23 October 2012

NHS Prescribing High Numbers of NICE-Approved Drugs

Uptake of NICE-approved medicines on the NHS to treat cardiovascular disease, diabetes and osteoporosis is higher than expected, latest figures reveal.

The data, published within an experimental report by the Health and Social Care Information Centre(HSCIC), examines the use of NICE-appraised medicines in England and covers prescribing during 2010 and 2011.

The review looks at medicines used for 25 different treatment groups. Of these, it was able to compare observed or actual use with expected use for 13 treatment groups.

The drugs whose use was higher than expected were: statins for adults with cardiovascular disease, insulin glargine and detemir for people with type 1 diabetes, varenicline to aid smoking cessation, temozolomide for newly diagnosed brain cancer in adults and carmustine implants for the treatment of recurrent glioblastoma multiforme

Prescribing of the osteoporosis drugs- alendronate, etidronate, risedronate, raloxifene, strontium ranelate, teriparatide and denosumab - was also higher than expected.

The review did find that use was lower than expected for six drugs including trastuzumab for advanced breast cancer, prucalopride for the treatment of chronic constipation in women and drugs to treat acute coronary syndrome.

However, variations in drug usage could be caused by the emergence of new alternative treatments, patient choice, safety concerns, and updates to existing NICE recommendations.

Uncertainties in the report can also become more apparent as trends are extrapolated to the local NHS organisations, and this may be a significant contributor to the magnitude of any variations.

The variation does highlight the need for further work to help support effective prescribing on the NHS, such as the development of a best practice guide for local formularies.

NICE is developing the guide, which is expected later this year, to help trusts develop local formularies to ensure that all patients in England have access to clinically and cost-effective drugs.

Currently, there is no standard process or advice for putting together a local formulary which has led to variations across the country.

Dr Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE said: “It is heartening to see that so many of the medicines that NICE has recommended are being used widely on the NHS.

“When we recommend a new drug, it is because we are satisfied that it is both clinically and cost-effective and should be available as a treatment option for all appropriate patients.

“Our new work with local formularies will help ensure NICE-recommended drugs are made available to the patients who could benefit from them.”

Tim Straughan, Chief Executive of the HSCIC, cautioned that this latest data is “experimental” as it relies on deriving estimates for the numbers of eligible patients and expected use of medicine which requires a number of assumptions for things such as average length of treatments.

“Regional variation could be due to a variety of factors - including gaps in data, differences in demography and disease prevalence across the country and the fact that figures may be based on small numbers of patients for each of the drugs considered.

“Users of the figures should also remember that many of the medicines considered are only one of a number of treatment options available to clinicians. This means some variation in use should be expected, and may be due to the prescribing preferences of clinicians in local areas.

“We are keen to encourage NHS organisations to look at this report and consider local medicines use in relation to the needs of the local population.”