UK - Analysis Reveals Uptake of Pharmaceuticals Following NICE Approval

A new report, Use of NICE-appraised Medicines in the NHS in England – Experimental Statistics, published by the NHS Information Centre in September 2009, has looked at the uptake of pharmaceuticals appraised by the National Institute for Health and Clinical Excellence (NICE).

The review studied 26 drugs positively appraised by NICE, covering 13 technology appraisals.

The report indicates that out of 12 appraisals where a comparison could be established, use on the NHS in 2008 was higher than expected for seven appraisals and lower for five appraisals.

The appraisals where observed use exceeded the predicted use in 2008 are:

• Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease;
• Ezetimibe for the treatment of primary (heterozygous-familial and non-familial) hypercholesterolaemia;
• Entecavir for the treatment of chronic hepatitis B;
• Zaleplon, zolpidem and zopiclone for the short-term management of insomnia;
• Varenicline for smoking cessation;
• Hormonal therapies for the adjuvant treatment of early oestrogen-receptor-positive breast cancer; and
• Alendronate, etidronate, risedronate, raloxifene and strontium ranelate for the primary prevention of osteoporotic fragility fractures in postmenopausal women, plus alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women.

The appraisals where observed use was lower than the predicted use in 2008 are:

• Omalizumab for severe persistent allergic asthma;
• Natalizumab for the treatment of adults with highly active relapsing-remitting multiple sclerosis;
• Drotrecogin alfa (activated) for severe sepsis;
• Riluzole (Rilutek) for the treatment of motor neuron disease; and
• Orlistat, sibutramine and rimonabant for the treatment of obesity in adults.

In one case, the use of the drug was lower than predicted in 2008 but its use is rising and it is likely to exceed the expected level in 2009.

The Association of the British Pharmaceutical Industry (ABPI), however, has questioned the basis on which the predictions were made as it appears to be too low. The ABPI also believes that the statistics on the use of such medicines in England should be set against a comparison of uptake in other, comparable European countries.

Further reading - An in-depth review of the UK pharmaceutical market, including some background information on NICE appraisals, is available from Espicom: The Pharmaceutical Market: United Kingdom (published June 2009)

UK - GP Consultations Rising

The number of GP consultations has risen from 217.3 million in 1995 to 300.4 million in 2008, according to data published by the NHS Information Centre in September 2009.

The study, conducted using the QResearch general practice database, revealed that an average patient had 5.5 consultations in 2008, compared with 3.9 in 1995. Meanwhile, the average GP surgery carried out 34,200 appointments in 2008, up from 21,100 in 1995.

The study also highlighted an increase in the number of patients seen by a nurse in primary care. In 1995, 76% of consultations were undertaken by GPs, 21% by nurses and 3% by other clinicians, whereas in 2008, 62% were carried out by GPs, 34% by nurses and 4% by other clinicians. However, this increase in proportion could be explained by an increase in patients seeing nurses in general, rather than fewer patients seeing a GP.

However, the study did not take into account the length of consultations, or the number of tasks undertaken within a consultation, which could impact on the reliability of the findings.

Further reading - A detailed analysis of the UK pharmaceutical market, including further statistics on ambulatory care, is available from Espicom: The Pharmaceutical Market: United Kingdom (published June 2009)

UK - Dentists’ Earnings Published

The NHS Information Centre has published the earnings of dentists in England and Wales. The 2007/08 Dental Earnings and Expenses Report, England and Wales, details the earnings and expenses of self-employed primary care dentists. The report looked at Providing-Performer dentists, who had a contract with a local health body and performed other dental services, and Performer Only dentists, who performed dental services but did not have a contract.

The report revealed that a total of 382 dentists out of 20,000 had a gross income of over £300,000 between 2007 and 2008, and 1,172 had gross earnings of more than £200,000 over the course of the year. It also highlighted a pay difference between dentists in England and Wales, with the average pay in England being £88,870 and the average in Wales being £93,924.

The key findings of the report are:

• The average taxable income for Providing-Performer dentists was £126,807, compared to £65,697 for Performer Only dentists. The overall average was £89,062;
• The average expenses for Providing-Performer dentists were £218,843, compared to just £33,512 for Performer Only dentists; and
• The average gross earnings for Providing Performer dentists were £345,651, compared to £99,208 for Performer Only dentists.

Further reading - A detailed review of the UK pharmaceutical market, including some background information on dentistry, is available from Espicom: The Pharmaceutical Market: United Kingdom (published June 2009)

UK - Number of Prescriptions Increase but Costs Fall

Prescriptions dispensed in England rose by 5.8% in 2008, while costs fell by 0.6%, according to figures from the NHS Information Centre released in July 2009.

In 2008, a total of 842.5 million prescriptions were dispensed, a rise of 5.8% over 2007, while the net ingredient cost of all prescriptions decreased by 0.6% to £8,325.5 million. Over the same period, the average net ingredient cost per prescription item fell by 6.0% to £9.88.

The leading BNF Chapter in terms of volume was the cardiovascular system, and in terms of cost was the central nervous system. The leading BNF Section in terms of prescription items dispensed was hypertension and heart failure and in terms of cost was drugs used in diabetes.

A total of 65.0% of prescription items were dispensed generically in 2008, representing 26.2% of the total cost.

Further reading - An in-depth analysis of the UK pharmaceutical market, including data on prescriptions dispensed, is available from Espicom: The Pharmaceutical Market: United Kingdom (published June 2009)