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

DMT

• No. of

patients

• n DMT Y1
• No. blood

tests Y1

• No. of

patients on DMT Y2

• No. blood

tests Y2

• No. of

patients on DMT Y3

• No. blood

tests Y3

• No. of

patients

• n DMT Y4
• No. blood

tests Y4

• No. of

patients

• n DMT Y5
• No. blood

tests Y5 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 & lab tariffs £350,954 320,064 £ 344,697 £ £397,072 £432,230

Cost burden

Year 1 Normal bloods Abnormal bloods Total bloods MSNS

• nly

1,161,717 £ 129,080 £ 1,290,797 £ MSNS + admin 682,958 £ 75,884 £ 758,843 £ Year 2 Normal bloods Abnormal bloods Total bloods MSNS

• nly

947,118 £ 117,718 £ 1,064,837 £ MSNS + admin 556,798 £ 69,205 £ 626,004 £

£3.00 Plebotomy unit average tariff £1.13 Clinical biochemistry unit average tariff

MSNS only – time spent on associated tasks: Band 7 (top) hourly rates applied. MSNS + admin – time spent on associated tasks divided between admin resource (top Band 4)and MSNS (top band 7); hourly rates applied.

Incl tariffs 1,641,751 £ 1,109,797 £ 1,415,791 £ 976,958 £

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?

http://www.multiplesclerosisacademy.org/resources

We’ve highlighted the variation Is this an issue for GIRFT?