THE ALL-WALES MEDICINES STRATEGY GROUP AND WELSH MEDICINES PARTNERSHIP:

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1 THE ALL-WALES MEDICINES STRATEGY GROUP AND WELSH MEDICINES PARTNERSHIP: Phil Routledge Welsh Medicines Partnership. Department of Pharmacology, Therapeutics and

2 BURDEN OF DISEASE IN ENGLAND AND WALES Age-standardised mortality rates

3 ISCHAEMIC HEART DISEASE MORTALITY IN WALES

4 HEALTH GAIN TARGETS FOR CORONARY HEART DISEASE (CHD) IN WALES to reduce deaths from coronary heart disease (as measured by the EASR) in yearolds from 600 per 100,000 in 2002 to 400 per 100,000 by improve the CHD mortality in the least deprived group and at the same time narrow the gap with the most deprived groups

5 Other Prescribing cost per head Wales England astro-intestinal system Cardiovascular system Respiratory system Central nervous system Infections Endocrine system stetrics, gynaecology & urinary-tract disorders Malignant disease & immunosuppression Nutrition & blood Musculoskeletal & joint diseases Eye Ear, nose & oropharynx Skin Immunological products and vaccines Anaesthesia

6 EXPENDITURE ON PRESCRIBED DRUGS PER PRESCRIBING UNIT (PU) Audit Commission (1994). A prescription for improvement London, HMSO Less Overprescribin certain drugs Generic prescribing Limited clinical val Appropriate use expensive treatment Therapeutic substitution Economies in prescribing, England and Wales ( millions) 1994

7 PATIENT CONDEMS PRESCRIPTION BY POSTCODE BBC NEWS, Thursday August 12th 1999 A man from South Wales who has multiple sclerosis has condemned the decision to stop his medication because it is too expensive

8 Delay is the deadliest form of denial C Northcote Parkinson ( )

9 BRO TAF HIGH COST DRUGS PANEL Established 1999 Chaired by Professor Norman Whitehouse Examined cost-effectiveness issues No explicit definition of high-cost Established priority for funding

10 TASK AND FINISH GROUP FOR PRESCRIBING IN WALES PROPOSED THE ALL- WALES MEDICINES STRATEGY GROUP PROPOSED SETTING UP THE WELSH MEDICINES PARTNERSHIP (WMP)

11 ALL-WALES MEDICINES STRATEGY GROUP Develop timely, independent and authoritative advice on new drugs...(particularly high-cost) Advise the Assembly of future developments in healthcare Advise the Assembly on the development of a prescribing strategy for Wales Advise the Assembly on the implementation of Task and Finish Group recommendations

12 THERAPEUTICS EDUCATION WELSH MEDICINES INFORMATION CENTRE (WMIC) PRESCRIBING INFORMATION WCM THERAPEUTICS AND TOXICOLOGY CENTRE (TTC) SAFE PRESCRIBING MESSAGES AND ENCOURAGEMENT OF ADR REPORTING WELSH MEDICINES RESOURCE CENTRE (WeMeReC) TRAINING AND AWARENESS COMMITTEE ON SAFETY OF MEDICINES (WALES)

13 Minister WMIC WeMeRec CSM Wales WCM TTC Welsh Assembly Government Officers Welsh Medicines Partnership AWMSG Steering Group Meetings held monthly Chairman AWMSG All Wales Medicines Strategy Group All Wales Prescribing Advisory Group NHS-Industry Forum

14 ALL-WALES APPRAISALS BY AWMSG (2003 to present) High-cost medicines Adalimumab (Humira ) Enfuvirtide (Fuzeon ) Epoetinum Alfa (Eprex ) Epoetin Beta (NeoRecormon ) Darbepoetin Alfa (Aranesp ) Drotrecogin (Xigris ) Laronidase (Aldurazyme ) Teriparatide (Forsteo ) Sodium Phenylbutyrate (Ammonaps ) Anagrelide hydrochloride (Xagrid ) Bortezomib (Velcade ) Pegvisomant (Somavert )

15 CVS item comparison 2,500 2,000 Num ber of item s Thousands 1,500 1,000 April 02-March 03 April 01- March 0 Actual Variation Lipid-Regulating Drugs 227 ACE Inhibitors 96 Angiotensin-Ii Receptor Antagonists 258 Antiplatelet Drugs Potassium-Channel Activators 21 5 Centrally-Acting Antihypertensive Drugs variation 33% 15% 32% 15% 17% 9%

16 Lipid regulating drugs 800 Thousands April 02-March 03 April 01-March 02 Actual Variation Simvastatin Atorvastatin Pravastatin Sodium Fenofibrate Omega-3 Marine Triglycerides ariation 39% 44% 35% 25% 15%

17 16 Prescribing Update Statins & Clopidogrel (11/AWMSG/0604) Simvastatin (Items) by preparation Atorvastatin (Items) by preparation

18 Prescribing Update Statins & Clopidogrel 11/AWMSG/ Rosuvastatin - Cost per 1000 PU THE VALE OF GLAMORGAN LHB POWYS LHB CARDIFF LHB RHONDDA CYNON TAFF LHB CARMARTHENSHIRE LHB MONMOUTH LHB BLAENAU GWENT LHB YNYS MON LHB GWYNEDD LHB FLINTSHIRE LHB MERTHYR TYDFIL LHB NEATH/PORT TALBOT LHB BRIDGEND LHB PEMBROKESHIRE LHB TORFAEN LHB CAERPHILLY LHB WREXHAM LHB SWANSEA LHB CONWY LHB DENBIGHSHIRE LHB NEWPORT LHB CEREDIGION LHB Cost per 1000 PU

19 ALL-WALES GUIDELINES Hypolipidaemic and antiplatelet therapy Issues highlighted December 2003 WeMeReC bulletin Prescribing clopidogrel published February 2004 AWPAG tasked in 2004 to produce draft guidelines Out to consultation Guidelines published March 2005 WeMeReC bulletin Optimising the use statins using statins wisely and distance-learning module published May 2005 (500 participants across Wales)

20 Generic Simvastatin as a Percentage of Statins Blaenau Gwent LHB Caerphilly LHB Monmouth LHB Newport LHB Torfaen LHB Merthyr Tydfil LHB Rhondda Cynon Taff LHB e Vale Of Glamorgan LHB Cardiff LHB Carmarthenshire LHB Ceredigion LHB Pembrokeshire LHB Powys LHB Ynys Mon LHB Conwy LHB Denbighshire LHB Flintshire LHB Gwynedd LHB Wrexham LHB Swansea LHB Bridgend LHB Neath/Port Talbot LHB National-GP Target 45% Sep-03 Sep-04

21 UIDELINES AND ANTI-PLATELET PRESCRIBING

22 FUTURE DIRECTIONS Broadening the appraisal process Shared-care policies Promoting rational and costeffective prescribing Prescribing indicators Prescribing incentives

23 Blaenau Gwent LHB Caerphilly LHB Monmouth LHB Newport LHB Torfaen LHB Merthyr Tydfil LHB Rhondda Cynon Taff LHB The Vale Of Glamorgan LHB Cardiff LHB Carmarthenshire LHB Ceredigion LHB Pembrokeshire LHB Powys LHB Ynys Mon LHB Conwy LHB Denbighshire LHB Flintshire LHB Gwynedd LHB Wrexham LHB Swansea LHB Bridgend LHB Neath/Port Talbot LHB National-GP Target 78% 2001/2002 Generic Prescribing Rate Sep-03 Sep-04 LHB

24 ELSH MEDICINES PARTNERSHIP orking together to promote safe and effective prescribing in Wales