Pharmaceutical industry representatives in the UK are calling for action to address the stark geographical variation in patient access to NICE-approved medicines on the National Health Service in England.

Spurred by findings of a novel analysis of data on the local usage of medicines throughout England, the Association of the British Pharmaceutical Industry (ABPI) says the NHS must now address the unexplained variation through the development and implementation of local action plans.

The fact that a postcode lottery of medicines access exists in the country is nothing new, but the report - compiled by the Department of Health, NICE, pharma and the Health and Social Care Information Centre - has revealed the true extent of the problem, by including for the first time a new section measuring the variation at a local level, as well as an estimate of use against NICE’s expectation for a small number of medicines.

It found that there can be a ten-fold difference in the usage of effective new medicines (those on the market for less than five years) between different areas of the country, as observed with Amgen's osteoporosis drug Prolia (denosumab), and in one case - the use of Bayer/Johnson & Johnson’s Xarelto (rivaroxaban) and Boehringer Ingelheim's Pradaxa (dabigatran) for atrial fibrillation for the prevention of strokes - the difference was a whopping 29-fold.

Also, around a third of medicine groups assessed against a NICE estimate were under par in terms of expected usage. For example, just one in three patients with metastatic renal cancer (and eligible for one of two new medicines available) did not receive these treatments because of where they live.

All-in-all, drugs for which usage was higher than expected were: donepezil, Shire's Reminyl (galantine), Novartis' Excelon (rivastigmine), Lundbeck's Ebixa (memantine) for Alzheimer's disease; and Merck & Co's Temodar (temozolomide), which is licensed for the treatment of newly diagnosed brain cancer in adults and as a second-line treatment of brain cancer in adults and children over three.

Those whose use was lower than expected were: carmustine implants for recurrent glioblastoma multiform; Pfizer's Sutent (sutinib) and GlaxoSmithKline's Votrient (pazopanib) for the treatment for renal cell cancer; Sanofi’s Rilutek (riluzole) for amyotrophic lateral sclerosis, a form of motor neurone disease; and Novartis' Lucentis (ranibizumab) for age related macular degeneration.

Unexplained variation

The ABPI says it recognises that there are a number of legitimate reasons behind local differences in uptake (demographic factors that influence health need and subsequent medicines supply, for example), but the significant unexplained variation needs to be the focus of NHS efforts, noted chief executive Stephen Whitehead.

Also commenting on the report, Steve Oldfield, Managing Director of Sanofi in the UK & Ireland, and Co-chair of DH/ABPI Metrics Oversight Group, said it must be given "the highest priority by the NHS," and noted that it "of particular interest to Academic Health Science Networks in their role in improving patient health outcomes by translating research into practice".