B&H CCG Prescribing Incentive Scheme Proposals 2013-14 Compulsory: 1. Practice meets with CCG Pharmaceutical Adviser and agrees a practice specific workplan.
List of Optional 2. Solifenacin 5mg to tolterodine 1mg bd and Solifenacin 10mg to tolterodine 2mg bd Initial prescription review suggests that at least 75% of patients prescribed solifenacin have never tried tolterodine. There is little difference in efficacy between the anticholinergics, though tolerability can vary. Tolterodine is substantially cheaper, and if 65% of patients were successfully switched, savings to the CCG would be £135,000pa. 3. Tiotropium switching to Aclidinium Aclidinium is a new LAMA for use in COPD patient. There is no evidence of any difference in efficacy, the device (a Novolizer) is considerably easier to use than the Spiriva devices, and is cheaper. A switch from Tiotropium to aclidinium in 80% of patients could result in savings of around £100,000pa 4. Tadalafil, vardenafil to sildenafil Viagra patent is due to expire June 2013 and generic price is expected to drop significantly and quickly. The British Society for Sexual Medicine recommends PDE5 inhibitors as first-line treatments for ED and states that they all have proven efficacy and safety in men with ED. All patients on NHS prescriptions should be reviewed to clarify eligibility. Patients taking tadalafil or vardenafil should be switched to sildenafil if appropriate. If the price of generic sildenafil falls by 75%, and 80% of patients are switched from tadalafil and vardenafil, potential savings could be over £100,000 pa 5. Duloxetine to escitalopram Duloxetine should be a 3rd or 4th line antidepressant NICE depression guidelines quote evidence that duloxetine and escitalopram are equally effective, but that escitalopram tends to be better tolerated. If 60% of patients can be switched (duloxetine 60mg to escitalopram 10mg and duloxetine 30mg to escitalopram 5mg), this could save around £80k pa. Duloxetine 30mg: £22.40 Escitalopram 5mg £8.97 Duloxetine 60mg: £27.72 Escitalopram 10mg: £14.91 6. Benzos Benzo prescribing continues to fall, with reports from SMS that it is increasingly difficult to get hold of black market benzos. B&H are still the highest prescribers in England, so we should continue to target this area. Public Health support the continuation of this indicator. 7. Pregabalin To reduce prescribing of pregabalin through reviewing patients with current or historic substance misuse and stopping prescribing as per policy.
8. Bisphosphonate withdrawal There is no evidence to support continuing bisphosphonate treatment beyond about 5 years. Review all pts on bisphosphonates and stop if they have been taking it for 5 years. 9. Formulary Adherence To adapt the indicator used in 2012-13 10. Lansoprazole step down Most cases of c.diff in the community are now associated with long term use of lansoprazole 30mg. In many cases, this high dose is not necessary. To review and step down where appropriate. 11. Varenicline review Spend in 2011-12 was £150,000. Review prescribing to ensure adherence to NICE guidelines
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