agent
for patients with type 2 diabetes
Medicines Optimisation Projects
• Prescribing of WaveSense JAZZ BGTS and
supplying the meter to all suitable patients
• Prescribing of Omnican Fine or GlucoRx
FinePoint pen needles to all suitable patients
• A review of the prescribing of 3rd line oral
antidiabetic agents in the management of type 2
diabetes
Any questions?