DMT Monitoring Project Rachel Dorsey-Campbell, Senior Lead - PowerPoint PPT Presentation

DMT Monitoring Project Rachel Dorsey-Campbell, Senior Lead Pharmacist Neurosciences , Imperial College Healthcare NHS Trust Anthony Lawton, Health Economist, NHS RightCare Associate Sue Thomas, CEO Wilmington HealthCare Consulting Amanda Worpole, Neurology Academy, Project Manager No funding has been received from any source to support this work

Aim of monitoring is to minimise risk • 11 DMTs with different monitoring schedules • Increasing choice for patients and clinicians • Increased effectiveness vs. increased risk BUT • Activity currently not commissioned or funded • Burden borne by MS service & usually MSN

Issues Finance: Activity currently not commissioned or funded Variation: • Multiple service models: spreadsheets, EPR, pharma-funded, DAWN, CCG shared care Workforce: • Impacts on MS nurse and pharmacy role reducing patient facing time • Time burden Systems • More than one pathology computer system • Interpretation of results

Where did the numbers come from? • 12 months anonymised Blueteq cost data: total spend on each DMT • Costs divided by published cost of each DMT • Estimate of number of patients treated (rounded down) • 5 year DMT blood monitoring estimate • Caveats: – Drug may be stopped – Different monitoring regime if blood results abnormal – Assumes 10% growth in prescriptions of all DMTs except interferons

Size of the burden - numbers No. of No. of No. of No. of No. of No. blood No. blood No. blood No. blood No. blood patients patients on patients on patients patients tests Y1 tests Y2 tests Y3 tests Y4 tests Y5 on DMT Y1 DMT Y2 DMT Y3 on DMT Y4 on DMT Y5 DMT ALEMTUZUMAB 2046 24549 2250 27004 2475 29704 2,723 35,645 2,995 39,210 DMF 3542 17710 3896 15939 4286 17533 4,714 21,000 5,186 23,101 FINGOLIMOD 2271 13628 2498 6360 2748 6496 3,023 7,695 3,325 8,465 INTERFERON 5508 11015 5508 11015 5508 11015 5,508 11,015 5,508 11,015 NATALIZUMAB 4069 8139 4476 9767 4924 9848 5,416 11,817 5,958 12,999 TERIFLUNOMIDE 513 7175 564 4100 620 5525 682 4,961 750 5,457 GLATIRAMER 2761 2761 3037 3313 3341 3341 3,675 4,009 4,042 4,410 TOTALS 20709 84977 22229 77497 23902 83462 25,741 96,143 27,764 104,656 Phlebotomy & £350,954 £ 320,064 £ 344,697 £397,072 £432,230 lab tariffs

Cost burden Normal Abnormal MSNS only – time spent on Year 1 Incl tariffs bloods bloods Total bloods associated tasks: Band 7 (top) MSNS hourly rates applied. £ 1,641,751 only £ 1,161,717 £ 129,080 £ 1,290,797 MSNS + MSNS + admin – time spent on £ 1,109,797 admin £ 682,958 £ 75,884 £ 758,843 associated tasks divided between admin resource (top Normal Abnormal Band 4)and MSNS (top band Year 2 bloods bloods Total bloods 7); hourly rates applied. MSNS only £ 947,118 £ 117,718 £ 1,064,837 £ 1,415,791 MSNS + admin £ 556,798 £ 69,205 £ 626,004 £ 976,958 £3.00 Plebotomy unit average tariff £1.13 Clinical biochemistry unit average tariff

Time burden 26.67 hours

Issues & risks • Single MSNS – holidays, sickness, time away • Uncertainty – have abnormal results been acted upon? • Absent neurologist • DMT choice based on monitoring burden • Patient complaints if drug not prescribed • Relying on goodwill of other staff • Transport of bloods to lab in time • Personnel changes • Extra costs for urgent homecare deliveries • Block contracts • Generics/biosimilars

What does the future hold? How do we future-proof? Scope of this project National overview Commissioning toolkit GIRFT Burden calculation tool – time, numbers, cost Service models Business case

The Future? We’ve highlighted the variation Is this an issue for GIRFT? http://www.multiplesclerosisacademy.org/resources