Patient access to drugs approved by the National Institute for Health and Clinical Excellence (NICE) continues to vary widely at Primary Care Trust (PCT) level, new research shows.

The findings of a second annual study comparing the predicted and observed use of NICE-approved drugs in the NHS across England show that “you need to look at a local level to see what medicines patients are really getting access to,” said Richard Barker, director-general of the Association of the British Pharmaceutical Industry (ABPI), commenting on the findings.

“With some of the medicines, at national or Strategic Health Authority (SHA) level usage data looks fine, but the picture looks quite different at the PCT level,” he added.

The study looked at the use of 47 new NICE-approved medicines in 18 groups, relating to 29 technology appraisals. Out of the 12 groups where a comparison could be made, observed use by the NHS in England was higher than the predicted use for eight, and lower for three.

Higher than predicted use was reported for: - Schering-Plough’s Temodar (temozolomide), used in glioblastoma multiforme: - Merck & Co’s cholesterol-lowerer Zetia (ezetimib); - Pfizer’s smoking cessation aid Champix (varenicline); - Genentech’s Lucentis (ranibizumab) for wet age-related macular degeneration (AMD); - Sanofi-aventis’ Lantus (insulin glargine) and Novo Nordisk’s Levemir (insulin detemir) for the treatment of diabetes; - osteoporosis drugs Merck & Co’s Fosamax (alendronate), Procter & Gamble’s Didronel (etidronate) and Actonel (risedronate), Eli Lilly’s Evista (raloxifene) and Forteo (teriparatide) and Servier’s Protelos (strontium ranelate); - for Alzheimer’s disease, Eisai/Pfizer’s Aricept (donepezil), Shire’s Reminyl (galantamine), Novartis’ Excelon (rivastigmine) and Lundbeck’s Ebixa (memantine); and - Roche’s Tarceva (erlotinib) for metastatic pancreatic cancer.

Use that was lower than predicted was seen for: Sanof-Aventis’ Rilutek (riluzole) for the treatment of motor neurone disease; - naltrexone for opioid dependency; and - Genentech/Roche’s breast cancer treatment Herceptin (trastuzumab).

Some of the “starkest” regional variations were revealed by data showing uptake of new NICE-approved medicines to treat diabetes and osteoporosis at PCT level; observed usage of insulins for diabetes varies from 65% less than predicted by NICE to 95% higher, while for the six NICE-approved medicines to treat osteoporosis the range runs from 79% less than expected to 632% higher, says the report.

The study is produced by the Metrics Group - whose members consist of representatives from the Department of Health, NICE and the ABPI - and published by the NHS Information Centre. It does not interpret data, but enables PCTs to compare uptake of NICE-approved medicines across England and provide a more accurate measurement against NICE expected uptake, says the Group.

The Metrics Group is also asking for comments and suggestions on how to address six medicines or groups of medicines where directly comparable estimates and observed data are not currently available. These are: hormonal treatments for early breast cancer -  AstraZeneca’s Arimidex (anastrazole), Pfizer’s Aromasin (exemestane), Novartis’ Femara (letrozole) ; - Sanofi-aventis/Bristol-Myers Squibb’s bloodthiner Plavix (clopidogrel); - Amgen’s Sensipar (cinacalcet) for secondary hyperparathyroidism; - Roche’s Xeloda (capecitabine) for breast cancer; - a range of drugs used in the treatment of schizophrenia; and – Basilea’s Toctino (alitretinoin) for eczema.

“The study is still very much work in progress, but it raises some serious questions for healthcare providers and makes the case for clear national guidance as we move towards a new era in local decision-making in NHS commissioning,” said Dr Barker.

“Recent reports repeatedly show the UK continues to lag behind other western European countries in the uptake of most innovative medicines despite having among the lowest prices. So price is obviously not the only factor in patient uptake: we need to understand the other factors that influence what patients receive,’ he added.