Transcript Drug purchase data for 2009

Antiretroviral Drugs
Data Analysis
Peter Sharott
High–Level Drug Expenditure Analysis
• Data sources:
– Drug purchase data for 2009: Pharmex database managed
by the NHS Commercial Unit
– HPA SOPHID patient data for 2008
• Analysis:
– SHA & Provider level
– Expenditure calculated using Basic NHS Prices and contract
prices (at either SHA and provider level)
– Expenditure including and excluding VAT
(NB: no individual provider data will be used in final reports)
ARV Data Quality Issues
• Patient Data
– relates 2008 SOPHID data to 2009 drug expenditure and, therefore, does
not take account of patient number growth during 2009
• Drug Expenditure Data
– excludes homecare supplies not processed through pharmacy computer
systems
– excludes drugs dispensed on hospital and GP FP10 prescriptions and
dispensed either by community pharmacies or homecare suppliers (not
common practice at present)
– excludes drugs supplied by third parties contracted to provide
outpatient dispensing service
– excludes existing and new drugs used in clinical trials/studies
– includes all non-HIV uses such as PEPSE/PEP, Hepatitis B
– includes additional prescriptions during swine flu pandemic alert in 2009
– VAT rate in 2009 was 15%, increased back to 17.5% in January 2010
Possible Next Steps for Drug Expenditure
Data Collection
• Collect actual drug expenditure data from providers, with a
split between hospital supply (to include VAT) and homecare
(to exclude VAT) - which time period?
• Identify numbers and percentage of ART patients on
homecare
• Calculate average costs for homecare service charges
(dispensing and delivery)
• Calculate patient costs using SOPHID 2009 data
or
• Consider an alternative approach based on agreed regimens,
stratified for complexity and inclusion of VAT for hospital
supplied patients and inclusion of services charges for
homecare patients
Comparison of ART Regimen Costs
Regimen
Regimen Drugs
Mean Annual Difference Between
Cost (excluding Lowest and Highest
VAT)
Annual Cost
First Line
Kivexa + Nevirapine 400
Kivexa + Efavirenz 600
Atripla
£5,386
£5,648
£7,290
29.6%
32.3%
41.9%
Second Line
Truvada + Atazanavir 300 +
Ritonavir 100
£8,572
40.7%
Toxicity
Switch
Truvada +
Raltegravir 800
£11,992
63.1%
Third Line
Multi Drug
Resistance
Darunavir 1200 +
Ritonavir 200 +
Etravirine 400 +
Raltegravir 800 +
Lavimudine 300 +
£18,945
26.8%
National vs Drug Pricing
• Development of national tariffs, as opposed to local tariffs, raises
questions about the need for national drug prices
• General rule:
– generic drugs: prices are contracted at a national level
– branded drugs: prices are contracted at a regional level (preferred
approach) or at provider level (usually because manufacturers will not
tender at regional level)
• Little incentive for manufacturers to provide lower prices for branded
drugs at a national level as there would be no clinical buy-in which could
be linked volume commitments
• For ARVs, a careful risk assessment would be needed to determine
whether national contracting would lead to an overall increase in drug
prices, rather than a redistribution of current expenditure across England
• Better approach might be to consider establishing a number of consortia
(in addition to London) to undertake a therapeutic tender involving
clinicians and commissioners and volume commitments linked to price