Objective To identify drug related cost benefits of an innovative hospital led service to provide unlicensed medicines to children at home.
Methods Actual costs of hospital led supply of unlicensed medicines (including drug costs, delivery costs and service charges) were compared with estimated costs for the same or equivalent regimens recently provided through the usual primary care supply route (general practitioner (GP) prescription dispensed by community pharmacist). Items were supplied under a novel service level agreement between Birmingham Children's Hospital (BCH) and Birmingham East and North (BEN) PCT for unlicensed medicines. The hospital led supply pathway includes GP referral to BCH Pharmacy who determine which unlicensed product is to be dispensed at an agreed price. This is then dispensed and delivered by a community pharmacy partner. Supply was authorised using a patient specific direction signed by a registered prescriber. Estimates of primary care costs were provided by BEN-PCT using recent ePACT data of equivalent dispensed items, or average costs of the item and quantity from a composite database of 22 PCTs.1 Estimated primary care costs include net ingredient costs and dispensing fees as reported on ePACT. Data were entered into MS Excel 2007 for analysis.
Results A total of 67 items were provided under the scheme during the period 15th December 2010 to 25th March 2011. All items were unlicensed medicines in the UK identified by the patient's GP as suitable for the hospital led service. A total of 25 different formulations were supplied (19 different chemical entities). Savings per item ranged from minus £79 (a loss, Sodium Chloride 1 mmol in 1 ml solution) to £1 621.12 (Sildenafil liquid 25 mg in 5 ml). A total of £23 238.39 was estimated as the saving to the PCT, an average of nearly £350 per item supplied. The total cost of the supply for all 67 items via the scheme was £7 144.92 (£106.64 per item). This cost included drug costs, dispensing fee, delivery costs plus a service charge by BCH and was re-charged to BEN-PCT.
Conclusion This study identifies for the first time drug related financial benefits of hospital led supplies of unlicensed medicines for children at home and supports this proposed innovation in National health service (NHS) processes.2 Some PCTs are known to spend more than £500 000 per annum on unlicensed medicines and therefore there is potential for large savings to the NHS.3 Further studies will be required to identify if this level of benefit is generalisable to other populations. It is acknowledged that this study only presents results for a relatively small population; multisite studies of this new innovation and related services, are in preparation.