Background
The increasing availability of a wide range of cancer medicines comes with a rise in cost of service provision posing a challenge to public health services due to limited budgets. Patient Access Schemes (PAS) are a mechanism to reduce cost and support market access by increasing the cost effectiveness of drugs when being assessed in Health Technology Appraisals. The volume of complex PAS proposals is expected to significantly increase for a range of reasons including growth in the number of cancer medicines being used to treat multiple indications (indication?based PAS, IB-PAS).
Objectives
In the National Health Service (NHS) in Scotland PASs are agreed by the Patient Access Scheme Assessment Group (PASAG) and require Senior Pharmacists using prescribing data in a manual process to supply data to PASAG for rebate calculations.
The objectives of this work are for Public Health Scotland (PHS), PASAG and NHS Boards to transition to automated, centralised reports generated with the use of national SACT prescribing data.
Methods
PHS uses national SACT data based on electronic prescribing data for all adult cancer patients treated in NHSScotland to identify the use of a drug within an IB-PAS and allocate this to the relevant indication depending on the information available in the system. PASAG uses this information to calculate the value of rebates based on the volume used per indication.
For validation, NHS Boards are asked to produce their report to be used as a gold standard. The centrally produced reports are compared with local data to investigate and consolidate differences. This process allows PHS to identify and address local variation in recording practices. PASAG, the NHS Boards, PHS and the pharmaceutical company involved in the PAS have to agree before a central reporting approach can be adopted.
Results
To date, two PASs have transitioned to central reporting with additional ones going through validation. So far, the results have shown an increased accuracy of central reports when compared to local reports. A small number of inaccuracies remain in central reports due to the lack of patient notes in national data. It is recognised that the accuracy relies on precise and complete data input and that treatments given outside of NHSScotland are not available when determining an indication.
Despite the additional time investment for validation purposes, results have shown increased efficiency across the system. A scheme that previously required 14 Senior Pharmacists, one per NHS Board, 3-8hours each to create a report can now be completed centrally in approximately 30 minutes.
Conclusions
The close collaboration of PASAG, PHS and the NHS Boards has shown that national SACT data can be used for centralised reporting of PASs. This process has proven to be highly accurate and has led to efficiency savings through minimising the administrative burden for pharmacists. Ultimately, this project has the potential to improve Scotland’s capability to support commercial access agreements, benefiting patients through increased access to new treatments.