More effective NHS prescribing of chronic lung disease treatment reduces drug bill

More effective NHS prescribing of chronic lung disease treatment reduces drug bill

More effective prescribing across the NHS in England has led to a reduction of £2 million a month being spent on a chronic lung disease treatment – according to researchers presenting new data at the British Thoracic Society’s Winter Meeting today (Wednesday 7th December.)

Researchers will tell delegates that the latest data (for June 2016) indicates the reduction in NHS spending on the treatment has now risen even higher – to £3 million a month – with potential for even greater efficiencies to be made.  They will also say that potential future savings for the NHS could be ‘enormous’ and that these could be invested in more effective treatments to help people ‘breathe easier.’

The study undertaken by Imperial College Healthcare NHS Trust on behalf of the London Respiratory Network, analysed the number, and cost, of High Dose Inhaled Corticosteroid combination drugs being prescribed by the NHS over a 15 month period.

High dose inhaled corticosteroids (HDICS) combination inhalers, which can help reduce inflammation in the airways, currently account for two of the top five ‘highest spend’ NHS medicines – and evidence shows there is an over-reliance on their use in treating Chronic Obstructive Pulmonary Disease (COPD) and almost certainly in patients with asthma too.

The treatment is only recommended for a small number of patients with asthma and COPD who have severe symptoms and there are increasing concerns about some of the side effects (e.g. pneumonia).

At the same time a range of evidence has also shown that many people with COPD aren’t always being offered what are often the most effective treatments for their condition – support and medication to help them stop smoking, and exercise and education through a pulmonary rehabilitation programme.

This study showed that in 2015/16 the monthly spend across the NHS on all high dose corticosteroids (HDICS) combination inhalers, fell from around £20 million a month to £18 million a month. And the number of prescriptions fell from around 400,000 a month to 365,000 a month. Although the research notes that some of the savings made will be offset by some patients being prescribed lower cost, lower dose inhaled corticosteroids (ICS.)

The researchers will tell delegates that this ‘prescribing drop’ might reflect welcome changes in NHS practice with more healthcare professionals now ‘stepping down’ patients off higher doses of these treatments – or withdrawing them altogether if they’re having no beneficial impact on their lung condition.

In a previous study reductions in HDICS spending were seen mainly in NHS Groups across London with integrated respiratory care teams and virtual clinics – where hospital-based lung consultants and pharmacists can work closely with GP practices to review patients’ notes, making sure people with COPD are receiving the most effective treatments and lifestyle support.

COPD is the name for a group of lung diseases that narrow the airways causing breathing difficulties. In total, 1.2 million people in the UK have been diagnosed with COPD.

Dr Vincent Mak of Imperial College Healthcare Trust who led the study, said:

‘Our study shows that the NHS is starting to get to grips with this issue, making sure people with COPD and asthma are on the right treatments for their condition – reducing or withdrawing unnecessary HDICS as appropriate.

The health benefits and costs savings of getting it right are eye-watering. The NHS has already reduced its spend by £24 million a year from more effective prescribing – but given the widespread overuse of these drugs, and the potential for harm and waste reduction that’s possible – we could go even further. This could be just the tip of the savings iceberg.

Every NHS Clinical Commissioning Group must get on top of this issue – as reviewing the appropriateness of HDIS prescribing in both COPD and asthma patients could reap real benefits.’

Dr Lisa Davies, Consultant Respiratory Physician at Aintree University Hospital, and Chair of the British Thoracic Society Board said:

“The NHS is under huge pressure to deliver quality care at the same time as reducing costs.

I think this series of studies really highlights the immense value of consultant lung specialists using their expertise outside the hospital gates, working with colleagues in the community, to rigorously evaluate care – and make sure people with lung disease are on the best possible treatments.

The potential financial savings for the NHS are huge – and these could be ploughed back into much more effective ways we can support people to breathe easier such as stop smoking support.”

Wendy Preston, Vice Chair of ARNS, Head of Nursing Practice at the RCN  said:

We are pleased that this research by Imperial College Healthcare Trust, on behalf of London Respiratory Network, is being disseminated at the BTS Winter Meeting. It is an example of how effective research can be utilised to improve outcomes for patient’s by ensuring evidence based prescribe which in turn has a big reduction on health care costs.

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