Fostair® Switch

Karen Homan

NHS Bedfordshire

Fostair® Switch

• Why the switch?

• Supporting information

• Considerations / limitations

• How have we tackled the switch?

• Future work

Top 10 products (current 12 months)

BNF Name Total Act Cost Proprietary Co Enteral Nutrit £1,448,762Seretide £1,235,952Proprietary Co Foods For Spec Diets £569,957Pioglitazone HCl £496,108Losartan Pot £415,929Clenil Modulite £341,751Valsartan £319,557Generic Co Prepn Bnf 0912000 £262,866Enzira £221,755

Seretide® use above SHA average

Alternatives to Seretide®

•

•Project Report Bedfordshire PCT

•28 January 2011 Fostair use first line [Bedfordshire PCT] 1/10

•Project: Fostair use first line

•Description: Fostair should be the first line choice of ICS/LABA combination for adults over the age of 18 with asthma

Target: 50.00%

PCT: 1.46%

SHA: 2.41%

National: 2.60%

Compliant Surgery/PCT: 0

Potential Monthly Savings

Non-Compliant Surgery/PCT: 62 Savings To Target: £43532.79

Savings To 100%: £88371.28

•Project Duration

Start: 28/01/2011

•End:

•Summary

Nov 2010 Aug 2010 May 2010

Total Packs 6,799 6,345 6,295

Total Spend £287,718 £269,447 £266,225

Preferred Packs 99 61 28

Preferred Spend £2,903 £1,789 £821

Restricted Packs 6,700 6,284 6,267

Restricted Spend £284,815 £267,659 £265,404

Compliance 1.46% 0.96% 0.44%

QIPP

• Quality– budesonide, formoterol– opportunity to review asthma management

• Productivity – cheaper alternative without compromising quality and may improve quality.

Supporting information• British guidelines on the management of

asthma• NICE guidance TAG138 www.nice.org.uk/TA138

• Scottish Medicines Consortium

• Fostair® Summary of Product Characteristics

• Joint Prescribing Committee Bulletin on Fostair®

British guidelines on the management of asthma

“…The addition of a long-acting beta2agonist (LABA) should be considered on an individual trial basis (step 3). However, before starting a new drug or stepping up treatment, the patient’s understanding of the role of treatment, adherence to treatment, inhaler technique, and appropriate elimination of trigger factors should be confirmed. Control of asthma should be assessed after an agreed duration, depending on the desire outcome, and the LABA discontinued in the absence of benefit.”

NICE guidance TAG138• “…if treatment with an ICS and LABA is considered

appropriate, the decision to use a combination device or separate devices should be made on an individual basis, taking into consideration therapeutic need and the likelihood of treatment adherence. If a combination device is chosen, then the least costly device that is suitable for the individual is recommended. For new patients, starting them on the most cost-effective option is the most straight forward way of achieving this.”

Scottish Medicines Consortium• Fostair® should be used in patients for whom

beclometasone and formoterol are appropriate choices of corticosteroid and LABA, respectively, and for whom a metered dose inhaler is an appropriate delivery device. It has costs similar to other combination products containing corticosteroid and LABA to which it was clinically non-inferior. The 100mcg dose of beclometasone in Fostair® is not bioequivalent to a 100mcg dose of beclometasone in several other inhaler formulations. The Fostair® summary of product characteristics contains information on transferring from these inhalers to Fostair®.

Considerations / limitations

• Opportunity to review asthma management

• Refrigeration

• 5 month shelf life once dispensed

• Spacer – AeroChamber Plus

• Extrafine particle size

Extrafine particle sizeBeclometasone MDI

Non-extra-fine beclometasone equivalent

Fostair® MDI beclometasone/ formoterol maintenance therapy options

Non-extra-fine beclometasone equivalent

Clenil Modulite® 250 micrograms MDI 2 puffs bd

1000 micrograms Fostair® 100/6 2 puffs bd

1000 micrograms

Qvar® 100 micrograms MDI 2 puffs bd

800-1000micrograms Fostair® 100/6 2 puffs bd

1000 micrograms

Clenil Modulite® 100 micrograms MDI 2 puffs bd

400 micrograms Fostair® 100/6 1 puff bd

500 micrograms

Qvar 50 micrograms MDI 2 puffs bd

400-500 micrograms Fostair® 100/6 1 puff bd

500 micrograms

Fostair®, Seretide®, Symbicort® comparison –not an exact science!

Fostair® Symbicort® Seretide®

Starting dose (ICS dose changed to equivalent in non-extra fine BDP as per SPC definition)

500mcg BDP daily12mcg F daily [Fostair® 100/6 1 puff bd]

400mcg BDP daily12mcg F daily[Symbicort® 200/6 Turbohaler 1 puff bd]

400mcg BDP daily100mcg S daily [Seretide® 50 2 puffs bd]

Maximum dose 1000mcg BDP daily24mcg F daily[Fostair® 100/6 2 puffs bd]

1600mcg BDP daily48mcg F daily[Symbicort® 200/6 Turbohaler 4puffs bd]

2000mcg BDP daily100mcg S daily[Seretide® 500 1 puff bd]

Key: BDP= Non-extra fine beclometasone dipropionate, F=Formoterol fumarate, S=Salmeterol xinafolate

The Switch• Whole system and team approach

• Bedfordshire and Luton Joint Prescribing Committee bulletin Fostair®

• PCT Professional Executive Committee

• JPC communications

• Two hospital Trust DTC approval

• PCT / PBC QIPP 2011 Plans

JPC Recommendation• “To recommend the use of Fostair® for asthma in new patients

who fulfil the licensing and NICE TAG 138 criteria. Patients on existing combination inhalers may be switched if clinically appropriate, but care must be taken as there is potential for error due to dose inequivalencies as the beclometasone in Fostair® is present as extra fine particles and so is not bio or dose equivalent to CFC-containing BDP. In addition, Fostair® has to be stored in a refrigerator prior to dispensing. Once dispensed, a 5 month shelf life is added to the label and the inhaler then does not have to be stored in a refrigerator. The JPC were mindful that this may lead to wastage should prescribers not be aware of this shelf life limitation.”

Fostair bulletin

Future work plans

• QIPP Plans 2011

• Monitor usage using Eclipse

• Work with Trusts to improve use in new patients

• Switching S.O.P.

• COPD

Fostair® switch