Recommendations of the Pharmaceutical benefit Advisory Committee
22 October 2009
1. SUMMARY
The Pharmaceutical Benefit Advisory Committee met on 22nd October 2009 to consider the inclusion and/or deletion of certain products from the Prescribed List. The recommendations of the Committee which have already been approved by the Minister are detailed in MD – S- 2009-0068.
A further item, subject to the development and ratification of guidelines was recommended by the Committee. A summary of the estimated cost of the recommendations of the Committee is provided in Appendix One.
2. BACKGROUND
Item for inclusion
2.1. Item to be added subject to ratified shared care guidelines
2.1.1 Pregabalin (Lyrica, Pfizer) capsules 25mg, 50mg, 100mg, 150mg, 200mg, 225mg, 300mg (Amber item).
Pregabalin is requested as an alternative to gabapentin in the treatment of patients with neuropathic pain. In short-term trials, the drug was more effective than placebo in reducing pain, but published trials have not compared the drug with other treatments for neuropathic pain.
The approximate annual costs of Pregabalin 150mg – 600mg daily in divided doses range from £840 – £1259
Alternatives available on Prescribed List:
Gabapentin 900mg – 1800mg daily in divided doses £81 – £162
In the absence of comparative evidence, it is difficult to justify the additional cost of pregabalin compared with gabapentin. However, the Committee recognised that it could be used in the community as a third line medicine but following protocols ratified by an appropriate specialist in pain management. After further consideration and debate, the Committee recommended approval by a 5:3 majority.
3. Cumulative effect on annual expenditure for all recommendations of the Committee’s recommendations of 22 October 2009
This is estimated to be a saving of £110,000
· The recommendation detailed in Table One is a transfer of £100,000 costs from Health and Social Services budget to the Health Insurance Fund.
· Table Two represent an additional £41,000 cost to the Fund and are recommendations approved in MD – S- 2009-0068
· Table Three represent an estimated saving of £250, 000 to the Fund. and are recommendations approved in MD – S- 2009-0068
4. RECOMMENDATION
Referring to Appendix One, the Minister is asked to approve items detailed in Table One to take effect from 1st April 2010. The cost is an estimated £100, 000 cost to the Fund.
Appendix One
Estimated effect on annual expenditure for proposed changes
Table One : Additional Items subject to ratified Guideline
Number | item | Cause | Net effect per annum |
2.2.1 | Pregabalin (Lyrica) capsules 25mg, 50mg, 100mg, 150mg, 200mg, 225mg, 300mg (open order) | Additional cost | £100,000 |
Table Two: Additional items as approved MD – S- 2009-0068
Number | item | Cause | Net effect per annum |
2.1.1. | Strontium ranelate (Protelos, Servier) granules 2g/sachet | Additional cost | £30,000 |
2.1.2 | Tripotassium dicitratobismuthate (De-Noltab) tablets 120mg | Low use, low cost | £0 |
2.1.3 | Betamethasone dipropionate 0.05%, calcipotriol 50 micrograms/g (Xamiol) scalp gel | Alternative product – similar price | £0 |
2.1.4 | Calceos Tablets (chewable), Calfovit D3 Powder, Adcal D3 Tablets | Alternative products – similar price | £0 |
2.1.5. | Levodopa/carbidopa/entacapone (Stalevo) tablets 125/31.75/200mg, 75/18.75/200mg, 200/50/200mg, 200/50/200mg | Flat price structure – no additional cost | £0 |
2.1.6 | Estradiol (Vagifem) vaginal tablets 25mcg | Removed in error from List – no additional cost | £0 |
2.1.7. | Olanzapine (Zyprexa) tablets 15mg, 20mg; orodispersible tablets 15mg,20mg | Extended dose range for existing product – no additional cost | £0 |
2.1.8 | Metronidazole (Acea; Rosiced) topical gel 0.75% | Alternative product – low use | £0 |
2.1.9 | Topiramate (Topamax) sprinkle capsules 15mg, 25mg | Extended product range for existing product | £0 |
2.1.10 | Telmisartan (Micardis) tablets 20mg, 40mg, 80mg | Alternative product – similar cost, low use | £0 |
2.1.11 | Beclometasone dipropionate 100mcg/ formoterol fumarate dehydrate 6mcg pressurised metered-dose inhaler (Fostair) | Lower cost than alternatives but uptake likely to be low | £0 |
2.1.12 | Oxybutinin 3.9mg/24h transdermal patch (Kentera) | Additional cost | £10,000 |
2.1.13 | Dimeticone 4% lotion (Hedrin) | No similar products on List | £1,000 |
2.1.14 | Prednisolone 0.5% preservative free single use eye drops (Minims) | Additional cost but low use | £1,000 |
2.1.15 | Dexamethasone 500mcg tablets | Less expensive than existing product but low use | -£1,000 |
| | Sub Total | £41,000 |
Table Three: Items Generic only and deleted items as approved MD – S- 2009-0068
Number | item | Cause | Net effect per annum |
3.1 | Beclazone Easi-Breathe (CFC-containing beclometasone dipropionate) inhalers 50mcg, 100mcg and 250mcg | Alternative product – similar price | £0 |
4.1. | Generic pantoprazole | Assuming price reduction similar to other drugs in class | -£200,000 |
4.2. | Generic venlafaxine | Assuming minimal reduction in price of m/r products | -£50,000 |
| | Subtotal | - £250,000 |
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