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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - April 2011

The National Institute of Health and Clinical Excellence has published new guidance for the month of April 2011. This month there are two clinical guidelines that impact upon primary care.

The lung cancer (QRG) and ovarian cancer (QRG) clinical guidelines both provide investigation guidance and referral criteria to aid early diagnosis.

Action: Clinicians should be aware of these recommendations and implement any necessary changes to practice.

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EpiPen changes hands

According to a letter sent to healthcare professionals, the marketing and distribution rights of EpiPen® (adrenaline in an auto-injector) have change to a different company, Meda Pharmaceuticals. This change is accompanied by a reduction in price of the product from £28.77 to 26.45.

In addition, the new distributor is working with the manufacturer to ensure consistent future supplies of this product and they have also launch a product website that offers an expiry date reminder service. This free service allows patients to register their details so they will receive an email and/or text message alert when their EpiPen is due to expire. These alerts are sent at 4 and 2 weeks prior to expiry and also on the day of expiry.

Action: Clinicians should be aware of the change of distributor and may wish to make patients aware of the expiry notification service.

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Pulse challenges statin rationing

Pulse has published a report that questions the rationing of high intensity statins stating that GPs are being forced to offer 'sub-optimal care' with simvastatin purely on the basis of cost.

The article is based on the results of a meta-analysis of 28 randomised controlled trials in acute coronary syndromes (ACS) published in the European Journal of Cardiovascular Prevention & Rehabilitation. This analysis reviews relative reductions in LDL-C and uses a threshold of £20,000 per QALY to assess cost-effectiveness.

The authors of this paper conclude that, "Our analyses show that current PCT policies intended to minimize primary care drug acquisition costs result in suboptimal care".

It is important to note that this analysis is restricted to the evidence base in ACS where it is already recommended that high intensity statins are used. The Lipid Modification guideline (PDF) published by NICE recommends use of high intensity statins in patients with ACS without waiting for lipid levels to be available and after considering informed preference, co-morbidities, other drug therapy and benefits and risks of treatment.

Action: The conclusions of an analysis into patients with ACS cannot be generalised to all patients with cardiovascular disease. Clinicians should continue to implement the recommendations of the NICE Lipid Modification guideline including the use of high intensity statins in patients with ACS.

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QOF changes for 2011/12

NHS Employers and the General Practitioners Committee (GPC) have agreed a number of changes to the quality and outcomes framework (QOF) effective from 1 April 2011.

The changes include amendments and retirements of some existing indicators as well as the introduction of new clinical and organisational indicators. The changes are available in a summary table.

A complete breakdown of all of the clinical and organisational domains with a full explanation of rationale behind each domain indicator is also available (PDF).

Action: Clinicians, and in particular general practitioners (GPs), should be aware of the changes. The Quality and Productivity indicators aimed at securing a more effective use of NHS resources will require careful consideration and planning.

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SMC Update - April 2011

The Scottish Medicines Consortium (SMC) has issued its monthly advice on new medicines.

Calcium acetate and magnesium carbonate (Osvaren®) has been rejected for the treatment of hyperphosphataemia associated with chronic renal insufficiency in patients undergoing dialysis (haemodialysis, peritoneal dialysis). Although the product has been to reduce hyperphosphataemia associated with chronic renal disease the manufacturer did not present a sufficiently robust economic analysis.

Cannabinoid (Sativex®) has been rejected as an add-on treatment for symptom improvement in patients with moderate to severe spasticity due to multiple sclerosis (MS) who have not responded adequately to other anti-spasticity medication. The manufacturer failed to make a submission.

Ethinylestradiol with drosperinone (Yasmin®) has been rejected for use as an oral contraceptive. The product has been shown to have similar contraceptive effectiveness to other combined oral contraceptives in routine use, with no significant differences in adverse event profile. The manufacturer did not present a sufficiently robust economic analysis.

Sevelamer carbonate (Renvela®) has been accepted for restricted use as second-line management in the control of hyperphosphataemia in adult patients receiving haemodialysis.

Action: Clinicians should be aware of the recommendations of the SMC. Routine use of rejected and restricted medicines should be avoided.

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