ConfirmedAnnex 3
MINUTES OF THE CARDIFF AND VALE OF GLAMORGAN
MEDICINES AND THERAPEUTICS EXECUTIVE COMMITTEE
HELD ON MONDAY 8th DECEMBER 2008
IN THE BOARDROOM, CARDIFF LHB
Present:
Dr Brendan Lloyd Medical Director, Cardiff LHB (Acting Chair)
Paul EmmersonDeputy Finance Director, Cardiff LHB
Rob MahoneyFinance Director, Vale of Glamorgan LHB
Kate MorrisHoPMM, Cardiff LHB
Karen MayHoPMM, Vale of Glamorgan LHB
Dave RobertsChief Pharmacist, Cardiff & Vale NHS Trust
Andrea HayesFinancial Planning Accountant, Cardiff & Vale NHS Trust
In attendance:
Maggie TomkinsRecorder
Louise GovierAdministration Manager, Pharmacy Administration Office, Cardiff & Vale NHS Trust
ACTION
08/62 / Apologies for AbsenceSharon Hopkins Medical Director, Vale of Glamorgan LHB
Dr Dwarak Sastry Associate Medical Director, Cardiff & Vale NHS Trust
Dr Richard Moore Clinical Director, Nephrology & Transplantation, Cardiff & Vale NHS Trust
08/63 / Declarations of interest with regard to items on this agenda
There were no declarations of interest.
08/64 / Minutes of the last meeting held on 13th October 2008
The minutes of the meeting were accepted as a true and accurate record.
08/65 / Action Notes of meeting held on 13th October 2008
Action 8: At the request of DR,the DTC secretary asked Dr Aziz to submit clarification of the costings he submitted for escitalopram. DR informed the committee that additional information had been received, but this appeared to be based on some erroneous assumptions, resulting in an estimated cost of £22million per annum. The committee agreed that it was not yet satisfied with the costings and was still not in a position to make a decision.
The claim that escatilopram is used by the Cardiff & Vale consultants will be investigated further, as MTEC was under the impression that it was not valued or used by consultants within the Cardiff & Vale NHS Trust.
Action 10:Discussions on the SLA for Professional and Administrative Support to the DTC are continuing outside of the MTEC arena between KMo and DR.
Actions 11-13:An update was provided on the progress of discussions regarding ESAs. A meeting has taken place between members of the C&V Trust, LHBs and LMC. BL has indicated to RMo (currently on leave) that it was felt appropriate that he should lead on this issue. His reply is awaited.
The LMC representative is looking into the implications for the workload of GPs. RMo and KMa have checked the QOF guidelines. RMa said that it was hoped to resolve outstanding issues in time for the start of the new financial year, with a block transfer of fundsin April 2009. There were, however, some doubts expressed as to whether this timescale could be met. / BL
08/66 / Matters Arising
There were no matters arising that were not on the agenda.
08/67 / (i)Bro Taf DTC – Minutes of previous meeting held on 13th November 2008: Matters arising for the attention of MTEC
The minutes were noted by MTEC members, and the following items discussed:
08/64 i): Exenatide
A letter from Dr Platts, Consultant Diabetologist was considered by the DTC and referred to MTEC. Dr Platts indicated that an audit will be carried out on the use of Exenatide against the NICE Guidelines for all patients on the drug in the Cardiff & Vale and Cwm Taf Trusts. Changes in Hb1C and weight will be monitored together with any adverse events and changes to concomitant medication. No indication was given as to the length of the audit, but MTEC members agreed that a period of six months would be acceptable. BL agreed to contact Dr Platts, and ask for the completed audit to be forwarded to MTEC.
08/64 iv): Synvisc
The DTC recommendation was considered. It was noted that there were no cost implications with a changeover to Synvisc. It was also concluded that a single injection would reduce the number of outpatient visits necessary, thereby creating the potential for savings in service delivery.
Accordingly, the committee was happy to approve the DTC recommendation that Synvisc 1 should be added to the formulary as a HOSPITAL ONLY product for the treatment of osteoarthritis of the knee.
08/64 v): Balsalazide
The Committee agreed with the reasons for the reinstatement of Balsalazide on the formulary and approved it as a 2nd line SPECIALIST INITIATED agent in patients unable to tolerate Mesalazine.
08/65ii): Vildagliptin
MTEC endorsed the DTC decision to defer consideration of the case for Vildagliptin until the anticipated NICE Guidance is published in February 2009, when Vildagliptin can be considered in the context of all the new agents in the treatment of Type 2 Diabetes.
08/72: Urokinase
DR drew members’ attention to the recommendation made by the DTC in respect of Urokinase (Syner-Kinase®) which is used in connection with blocked catheters. DR pointed out that hitherto, the pharmacy had been buying an expensive unlicensed product from France. Now that there is a new licensed product, available in a range of strengths, MTEC’s approval was sought for it to be included on the formulary.
Members assumed that the cost would be equivalent or lower, and were happy for Urokinase to be added to the formulary.
The DTC Secretary and Formulary Pharmacist will be informed of the above decisions.
08/73: Merger
MTEC members noted the recommendation by Dr Brian Hawkins that the North Bro Taf MTEC should merge with the NICE & High Cost Drugs Group. It was felt that this was not the appropriate way forward for the South Bro Taf area, and that a parallel merger would have no advantages. / BL
MT
New drug recommendations from Bro Taf DTC for addition to the formulary
(ii)Moviprep® bowel preparation for colonoscopy
As this new preparation enables the bowels to be cleaned more effectively prior to colonoscopy, and allow detection of more subtle abnormalities,MTEC members agreed that it should reduce the number of repeat procedures. It was thought necessary to make clear that this preparation should not be used routinely as a laxative.
Moviprep was approved for inclusion in the formulary as a first line agentfor use as a bowel preparation in colonoscopy patients.
The proposer will be duly informed by letter. / BL
(iii)Esomeprazole (Nexium®) for symptomatic treatment of gastro-oesophageal reflux disease (GORD)
Copies of an algorithm prepared by Dr Stone for the use of Esomeprazole in primary care were passed to members for consideration. Also provided was an estimate of the cost impact of the use of esomeprazole (£1,927.55 to £3,855.10) based on an estimated 95 patients in Cardiff and the Vale. An assumption was made that the use of esomeprazole will take the place of existing therapy with lanzoprazole.
The committee agreed for it to be added to the formulary as a HOSPITAL ONLY agent for patients with severe GORD, grade C and D. The initial prescription will be prescribed and supplied in full by the hospital. On discharge to primary care, patients are to be stepped down to treatment with omeprazole or lanzoprazole as per the algorithm supplied by Dr Stone.
The proposer will be duly informed by letter. / BL
Quetiapine fumarate (Seroquel XL®) for schizophrenia and manic episodes associated with bipolar disorder: Fast Track
As this product is a new formulation of other products already on the formulary, the committee accepted that there were no clinical issues to consider, other than the fact that the one-daily dose will have better compliance. Costs were identical, so there were no implications requiring the consideration of the committee.
The committee agreed for it to be added to the formulary as a SPECIALIST INITIATED agent for patients with schizophrenia and manic episodes associated with bipolar disorder.
The proposer will be duly informed by letter. / BL
08/68 / NICE Technology Appraisals: to approve DTC recommendations
TA 157: MTEC members noted the NICE recommendation in respect of Dabigatran (a low molecular weight heparin), with the expectation that that it will be implemented. Failure to do so could raise issues of corporate manslaughter, and it is hoped that this will be noted by the Trust’s Clinical Governance Committee. The Committee were happy to endorse the DTC recommendation that Dabigatran should be included in the formulary as a HOSPITAL INITIATED drug.
TA 158: The committee noted the NICE recommendation for Oseltamivir and Zanamivir to be made first line agents in the formulary, and this will be implemented.
The DTC Secretary and Formulary Pharmacist will be informed of the above decisions. / MT
08/69 / NICE Clinical Guidelines: to approve DTC recommendations
CG 72: The committee noted that the drugs referred to in this Guideline for the diagnosis and management of ADHD in children, young people and adults are already in the formulary as SPECIALIST INITIATED, and a Shared Care Protocol is nearly complete for Methylphenidate.
CG 40: It was noted that there has been some interest expressed in the use of Botulinum Toxin A in cases of urinary incontinence in women. The LHB has received a few requests to use it, and a business case has been submitted within the Cardiff & Vale Trust. Members felt unable to comment further without more information, and AH offered to find out whether the business case has been accepted.
The DTC Secretary and Formulary Pharmacist will be informed of the above decisions. / AH
08/69 / All Wales Medicines Strategy Group (AWMSG) recommendations
The recommendations of the AWMSG were noted by MTEC and the following observations made:
It was felt that GPs would be unhappy to prescribe Rufinamide without a Shared Care Protocol, and that the recommendation made by the DTC should be reappraised.
Members wished to clarify the formulary status of Abacavir and Iamivudine fixed dose (Kivexa®) for the treatment of HIV, which should be HOSPITAL ONLY.
The DTC Secretary and Formulary Pharmacist will be informed of the above decisions. / MT
08/70 / NICE & High Cost Drugs Group
The minutes of the latest meeting were noted.
With regard to Lucentis, it was noted that DR has undertaken to find out whether any LHBs had taken up the reimbursement scheme offered by Novartis.
RB reported that the Sleep Apnoea business case is nearly finalised.
Requests for the use of non-formulary drugs were discussed. DR explained that the requests are sent electronically to him and are then passed to the Trust Commissioning Department. Two forms were needed: an electronic one that elicits all clinical information and a standard form for the Individual Patient Panel. Both are required for a decision to be made.
The materiality limit, discussed at the last NICE & High Cost Drugs meeting, was explained for the benefit of MTEC members. If the cost was likely to be less than £15,000, then it was assumed that this could be met by the Trust from within the LTA. Members were also made aware that where a NICE/AWMSG approved drug ceases to be effective for a patient, then the Trust may request to use an alternative drug, provided that the cost of the alternative treatment is approximately equal to that of the drug previously used.
08/71 / Any Other Business
There was no further business.
08/72 / Dates for future meetings
A draft schedule of dates will be drawn up and sent out to members. /
MT
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South Bro Taf Medicines and Therapeutics Executive Committee
8th December 2008