MEDICINES

OPTIMISA

TION IN

DIABETESYv

onne Parker

Medicines O

ptimisation

Pharmac

ist

Stoke

-on-Trent C

CG

Current Prescribing TrendsCCG Total Cost

2013/14Total Items 2013/14

Total Cost 2014/15

Total Items 2014/15

% Growth in Cost

Stoke-on-Trent £3,501,381 261,712 £3,791,344 273,258 8%

North Staffs £2,496,073 172,374 £2,699,642 177,478 8%

England Total £622,417,673 37,792,688 £669,032,451 39,415,271 7%

Figures taken from PrescQIPP Drugs used for diabetes snapshot 2014/15 – April to January

Growth by BNF chapter – Actual Growth Cost

Top 6 BNF chapters (highest to lowest growth cost):

Stoke-on-Trent North Staffs

Endocrine System Endocrine System

Nutrition and Blood Nutrition and Blood

Respiratory System Stoma Appliances

Gastro-Intestinal System Gastro-Intestinal System

Appliances Appliances

Stoma Appliances Immunological Products & Vaccines

Endocrine System Growth

CCG Actual Growth Items

Actual Growth Cost

% Growth Items

% Growth Cost

Difference in cost per item

Stoke-on-Trent

18,568 £491,356 3.61% 9.38% £0.57 - Endocrine£0.55 - Diabetes

North Staffs

8,605 £367,165 2.29% 9.48% £0.72 - Endocrine£0.77 - Diabetes

Actual growth April to February 13/14 vs 14/15

Top 10 Diabetes Drugs/Reagents by CostStoke-on-Trent (2014/15) North Staffs (2014/15)

Drug/Reagent Cost No. of Items Drug/Reagent Cost No. of Items

BGTS £646K 37,247 BGTS £497K 26,075

Metformin HCl £614K 128,930 Metformin HCl £436K 81,543

Insulin glargine £404K 8,178 Insulin glargine £377K 7,400

Sitagliptin £365K 11,621 Sitagliptin £274K 7,769

Biphasic insulin aspart £312K 7,324 Biphasic insulin aspart £195K 4,410

Exenatide £266K 3,401 Insulin aspart £191K 4,996

Insulin aspart £255K 6,420 Gliclazide £132K 35,946

Liraglutide £233K 2,011 Exenatide £125K 1,578

Gliclazide £215K 60,236 Liraglutide £106K 982

Linagliptin £132K 4,276 Insulin detemir £100K 1,801

Main areas of concern

Stoke-on-Trent

•2,000% (£18,500) increase in insulin degludec•250% (£5,600) increase in combination product sitagliptin/metformin (Janumet)

North Staffs

•365% (£10,000) increase in insulin degludec•11% (£10,000) increase in liraglutide

Main areas of improvement

Stoke-on-Trent

•Decreased spend on non-formulary drugs•Decreased spend on BGTS•Decreased spend for 3 combination products

North Staffs

•Decreased spend on non-formulary drugs•Decreased spend for 3 combination products

North Staffordshire Joint Formulary

AIMS:

•To promote safe, effective and economic prescribing in both primary and secondary care•Help to ensure seamless prescribing, thereby reducing possible errors and confusion•Each section approved by the North Staffordshire and Stoke-on-Trent Area Prescribing Committee

Medicines are categorised according to a traffic light system

The formulary can be found at: http://www.stokeccg.nhs.uk/joint-formulary

•1st line – Byetta (exenatide twice daily)•2nd line – Bydureon (exenatide once weekly)•3rd line – Victoza (liraglutide once daily)

Essential Shared Care Agreements (ESCAs) set out specialist, GP and patient responsibilities and are required due to the amber 1 classification of GLP1s on the formulary

GLP-1 mimetic prescribing and ESCAs

7 GP practices in Stoke are taking part in the GLP1 LIS service

Prescribing needs to be in line with NICE guidance

•Triple therapy – 1.0% reduction in HbA1c and 3% reduction in weight 6 months after initiation•Dual therapy – 1.0% reduction in HbA1c 6 months after initiation

GLP-1 mimetic prescribing and ESCAs

Guidelines for diabetes

• Management of adults with diabetes mellitus – Guidelines for clinical care

• At-a-glance guide for self monitoring blood glucose (SMBG) in diabetes

• Patient guide for self monitoring of blood glucose (SMBG) in diabetes

• At-a-glance guide for treatment with a 3rd line oral agent for patients with type 2 diabetes

Medicines Optimisation Projects

• Prescribing of WaveSense JAZZ BGTS and supplying the meter to all suitable patients

• Prescribing of Omnican Fine or GlucoRx FinePoint pen needles to all suitable patients

• A review of the prescribing of 3rd line oral antidiabetic agents in the management of type 2 diabetes

Any questions?