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What can prescribing data tell us about FLS effectiveness
1. What can prescribing data
tell us about FLS?
Findings from a new analysis’
3 March 2017
2. 2
Source data
Prescribing data for all CCGs in England is freely
available in easily downloadable files:
https://openprescribing.net/
CCG registered population data is available from:
http://content.digital.nhs.uk/catalogue/
3. 3
This analysis (1)
Looked at a range of data for 44 months, from Apr
2013 to Nov 2016. Available data include:
•All major medicines prescribed for osteoporosis
•Cost
•Number of items
•Quantity per item
•Month of prescription
•CCG
Note: the data are for medicines prescribed in primary
care only
4. 4
This analysis (2)
Using these data we were able to estimate the
number of patients on treatment for each month.
Population data were added to create rates of patients
on treatments for the population aged 50 and over for
each CCG. This is the denominator in every chart in
this presentation
This analysis has yielded a number of findings
11. 11
44 months of decline in rate of PoT
This is equivalent to a decline of around 11.2%. Possible reasons:
Being stopped after 3/5years due to the concerns of the longer term complications
(atypical fractures including in the ear and osteonecrosis of the jaw)
• NICE’s recommendation of discussing stopping after 3 years and NOGGs recommendation
slightly different, as NOGG suggest that patients who go on this ‘drug holiday’ should be
reviewed for fracture risk after 2 years if no fracture in that time (fracture before 2 years =
automatic review) – this is something that is not represented in the NICE pathway for
secondary prevention of Osteoporosis.
• GP’s only have to keep a list of patients who ARE on bisphosphonates. How are GP
surgeries keeping track of all the people they might be stopping for a drug holiday to
review in 2 years? Are people stopped and just not been reviewed again?
Poor adherence to treatment due to:
• Patients perceive that the longer term complications of treatment carry a greater risk that
the complications of another fracture if they didn’t take the bisphosphonates (MHRA
warning etc)
• Administration issues – patients cease to take medication or GPs stopping it as per the
MHRA recommendation that states ‘alendronate, oral ibandronate and risedronate should
be used with caution in patients with active or recent upper gastrointestinal problems’.
17. 17
Will FLS make a difference?
All data from FLS Benefits Calculator and FLS Pathway and Costing Tool
Typical CCG population 300,000
Number of people 50 and over 106,456
FLS cases 1,212
Numbers onto treatment (year) 781
Numbers on treatment at 12 months follow up 625
FLS additional numbers on treatment (year) 312.5
FLS additional numbers on treatment (month) 26.0
18. 18
Will FLS make a difference?
Hypothetical example of a FLS covering 300,000 population typical for England
19. 19
When does the difference show?
Hypothetical example of a FLS covering 300,000 population typical for England
20. 20
Summary (1)
Prescribing data are readily available thanks to
https://openprescribing.net/. These are refreshed
monthly
Population data are readily available and allow us to
create rates of patients on treatment for the target
population
The Charity has this data for every CCG in England
21. 21
Summary (2)
There is a long term and steady decline in rates of
patients on treatment
There are distinctive patterns for CCGs with FLS
services in many cases
Crude models suggest that rate of patients on
treatment per 1000 population 50 and over is useful
measure of effectiveness at a service level
22. 22
Caution
Data is for prescribing in primary care only and does
not tell the whole story
There are large underlying variations in ‘historical’
rates for which we have no explanation
Effective services depend on effective primary care