Following guidance from the National Institute for Health and Clinical Excellence (NICE) when prescribing drugs to treat conditions such as heart disease and diabetes could help in the drive to save £20 billion in the NHS by 2013, says a new report.
The study, produced the National Prescribing Centre (NPC), outlines how general practitioners (GPs) can use NHS resources efficiently to reduce spending on primary care prescribing.
It encourages GPs to review prescribing, and make revisions where necessary, to ensure that it is in line with NICE recommendations. The report sets out 15 areas where savings can be made, including the prescribing of proton pump inhibitors (PPIs), antipsychotics for dementia patients and the use of the anti-obesity drug orlistat (Roche’s Xenical) for weight loss.
GPs should follow NICE recommendations on the use of statins and offer patients generic simvastatin (40mg – Merck & Co’s Zocor) daily as the first-line statin, says the study, noting that while simvastatin is the most commonly prescribed statin, the National Audit Office (NAO) has highlighted that there are still substantial savings to be made through use of low-cost statins, and that Trusts in the North West of England and Yorkshire and the Humber have the greatest potential to make savings.
However, it adds that the use of the cholesterol-lowering drug ezetimibe (Merck & Co/Schering-Plough’s Zetia), for patients who are unable to tolerate statins, should be reduced to bring it in line with NICE recommendations.
Since NICE guidance was published in November 2007, annual spend on ezetimibe has increased from £48 million to £68 million. This suggests potential over-prescribing, the report states.
It also advises that any decision to start a patient on an insulin analogue to treat diabetes should be balanced carefully against the lack of long-term safety data and increased prescribing costs. NICE recommends that long-acting insulin analogues have a specific but limited place in therapy. They are substantially more expensive than conventional insulins, but their use has increased enormously over the past few years.
In addition, people with glycaemic control problems should be properly assessed for underlying causes before these newer, more expensive insulins are considered. This includes education, and checking understanding around how to manage their disease and treatment.
Neil Maskrey, director of evidence-based therapeutics at the NPC, said that the report “identifies some key therapeutic medicines management options for local implementation in 2010/11.”
“Importantly, whilst the purpose of this piece of work was to identify topics that would increase the efficiency of primary care prescribing, the evidence base for all the topics identified has been carefully examined to ensure that safety and clinical effectiveness would be maintained, or in some cases even improved, if they were incorporated into prescribing practice with less variation than at present,” added Dr Maskrey.
Peter Rowe, lead for the Quality, Innovation, Productivity and Prevention (QIPP) programme at the Department of Health, said: “This document provides an initial list of therapeutic topics which offer real opportunities for maintaining or improving quality and also, in most cases, improving value."
“Some of the topics here improve quality but have little or no associated cost savings. Others, when considered alone locally, can deliver relatively small cost savings, but when aggregated nationally and implemented with much less variation than currently, the savings become very significant,” he added.