CCG Prescriber for Clinical Commissioning Groups

Transcription

1 CCG Prescriber for Clinical Commissioning Groups Analysis on Fostair Inhalers NHS savings of 107million per year Analysis April 2016 Protecting Patients Together

2 Editor Dr Julian Brown Data Editor Stephen Harrington Data Sources: EPACT NHS Information Centre Hospital Episode Statistics Safe Dispenser Surveys European Medicines Agency NHS Business Services Authority CCGPRES_FOS_UD_290316_GB_a

3 Optimisation of Combination Corticosteroid / LABA Inhalers has the potential to save the NHS 107million a year. Contents Page 04 Page 06 Page 09 Page 11 Page 13 Page 20 Section 1 Overview Section 2 Market Analysis Section 3 Tariff Information Section 4 Usage Information Section 5 Potential Savings by CCG Section 6 Action Plan

4 Section 1 Overview

5 Overview Background The NHS spends over 46 million each month on combination Corticosteroid / LABA inhalers. This makes this the single most expensive subclass for the NHS. A number of cost-effective alternatives have become available in recent years. This article will evaluate the impact of using Fostair (beclometasone dipropionate and formoterol fumarate), a product with dual licenses for COPD and Asthma, which has recently lauched a dry powder version and an additional strength giving it the versitility to be a single formulary solution for NHS Prescribers. Objective This article will evaluate the benefits for CCGs, Practices and Patients from utilising Fostair as the combination Corticosteroid / LABA inhaler of choice. Data from the HSCIC, NHS Business Services Authority (Dec 2015 epact Data), Dictionary of Medicines & Devices (Jan 2016) and European Medicines Agency was used to prepare the data and identify available agents, costings, medicines utilisation and CCG uptake of the newer agents in order to enable a standardised evaluation to empower Prescribers to deduce the true benefits of this agent. We also considered wholesaler availability levels and the manufacturing chain. The nine most utilised brands were analysed based on monthly epact data. Analysis: Despite appearing to be highly cost-effective, these newer inhalers only account for a very small percentage of the overall market share. There is a large variation in the uptake of newer, appropriately licensed and costeffective combination inhalers across the CCGs within England. Patients and clinicians utilising these inhalers need to have complete confidence in their efficacy, quality and costeffectiveness. The fact that the combination inhaler prescribing decision is multifaceted could explain why the established brands, despite being the most expensive, have retained the highest market share. Discussion: Newer alternative combination inhalers are available with the same or wider clinical indications, proven inhaler devices, equal manufacturing quality processes and far superior cost-effectiveness. Utilisation of these newer combination inhalers would result in savings of more than 107 million per annum. Fostair appears to have produced a full range of viable alternatives to the established inhaler portfolio which enables a simple implementation program and can generate annual savings of up to 1 million for CCGs with the ability for optimisation programs to significantly improve patient outcomes. 1 Prescribing of Corticosteroid / LABA inhalers by brand will reduce the risk of unintended devices being supplied to patients and any bioavailability issues connected to differing particle size associated with inhaler devices. Conclusions: It is vital that all CCGs have a proactive action plan to optimise utilisation of cost-effective combination inhalers within their formulary. Failure to undertake an appropriate implementation program of cost-effective alternatives will cost your CCG hundreds of thousands of pounds within the current calendar year. 1.CCG Prescriber Fostair Analysis April

6 Section 2 Market Analysis

7 Market Analysis Combination Corticosteroid / LABA Inhaler Update on: Corticosteroids (Respiratory) BNF Sub Class Combination Inhalers (Rank 1) Dec 2015 (change from Dec 2014) Drug Class Spend Per Month 64,482,724 (- 714,925) Drug Class Packs Per Month 2,305,354 (-7,746) Combination Inhaler Spend Per Month 46,503,899 (+ 2,948,120) Combination Inhaler Packs Per Month 1,293,011 (+ 120,426) Fostair Nexthaler Spend Per Month 378,726 (+ 321,581) Fostair Nexthaler Packs Per Month 12,917 (+ 10,968) Fostair MDI Spend Per Month 6,732,453 (+ 2,240,881) Fostair MDI Packs Per Month 229,620 (+76,428) NHSBSA Prescribing data December 2015 The combination corticosteroid / LABA inhalers are classified within BNF Subparagraph 3.2 Corticosteroids (Respiratory). Our automated Evolve analysis measures the relative monthly spend by each Practice and each CCG utilising the subparagraph. Although this does contain some corticosteroid-only inhalers, it allows better overall representation of Asthma and COPD prescribing trends and this is the dataset utilised in the league tables in section 5 of this document. It can be seen that Fostair currently has a 15% market share within this drug group for both packs utilised and cost. Top Combination Inhalers (December 2015) Drug Cost / Month Dec 2015 Cost diff from Dec 2014 Packs / Month Dec 2015 Packs diff from Dec 2014 Cost Rank Budesonide/ Formoterol (Symbicort Turbohaler) Salmeterol/ Fluticasone Accuhaler (Seretide Accuhaler) Salmeterol/ Fluticasone MDI (Seretide Evohaler) 15,567,507-1,203, ,770-31,709 3( ) 10,973,194-1,241, ,771-33,509 4( 1) 7,379, , ,596-16,000 12( 10) 4 Beclometasone / Formoterol MDI (Fostair) 6,732,453 2,240, ,620 76,428 13( 7) 5 Fluticasone / Formoterol (Flutiform) 2,254, ,266 66,144 22,268 55( 32) 6 Budesonide /Formoterol (Duoresp Spiromax) 1,377,151 1,288,320 45,951 42,987 -(-) 7 Salmeterol/ Fluticasone MDI (Sirdupla) 1,130,418 1,130,418 31,260 31,260 -(-) 8 9 Fluticasone / Vilanterol Inhaler (Relvar Ellipta) Beclometasone / Formoterol dry powder inhaler (Fostair NEXThaler ) 710, ,181 23,982 17,733 -(-) 378, ,581 12,917 10,968 -(-) *Prices correct at time of printing. 7

8 Class Analysis Combination Corticosteroid / LABA Inhaler Combination corticosteroids/laba Inhalers are the most expensive drug class for the NHS. The NHS needs to look at the suitability of alternative agents and the true potential savings from using these including information on patient outcomes. Background Combination preparations of a steroid and long acting bronchodilator (LABA) have been used for the management of asthma and chronic obstructive pulmonary disease (COPD) since Seretide Evohaler was first launched by GSK in March Seretide Evohaler has gone on to become the most expensive drug for the NHS costing over 16 Million per month (branded and generic presentation). In Dec 2015 (the data from which this analysis is undertaken) there were six combination steroid / LABA inhalers licensed for the UK market. AstraZeneca s Symbicort, a combination of Budesonide and Formoterol, was the second to market in 2001, followed by Chiesi s Fostair, a combination of Beclometasone Dipropionate and Formoterol in 2007 and Napp s Flutiform, a combination of Fluticasone propionate and Formoterol in In 2014 two combination devices entered the market; GSK s Relvar Ellipta and Teva s DuoResp Spiromax. In 2015, Fostair NEXThaler was launched. Despite appearing to be highly cost-effective, these newer inhalers only account for a small percentage of the overall market share. The increasing financial burden of corticosteroid-based inhalers and the need for the NHS to consider the use of cost-effective agents means it is vital that a full analysis is undertaken to gain a perspective of the true value of these newer agents. This needs to include a full appraisal of both the cost of the agents and the impact of their use. Table - Summary of Licences for the Combination Inhalers Drug Steroid Strength LABA Strength Actuations Asthma COPD Spacer Seretide Evohaler Fluticasone Propionate Symbicort Turbohaler Budesonide 50mcg 25mcg mcg Salmeterol 25mcg mcg 25mcg mcg 6mcg 120 n/a 200mcg Formoterol 6mcg 120 n/a 400mcg 12mcg 60 n/a Seretide Accuhaler 100mcg 50mcg 60 n/a Fluticasone Propionate 250mcg Salmeterol 50mcg 60 n/a 500mcg 50mcg 60 n/a Fostair MDI Beclometasone 100mcg Formoterol 6mcg 120 Flutiform Fluticasone Propionate 200mcg 6mcg mcg 5mcg mcg Formoterol 5mcg mcg 10mcg 120 Fostair NEXThaler Beclometasone DuoResp Spiromax Relvar Ellipta Budesonide Fluticasone Furoate 100mcg 6mcg 120 n/a Formoterol 200mcg 6mcg 120 n/a 160mcg Formoterol 4.5mcg 60 n/a 320mcg 9mcg 60 n/a 92mcg 22mcg 30 n/a Vilanterol 184mcg 22mcg 30 n/a Sirdupla MDI Fluticasone Propionate 125mg 25mcg 120 Salmeterol 250mg 25mcg 120 8

9 Section 3 Tariff Information Prices received from the Dictionary of Medicines and Devices March 2016

10 Actual Cost Tariff Prices (March 2016). Prescribing Data (December 2015) Protecting Patients Together The tables below include all available high and medium dose combination corticosteroid inhalers based on the data available for analysis. Drug Tariff Mar 2016 Cost per year Spend Dec 2015 Packs Dec 2015 Potential Monthly Saving Duoresp Spiromax 160/4.5mcg (120 dose unit) ,491 25,642 16, Seretide Accuhaler 250/50mcg (60 dose unit) ,534,520 72, , Symbicort Turbohaler 200/6mcg (120 dose unit) ,644, ,478 1,974, Sirdulpa 250/25mcg (120 dose unit) ,838 16, , Flutiform 250/10mcg (120 dose unit) ,306,842 28, , Seretide Evohaler 250/25mcg (120 dose unit) ,702,002 79,052 2,384, Total 25,803, ,108 5,510, Drug Tariff Mar 2016 Cost per year Spend Dec 2015 Packs Dec 2015 Potential Monthly Saving Duoresp Spiromax 320/9mcg (60 dose unit) ,661 20,309 13, Symbicort Turbohaler 400/12mcg (60 dose unit) ,645, ,553 1,289, Seretide Accuhaler 500/50mcg (60 dose unit) ,823, ,199 2,217, Total 14,094, ,626 3,520,

11 Section 4 Usage Information

12 Drug Steroid Strength LABA Strength Actuations Tariff Mar 2016 Packs Dec 2015 Cost Dec 2015 Fostair NEXThaler Beclometasone 100 mcg Formoterol 6 mcg , ,403 Fostair MDI Beclometasone 100 mcg Formoterol 6 mcg ,055 6,715,888 Duoresp Spiromax Budesonide 160 mcg Formoterol 4.5 mcg , ,491 Seretide Accuhaler Salmeterol 250 mcg Fluticasone 50 mcg ,415 2,534,520 Symbicort Turbohaler Budesonide 200 mcg Formoterol 6 mcg ,478 8,644,115 Flutiform Fluticasone 250 mcg Formoterol 10 mcg ,684 1,306,842 Seretide Evohaler Salmeterol 250 mcg Fluticasone 25 mcg ,052 4,702,002 Sirdulpa Salmeterol 250 mcg Fluticasone 25 mcg , ,838 Fostair NEXThaler Beclometasone 200 mcg Formoterol 6 mcg Fostair MDI Beclometasone 200 mcg Formoterol 6 mcg ,566 Duoresp Spiromax Budesonide 320 mcg Formoterol 9 mcg , ,661 Symbicort Turbohaler Budesonide 400 mcg Formoterol 12 mcg ,553 5,645,007 Seretide Accuhaler Salmeterol 500 mcg Fluticasone 50 mcg ,199 7,823,849 12

13 Section 5 Potential Savings by CCG

14 Potential Savings by CCG League Table of Potential Monthly Savings per CCG through utilisation of Fostair MDI or NEXThaler in place of other dose equivalent CSD/LABA Inhalers - December 2015 Data CCGs in the top third for available savings CCGs in the middle third for available savings CCGs in the bottom third for available savings CCG Name Packs Dec 2015 Total Cost Dec 2015 Patients Population Potential Savings per month Rank AIREDALE, WHARFDALE AND CRAVEN CCG 3, , ,336 25, ASHFORD CCG 2,698 98, ,800 18, AYLESBURY VALE CCG 2, , ,572 19, BARKING AND DAGENHAM CCG 3, , ,262 27, BARNET CCG 4, , ,657 47, BARNSLEY CCG 7, , ,721 46, BASILDON AND BRENTWOOD CCG 5, , ,458 41, BASSETLAW CCG 2,799 98, ,054 16, BATH AND NORTH EAST SOMERSET CCG 3, , ,057 26, BEDFORDSHIRE CCG 9, , ,794 58, BEXLEY CCG 4, , ,634 26, BIRMINGHAM CROSSCITY CCG 12, , , ,833 2 BIRMINGHAM SOUTH AND CENTRAL CCG 3, , ,813 30, BLACKBURN WITH DARWEN CCG 4, , ,322 30, BLACKPOOL CCG 6, , ,847 30, BOLTON CCG 5, , ,711 62, BRACKNELL AND ASCOT CCG 2,549 96, ,181 21, BRADFORD CITY CCG 1,474 57, ,875 14, BRADFORD DISTRICTS CCG 6, , ,204 64, BRENT CCG 3, , ,042 32, BRIGHTON AND HOVE CCG 3, , ,769 44, BRISTOL CCG 7, , ,347 67, BROMLEY CCG 4, , ,123 41, BURY CCG 4, , ,047 28, CALDERDALE CCG 3, , ,334 39, CAMBRIDGESHIRE AND PETERBOROUGH CCG 17, , , ,940 6 CAMDEN CCG 2,377 84, ,526 14, CANNOCK CHASE CCG 3, , ,504 32, CANTERBURY AND COASTAL CCG 4, , ,419 34, CASTLE POINT AND ROCHFORD CCG 3, , ,665 32, CENTRAL LONDON (WESTMINSTER) CCG 1,919 72, ,638 15, CENTRAL MANCHESTER CCG 3, , ,027 40, CHILTERN CCG 4, , ,473 31, CHORLEY AND SOUTH RIBBLE CCG 3, , ,963 30, CITY AND HACKNEY CCG 1,925 76, ,141 20, COASTAL WEST SUSSEX CCG 7, , ,212 74, CORBY CCG 1,870 65,816 71,719 10, *Analysis was undertaken using March 2016 tariff and December 2015 NHSBSA Prescribing data 14

15 CCGs in the top third for available savings CCGs in the middle third for available savings CCGs in the bottom third for available savings CCG Name Packs Dec 2015 Total Cost Dec 2015 Population Potential Savings per month Rank COVENTRY AND RUGBY CCG 8, , ,707 61, CRAWLEY CCG 2,146 85, ,117 22, CROYDON CCG 3, , ,719 32, CUMBRIA CCG 9, , ,098 74, DARLINGTON CCG 2,359 92, ,305 23, DARTFORD, GRAVESHAM AND SWANLEY CCG 4, , ,078 44, DONCASTER CCG 8, , ,141 76, DORSET CCG 14, , , ,934 5 DUDLEY CCG 6, , ,602 54, DURHAM DALES, EASINGTON AND SEDGE- FIELD CCG 7, , ,103 74, EALING CCG 3, , ,003 45, EAST AND NORTH HERTFORDSHIRE CCG 9, , ,460 99,241 8 EAST LANCASHIRE CCG 10, , ,629 50, EAST LEICESTERSHIRE AND RUTLAND CCG 6, , ,432 51, EAST RIDING OF YORKSHIRE CCG 7, , ,064 55, EAST STAFFORDSHIRE CCG 2,265 85, ,457 19, EAST SURREY CCG 2, , ,106 29, EASTBOURNE, HAILSHAM AND SEAFORD CCG 3, , ,758 44, EASTERN CHESHIRE CCG 4, , ,831 31, ENFIELD CCG 4, , ,248 26, EREWASH CCG 2,088 70,585 97,293 9, FAREHAM AND GOSPORT CCG 3, , ,965 28, FYLDE & WYRE CCG 4, , ,932 34, GATESHEAD CCG 3, , ,292 25, GLOUCESTERSHIRE CCG 12, , , ,805 7 GREAT YARMOUTH AND WAVENEY CCG 5, , ,810 37, GREATER HUDDERSFIELD CCG 3, , ,726 35, GREATER PRESTON CCG 4, , ,125 38, GREENWICH CCG 3, , ,009 33, GUILDFORD AND WAVERLEY CCG 2, , ,973 32, HALTON CCG 3, , ,662 43, HAMBLETON, RICHMONDSHIRE AND WHITBY CCG 2, , ,264 24, HAMMERSMITH AND FULHAM CCG 2,438 94, ,892 23, HARDWICK CCG 2,006 67,763 97,231 8, HARINGEY CCG 2, , ,833 13, HARROGATE AND RURAL DISTRICT CCG 2, , ,798 26, HARROW CCG 3, , ,513 34, HARTLEPOOL AND STOCKTON-ON-TEES CCG 7, , ,215 74, *Analysis was undertaken using March 2016 tariff and December 2015 NHSBSA Prescribing data 15

16 CCGs in the top third for available savings CCGs in the middle third for available savings CCGs in the bottom third for available savings CCG Name Packs Dec 2015 Total Cost Dec 2015 Population Potential Savings per month Rank HASTINGS AND ROTHER CCG 3, , ,295 40, HAVERING CCG 3, , ,184 34, HEREFORDSHIRE CCG 3, , ,415 28, HERTS VALLEYS CCG 7, , ,932 75, HEYWOOD, MIDDLETON AND ROCHDALE CCG 4, , ,279 47, HIGH WEALD LEWES HAVENS CCG 3, , ,011 39, HILLINGDON CCG 2,358 91, ,618 22, HORSHAM AND MID SUSSEX CCG 3, , ,203 34, HOUNSLOW CCG 3, , ,894 31, HULL CCG 7, , ,844 46, IPSWICH AND EAST SUFFOLK CCG 6, , ,888 37, ISLE OF WIGHT CCG 4, , ,951 39, ISLINGTON CCG 2,206 79, ,110 14, KERNOW CCG 12, , ,195 86, KINGSTON CCG 1,548 60, ,186 15, KNOWSLEY CCG 5, , ,996 44, LAMBETH CCG 2,029 78, ,666 18, LANCASHIRE NORTH CCG 3, , ,395 22, LEEDS NORTH CCG 3, , ,621 31, LEEDS SOUTH AND EAST CCG 5, , ,991 54, LEEDS WEST CCG 5, , ,628 60, LEICESTER CITY CCG 6, , ,307 52, LEWISHAM CCG 3, , ,569 33, LINCOLNSHIRE EAST CCG 8, , ,577 66, LINCOLNSHIRE WEST CCG 6, , ,239 50, LIVERPOOL CCG 13, , , ,359 4 LUTON CCG 3, , ,153 24, MANSFIELD AND ASHFIELD CCG 4, , ,960 19, MEDWAY CCG 5, , ,417 57, MERTON CCG 2,411 92, ,125 21, MID ESSEX CCG 5, , ,979 54, MILTON KEYNES CCG 4, , ,424 24, NENE CCG 13, , ,510 95, NEWARK & SHERWOOD CCG 3, , ,322 18, NEWBURY AND DISTRICT CCG 1,859 70, ,417 15, NEWCASTLE NORTH AND EAST CCG 2, , ,224 27, *Analysis was undertaken using March 2016 tariff and December 2015 NHSBSA Prescribing data 16

17 CCGs in the top third for available savings CCGs in the middle third for available savings CCGs in the bottom third for available savings CCG Name Packs Dec 2015 Total Cost Dec 2015 Population Potential Savings per month Rank NEWCASTLE WEST CCG 3, , ,408 36, NEWHAM CCG 3, , ,694 36, NORTH & WEST READING CCG 2,040 76, ,029 16, NORTH DERBYSHIRE CCG 5, , ,788 30, NORTH DURHAM CCG 4, , ,900 52, NORTH EAST ESSEX CCG 5, , ,293 58, NORTH EAST HAMPSHIRE AND FARNHAM CCG 2, , ,392 29, NORTH EAST LINCOLNSHIRE CCG 3, , ,198 18, NORTH HAMPSHIRE CCG 3, , ,806 22, NORTH KIRKLEES CCG 3, , ,940 37, NORTH LINCOLNSHIRE CCG 4, , ,970 24, NORTH MANCHESTER CCG 5, , ,633 43, NORTH NORFOLK CCG 3, , ,213 35, NORTH SOMERSET CCG 3, , ,298 24, NORTH STAFFORDSHIRE CCG 5, , ,283 45, NORTH TYNESIDE CCG 5, , ,310 46, NORTH WEST SURREY CCG 5, , ,655 60, NORTH, EAST, WEST DEVON CCG 20, , , ,229 1 NORTHUMBERLAND CCG 7, , ,328 70, NORWICH CCG 3, , ,834 35, NOTTINGHAM CITY CCG 7, , ,643 47, NOTTINGHAM NORTH AND EAST CCG 3, , ,903 20, NOTTINGHAM WEST CCG 1,959 71,496 93,856 14, OLDHAM CCG 5, , ,695 43, OXFORDSHIRE CCG 8, , ,773 68, PORTSMOUTH CCG 4, , ,016 25, REDBRIDGE CCG 3, , ,170 27, REDDITCH AND BROMSGROVE CCG 3, , ,507 37, RICHMOND CCG 1,422 55, ,765 13, ROTHERHAM CCG 5, , ,434 50, RUSHCLIFFE CCG 2,094 76, ,087 14, SALFORD CCG 5, , ,896 66, SANDWELL AND WEST BIRMINGHAM CCG 9, , ,624 82, SCARBOROUGH AND RYEDALE CCG 2,165 88, ,005 24, SHEFFIELD CCG 11, , , ,707 3 SHROPSHIRE CCG 6, , ,006 58, SLOUGH CCG 2,498 93, ,963 19, SOLIHULL CCG 4, , ,753 42, SOMERSET CCG 11, , ,660 67, *Analysis was undertaken using March 2016 tariff and December 2015 NHSBSA Prescribing data 17

18 CCGs in the top third for available savings CCGs in the middle third for available savings CCGs in the bottom third for available savings CCG Name Packs Dec 2015 Total Cost Dec 2015 Population Potential Savings per month Rank SOUTH CHESHIRE CCG 4, , ,177 34, SOUTH DEVON AND TORBAY CCG 6, , ,166 57, SOUTH EAST STAFFS AND SEISDON PENINSU- LAR CCG 4, , ,250 44, SOUTH EASTERN HAMPSHIRE CCG 3, , ,104 30, SOUTH GLOUCESTERSHIRE CCG 4, , ,523 53, SOUTH KENT COAST CCG 5, , ,720 43, SOUTH LINCOLNSHIRE CCG 4, , ,949 27, SOUTH MANCHESTER CCG 4, , ,712 37, SOUTH NORFOLK CCG 5, , ,523 39, SOUTH READING CCG 2,183 83, ,110 19, SOUTH SEFTON CCG 3, , ,893 47, SOUTH TEES CCG 6, , ,092 68, SOUTH TYNESIDE CCG 4, , ,290 34, SOUTH WARWICKSHIRE CCG 5, , ,426 43, SOUTH WEST LINCOLNSHIRE CCG 2, , ,152 25, SOUTH WORCESTERSHIRE CCG 5, , ,188 53, SOUTHAMPTON CCG 4, , ,092 23, SOUTHEND CCG 3, , ,920 32, SOUTHERN DERBYSHIRE CCG 9, , ,288 52, SOUTHPORT AND FORMBY CCG 2,463 97, ,306 25, SOUTHWARK CCG 2,274 89, ,879 22, ST HELENS CCG 5, , ,365 45, STAFFORD AND SURROUNDS CCG 2, , ,965 31, STOCKPORT CCG 6, , ,048 57, STOKE ON TRENT CCG 7, , ,422 66, SUNDERLAND CCG 7, , ,927 72, SURREY DOWNS CCG 3, , ,181 42, SURREY HEATH CCG 1,329 53,262 91,794 14, SUTTON CCG 3, , ,011 24, SWALE CCG 2,352 91, ,999 22, SWINDON CCG 4, , ,894 39, TAMESIDE AND GLOSSOP CCG 6, , ,544 62, TELFORD AND WREKIN CCG 2, , ,698 29, THANET CCG 3, , ,733 34, THURROCK CCG 3, , ,579 24, TOWER HAMLETS CCG 2,234 88, ,156 23, TRAFFORD CCG 4, , ,628 49, VALE OF YORK CCG 5, , ,808 46, VALE ROYAL CCG 2,252 85, ,382 19, *Analysis was undertaken using March 2016 tariff and December 2015 NHSBSA Prescribing data 18

19 CCGs in the top third for available savings CCGs in the middle third for available savings CCGs in the bottom third for available savings CCG Name Packs Dec 2015 Total Cost Dec 2015 Population Potential Savings per month Rank WAKEFIELD CCG 10, , ,524 64, WALSALL CCG 5, , ,287 45, WALTHAM FOREST CCG 3, , ,414 36, WANDSWORTH CCG 3, , ,208 37, WARRINGTON CCG 4, , ,596 35, WARWICKSHIRE NORTH CCG 3, , ,946 33, WEST CHESHIRE CCG 4, , ,751 52, WEST ESSEX CCG 5, , ,702 51, WEST HAMPSHIRE CCG 10, , ,369 97,180 9 WEST KENT CCG 8, , ,055 88, WEST LANCASHIRE CCG 2,504 98, ,344 24, WEST LEICESTERSHIRE CCG 7, , ,549 55, WEST LONDON (K&C & QPP) CCG 2, , ,896 26, WEST NORFOLK CCG 4, , ,815 38, WEST SUFFOLK CCG 5, , ,333 44, WIGAN BOROUGH CCG 6, , ,625 60, WILTSHIRE CCG 8, , ,470 87, WINDSOR, ASCOT AND MAIDENHEAD CCG 2,288 86, ,122 19, WIRRAL CCG 9, , ,389 54, WOKINGHAM CCG 2,534 96, ,400 22, WOLVERHAMPTON CCG 3, , ,187 33, WYRE FOREST CCG 2,020 80, ,406 20, *Analysis was undertaken using March 2016 tariff and December 2015 NHSBSA Prescribing data 19

20 Section 6 Action Plan

21 Action Plan for CCGs 1. Review your CCG Combination Corticosteroid / LABA Inhaler prescribing data and identify the potential savings available. 2. Update your formulary to encourage utilisation of the newer cost-effective combination inhalers. Do not retain the high cost combination inhalers on your formulary. 3. Contact your practices to ensure that they are aware of these potential savings and formulary changes. 4. Encourage practices to identify patients on less cost-effective Combination Corticosteroid / LABA Inhalers and where clinically appropriate transfer them onto more cost-effective inhalers. 5. Provide a clear guide on how your practices can safely switch to a cost-effective inhaler 1 6. Monitor practices to check their progress in optimising their Combination Corticosteroid / LABA Inhaler usage. Feedback overall CCG and practice performance to inform them of savings generated through the optimisation. 7. Encourage standardised feedback from Patient, Clinicians and Specialists to validate improvements made from this optimisation. 8. Provide a formal quarterly report to the CCG clinical team sharing your success to ensure continued support and future Medicines Management Team impact. Optimising the use of Fostair could result in NHS savings of greater than 107 Million per year. 1.To obtain the Evolve safe optimisation guide please visit 21

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23 Editor Dr Julian Brown Data Editor Stephen Harrington Data Sources: EPACT NHS Information Centre Hospital Episode Statistics Safe Dispenser Surveys European Medicines Agency NHS Business Services Authority

24 CCG Prescriber