Confirmed
MINUTES OF THE CARDIFF AND VALE OF GLAMORGAN
MEDICINES AND THERAPEUTICS EXECUTIVE COMMITTEE
HELD ON 4th August 2008
AT CARDIFF LOCAL HEALTH BOARD
Present:
Dr Brendan Lloyd Medical Director, Cardiff LHB (Acting Chair)
Rob MahoneyFinance Director, Vale of Glamorgan LHB
Kate MorrisHoPMM, Cardiff LHB
Karen MayHoPMM, Vale of Glamorgan LHB
Paul EmmersonDeputy Finance Director, Cardiff LHB
Darrell BakerPrincipal Pharmacist, Clinical & Patient Services, Cardiff & Vale NHS Trust
Dr Dwarak SastryAssociate Medical Director, Cardiff & Vale NHS Trust
Dr Richard MooreClinical Director, Nephrology & Transplantation, CardiffVale NHS Trust
Maggie TomkinsRecorder
ACTION
08/36 / ApologiesSharon HopkinsMedical Director, Vale of Glamorgan LHB
Fiona BunceAssistant Director of Finance, Cardiff & Vale NHS Trust
Dave RobertsChief Pharmacist,Cardiff & Vale NHS Trust (deputy Darrell Baker attending)
08/37 / Declarations of interest with regard to items on the agenda
There were no declarations of interest.
08/38 / Minutes of the last meeting held on 7th July 2008
The minutes were agreed to be a true and accurate record with the amendments listed below.
08/30(iv) last sentence to be replaced with:
“DR noted that he and Robin Burfield run a confidential UK-wide web-site for reporting dispensing errors in secondary care. Dispensing errors with insulin was the single most common error reported. Insulin also features in the top 5 medication-related clinical incident reports to the NPSA from across the UK.”
08/32 last paragraph to be replaced with:
“Discussion took place about the risk management of anticoagulant use. Due to the varying target ranges and dosing implications, practice varies across different specialities. A care pathway approach, supported by dosing nomograms, has been developed and an All-Wales prescription chart is being explored.” /
MT
08/39 / Action Notes of meeting held on 7th JulyMembers were able to confirm that all actions listed had been completed.
08/40 / Matters Arising
There were no matters arising not covered by the agenda.
08/41 / (i) Bro Taf D&T Committee – Minutes of previous meeting held on 10th July 2008
The minutes were duly noted by the committee. The attention of members was drawn to the changes to the D&T Committee’s constitution,in light of the merger of Pontypridd & Rhondda and North Glamorgan Trusts.
Other items in the D&T Committee minutes are dealt with in separate agenda items.
(ii) Escitalopram for Generalised Anxiety Disorder
Members noted the e-mailed message from Dr Moore with regard to the anticipated costs of using escitalopram in place of paroxetine (the only other licensed SSRI). The annual cost per patient of using escitalopram would be 2.5 times greater than that of using paroxetine. Based on 1% of the population of Cardiff and the Vale of Glamorgan, the increase in cost was estimated at approximately £¾M.
LHB members raised concerns about the potential increase in the use of this drug outside of the approved indication, and the larger increase if this drug were approved for use in primary care.
It was pointed out that the request for Escitalopram came from a consultant in the North Bro Taf area – but there appears to be little interest from Whitchurch consultants in using this drug.
On the other hand, a view had been expressed by a member of the D&T that this could be a useful 2nd line drug in primary care for those patients unable to tolerate the 1st line choice.
It was felt that further information should be sought from the Clinical Director of Psychiatry, and DB agreed to follow this up.
The Chair also expressed a desire to take advice from a number of primary care representatives before a decision is made, and suggested that a clinical member of the Cardiff Prescribing Steering Group could be nominated for this role.
The proposer, Dr Aziz, Consultant Psychiatrist at St Tydfil’s Hospital, Merthyr Tydfil will be informed by letter that no decision will be made until further advice has been sought. / DB
KMo
BL
(iii) Sitagliptin for Glycaemic Control in Diabetes
It was explained by DB that the D&T Committee had given this request its support because of its proven clinical efficacy and weight reduction. Sitagliptin is also licensed for triple therapy with metformin and a sulphonylurea.
It was noted that the yearly cost per patient is more than the existing glitazones on the formulary, but less than the insulins.
The committee was happy to approve Sitagliptin for formulary inclusion in line with NICE Guidance, as a Second Line agent for initiation in both primary and secondary care, when first line agents have failed or are inappropriate.
The proposers will be duly notified by letter of the decision. / BL
08/42 / NICE Technology Appraisals & Clinical Guidelines
The committee noted and endorsed the decisions made by the D&T Committee in respect of the following NICE Technical Appraisals:
TAG No 142 Epoetin alfa, epoetin beta and darbepoetin alfa for cancer treatment-induced anaemia: Hospital Only for that specific indication
TAG No 143 Adalimumab, etanercept and infliximab for ankylosing spondylitis: Hospital Only
TAG No 144 Rimonabant for the treatment of overweight and obese patients: Specialist Initiated – 2nd line.
Members noted that there was little choice given in the NICE guidance. It was agreed that as the use of Rimonabant is likely to increase under public pressure, it should be monitored carefully through a NICE/High Cost Drugs work programme. BL will take this up with Andrew Evans.
It was also noted that £400,000 is spent on anti-obesity drugs, but we do not have a specific service or commission NPHS to help.
TAG No 145 Cetuximab for the treatment of head and neck cancer: Hospital Only
TAG No 146 Adalimumab for the treatment of psoriasis: Hospital Only
CG No 66 The management of type 2 diabetes (update of clinical guidelines E, F, G and H): Exenatide to be added to the formulary as Specialist Initiated. Auditing against NICE Guidance to be undertaken by the Diabetology Department, which will be asked for provide an audit proposal with criteria.
CG No 67Lipid modification – Recommendations on simvastatin, pravastatin, atorvastatin and rosuvastatin in the formularies to remain the same. / BL
08/43 / All Wales Medicines Strategy Group (AWMSG)
MTEC members noted the drug recommendations made by the AWMSG at its meeting of 13th June, and made the following decisions where appropriate:
- Ziconotide for severe chronic pain: Not recommended – case for cost-effectiveness not proven
- Buprenorphine/naloxone (Suboxone) for opioid dependence: Recommended for restricted use
- Desferasirox (Exjade) for chronic iron overload in ßThalassaemia: Not suitable for shared care
- Lenalidomide (Revlimid) for multiple myeloma: Not recommended – case for cost-effectiveness not proven
- Docetaxel (Taxotere) for head and neck cancer: Recommended for restricted use – not suitable for shared care
6.Fondaparinux sodium (Arixtra®) (STEMI and UA/STEMI) has now been endorsed by the minister. Decision: Hospital Only.
Also noted was a Shared Care Protocol (SCP) for Amiodarone now available and posted on the AWMSG website. DB informed members that there were concerns about the principle of GP opt-out associated with this SCP for Amioderone. For clinical governance reasons, it was felt that there should be confirmation that a GP is willing to take on the patient. The Shared Care Group meets again in early October, and will be raising this issue on grounds of patient safety. MTEC members agreed that these concerns were justified, and some suggestions were made regarding the best administrative way to obtain GP consent. DB thanked MTEC members for their support.
08/44 / Formulary Progress
Emedastine Eye Drops
The recommendation by the D&T Committee that Emedastine eye drops should be removed from the formulary was endorsed.
Decision: Emedastine Eye Drops to be removed from the formulary.
Solaraze
The D&T committee recommended that the instruction for Solaraze should return to the original version as ‘first line’. This was approved.
Decision: Solaraze as first line was endorsed.
Ketoprofen Gel
The addition of the non-proprietary ketoprofen gel to the formulary list of topical NSAIDs (as supported by NICE Clinical Guidance No 59) was then considered. MTEC members noted that there is an all-Wales contract for ketoprofen gel 100g, which will mean that the price will be no higher than ibuprofen.
Decision: Ketoprofen gel to be included on the formulary.
Pregabalin for neuropathic pain
KMa drew attention to MTEC’s decision made in March 2006, which asked for the monitoring and auditing of patients treated with Pregabalin for a year. This was communicated to the proposer, Mr Brian Simpson, Consultant Neurosurgeon in a letter from KMo dated 8th March 2006.
It was agreed that the future of pregabalin in the formulary should not be decided until the pregabalin audit information has been sought from Mr Simpson and given full consideration. The Chair agreed to write to him requesting this information.
The D&T Secretary and Formulary Pharmacist will be informed of these decisions. / BL
MT
08/45 / Doublebase: Rationalisation of Emollients in the Formulary
The attention of MTEC members was drawn to a letter from Dr Andrew Morris who had responded to the Chair’s request for a rationalised list of emollients for the formulary. The list has been reduced to eight, and four emollients have been removed.
The revised list of emollients will be forwarded to the D&T Secretary and Formulary Pharmacist. / MT
08/46 / NICE & High Cost Drugs Group
Members noted the latest minutes from the NICE/High Cost Drugs Group, date 26th June.
BL highlighted the work of the Cardiff & Vale Trust’s Clinical Governance Team in producing an audit to the specifications of the LHB on Anti-TNF Drugs.
Further audits are planned, the first of which will be atypical antipsychotics. The methodology will be discussed at the next meeting of the group on 28th August. Another possible area for audit under discussion is the use of Imatinib for Chronic Myeloid Leukaemia.
08/47 / Any Other Business
There was no further business.
08/48 / Date of Next Meeting
A new date in October will be sought for the next MTEC meeting, details to be advised. / MT
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South Bro Taf Medicines and Therapeutics Executive Committee
Monday 4th August 2008