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NHS
Time to invest in prescribing?
From Mr N. Evans, MRPharmS
Payment by Results (PBR) was first introduced into the English NHS in
April 2003 but the big bang came in April 2006 when the majority of inpatient
and outpatient stays came under this new finance system.
PBR is important because it makes it possible for PCTs and GPs to disinvest
from hospitals for the first time. Under the old block contract system
it was extremely difficult to reduce the amount of money paid to the local
hospital.
Under PBR each patient going into hospital is paid for individually and
according to a national tariff. So, for example, a cardiology outpatient
appointment costs £151 (specialty code 320), an emergency admission
into hospital for hypertension costs £1,844 (code HRG E24) and an
emergency MI costs £4,747(code HRG E11). If the patient does not
go into hospital the PCT does not have to pay the hospital. This means
that drug company pharmaco-economic arguments about “use our drug
to keep patients out of hospital and save money” may actually become
real instead of entirely academic.
Should we, as pharmacists advising on prescribing, start to consider NHS
total costs of disease management rather than simply the cost of medicines
management on prescribing budgets? Should we take into account the real
world of the NHS where prescribing costs are actually only a small portion
of total costs and, I would argue, a very cost effective part of total
NHS costs?
One such argument that I have recently been impressed with is that for
lercanidipine (Zanidip).
At £5.80 for 28 days’ treatment with 10mg, Zanidip is priced
similarly to generic antihypertensive medicines and costs in fact only £2.39
more than generic amlodipine 5mg.
The manufacturers have published trials showing less oedema with Zanidip
than with amlodipine as well as improved compliance and reduced drop-out
rates when patients are switched from other calcium channel blockers to
Zanidip.
This reduced oedema and improved compliance comes with no loss of efficacy.
With medicines compliance being a major issue of which we are all aware,
it does not require too much of a leap in faith to believe that fewer side
effects and greater compliance will lead to fewer expensive hospital admissions
(the cost of non-compliance in the UK has recently been estimated at £1.3bn).
Incidentally I also notice that a large chunk of amlodipine prescriptions
are still priced at Istin prices, which, of course, costs much more than
branded Zanidip.
I would be interested in knowing the views of colleagues on how they believe
PBR will affect their advice on prescribing. In short, is improved compliance
and reduced side effects with drugs such as Zanidip worth £2.39 extra
per month on the drugs bill to save money in other areas of the health
economy?
Norman Evans
Consultant in Pharmaceutical Public Health
Wandsworth Teaching Primary Care Trust
London |
The
Pharmaceutical Journal