A case study reviewing Vitamin D prescribing and service development within Oxfordshire
A medicines management opportunity
In 2017 the 70 GP practices within Oxfordshire CCG were dispensing over 5,000 units per month of low dose vitamin D3 supplements as Fultium D3 800 IU capsules or as generic Vitamin D3 800 IU capsules. Oxfordshire CCG identified through routine horizon scanning that a new entrant to the market, InVita D3 800 IU soft capsules, had the potential to save the CCG over £45k per annum due to its lower acquisition price to both Fultium D3 800 IU capsules and generic Vitamin D3 800 IU capsules.
The CCG further reviewed the opportunity and concluded a switch to InVita D3 should be made for several reasons:
- As Vitamin D3 is a Category C medication (branded generic) products are relatively interchangeable
- There would be no patient training involved in the switch as is the case with devices for example
- Some patients prescribed a Vitamin D supplement would have low brand familiarity or loyalty and therefore not be resistant to being switched to another product. (Category C products prescribed under their generic name can be fulfilled at a community pharmacy level by any of the available brands meaning patients may get a different brand of Vitamin D supplements each time they pick up a prescription)
- By changing from generic prescribing to prescribing InVita D3 800 IU soft capsules by brand there was an opportunity to deliver continuity of prescribing
- There was an opportunity to improve dosing for patients by moving patients being prescribed 400 IU twice daily to 800 IU once daily
- Generally there was clinical willingness to prescribe Vitamin D as the brand InVita D3 800 IU soft capsules
- The switch could be made with minimal medicines management resource due to the lack of complexity of the switch
- There were remote opportunities to implement the switch. ScriptSwitch is used in primary care across Oxford and EMIS web is used within each of the practices in Oxfordshire CCG
- Cost savings were sufficient, particularly given the little input that would be required from a CCG perspective. Generic Vitamin D3 800 IU capsules and Fultium D3 800 IU capsules are 34% more expensive than InVita D3 800 IU soft capsules:
Fultium D3 (800 IU capsules)
£3.60 for 30 tablets 1
InVita D3 (800 IU soft capsules)
£2.50 for 28 tablets 1
prescribing generically (800 IU capsules)
£3.60 for 28 tablets 1
Oxfordshire CCG started implementing a switch to InVita D3 800 IU soft capsules as of April 2017 but did not put any proactive work behind the switch due to other priorities. No analysis took place to identify those localities that used the highest volumes of Vitamin D3 to target. Switches were made remotely using ScriptSwitch and EMIS Web and in practice by a member of the medicines management team when they were in practice anyway delivering other workstreams.
Looking at prescribing data in Oxfordshire CCG in 2018, it can be concluded that switching patients to InVita D3 800 IU soft capsules was straight forward and effective at delivering savings.
generic Vitamin D3 to InVita D3 800 IU soft capsules
provided the CCG with
their 4th biggest saving*
* in the QTR ending Jul 2018.
Fultium to InVita D3 800 IU soft capsules
provided the CCG with
their 5th biggest saving*
* in the QTR ending Jul 2018.
In total, the two switches resulted in £15K savings across a 4-month period ending in July 2018.
In summary, the medicines management team from Oxfordshire CCG believe the achievements with Vitamin D3 800 UI soft capsules made to date have been successful in both lowering spend on Vitamin D3 and at improving the quality of prescribing by improving dosing and brand continuity for patients. The medicines management team also feel this has been a useful therapy area to review due to the lack of resource required to achieve the savings and improvements in prescribing.
The secondary care perspective
Aside from optimising prescribing, there was a desire to improve care and service provision to patients in Oxfordshire.
The Oxfordshire Osteoporosis Service formulated a business case to agree funding from the CCG for a new FLS service.
The business case highlighted the ability to make savings by reducing fracture rates and therefore the health and social care costs associated with fractures.
After reviewing the business case, funding for a three year pilot was agreed by the CCG.
- Developing a Fracture Liaison Service which has reduced recurrent fractures by between 20% and 50% and delivered care cost savings in the region of £5M across a five year period
Improving medicines utilisation
- Delivering cost savings by switching patients to a lower cost Vitamin D 800 IU soft capsule supplement (InVita D3)
- Improving dosing and continuity for patients by:
- Moving patients from 400 IU twice daily to 800 IU once daily
- Moving patients from generic prescribing of Vitamin D 800 IU soft capsules to brand prescribing as InVita D3 800 IU soft capsules
- Working to take a baseline assessment of dietary calcium intake so patients are not prescribed calcium and Vitamin D3 combination options when Vitamin D3 is more appropriate
- Prescribing Vitamin D alongside denosumab and other parenteral osteoporosis medications
1. MIMS September 2018.