Our ref:MMT/AdvisoryNote/Spiriva Handihaler
DateOctober2016
To:Practice Prescribing Leads
Practice Managers / Unit 1
St James Business Park
Grimbald Crag Court
Knaresborough
HG5 8QB

Re:Spiriva Handihaler

Dear Colleague,

For the October “Hints and Tips on Prescribing”, the Medicines Management Team would like to encourage practices to review patients who have been prescribed a Spiriva Handihaler for the treatment of COPD.

This is because there are now alternative inhalers available which patients may find easier to use. The Handihaler requires patients to load a capsule into the device, whereas Spiriva Respimat and the newer options such as Incruse Ellipta and Eklira Genuair are ready to use and do not require pre-loading and so are particularly beneficial for elderly patients and those with reduced manual dexterity.

Spiriva Handihaler contains tiotropium and the alternative devices also contain long acting muscarinic agonists (LAMAs). In addition, the newer devices are also lower in price and by switching over to one of these products, over £60k could be saved per annum in HaRD CCG.

Incruse Ellipta, Eklira Genuair and Spiriva Respimat are included in the new guidelines for the diagnosis and management of COPD from HDFT and the Respiratory Team at HDFT are also encouraging the use of these new devices.

Brand name / Manufacturer / LAMA / Strength / Manufacturer’s licensed dose / Price
Spiriva Handihaler / Boehringer Ingleheim / Tiotropium / 18 microgram capsule / 18micrograms (one capsule) once a day / Device plus 30 caps £34.87
30 capsules only £33.50
Spiriva Respimat / Boehringer Ingleheim / Tiotropium / 2.5 microgram per dose / 5 micrograms (two puffs) once daily / 60 dose inhaler
£23
Incruse Ellipta / GSK / Umeclidinium bromide / 65 micrograms per dose (equiv. to 55micrograms of umeclidinium) / 55micrograms of umeclidinium once a day / 30 dose dry powder inhaler
£27.50
Eklira Genuair / Astra Zeneca / Aclidinium bromide / 375 micrograms per dose (equiv. to 322 micrograms of aclidinium) / 322 micrograms of aclidinium twice a day / 60 dose dry powder inhaler
£28.60

Action points

  • Please review all patients who are currently prescribed a Spiriva Handihaler and consider changing to Spiriva Respimat, Incruse Ellipta, Eklira Genuair.
  • We suggest that each practice obtains some placebo devices from the local company reps in order to allow all staff involved in the treatment of COPD to become familiar with these new devices.

Contact details of company reps:GSK: Maria Lancaster 07771 810661

Astra Zeneca: Yvonne Webster 07810 528683

Boehringer: Donna Dabell 07770 334904

  • Ensure that patients are shown how to use their new inhaler.
  • If patients are switched to Spiriva Respimat, Incruse Ellipta or Eklira Genuair, please prescribe by the brand name.
  • Please be aware there have been two recent prescribing errors involving Spiriva Respimat inhaler, which contains only tiotropium and Spiolto Respimat inhaler, which is a LAMA / LABA combination inhaler and contains tiotropium and olodaterol.
  • Please share this information with all members of staff in the practice who are involved in the treatment of patients with COPD.

Prescriptions for Spiriva Handihaler in HaRD practices - 3 months to June 2016

Prescriber Name / Total Items (3m) / Total Costs (3m) / Est. annual savings if switch
BEECH HOUSE SURGERY / 137 / £4,254.66 / £2794
CHURCH AVENUE MEDICAL GROUP / 179 / £7,640.41 / £5018
CHURCH LANE SURGERY / 348 / £11,434.45 / £7509
DR AKESTER & PARTNERS / 111 / £3,538.36 / £2324
DR INGRAM & PTRS / 48 / £1,533.30 / £1007
EAST PARADE SURGERY / 78 / £4,325.86 / £2841
EASTGATE MEDICAL GROUP / 262 / £8,827.30 / £5797
KINGSWOOD SURGERY / 108 / £3,878.87 / £2547
NIDDERDALE GROUP PRACTICE / 139 / £4,326.10 / £2841
NORTH HOUSE SURGERY / 226 / £7,095.62 / £4660
PARK PARADE SURGERY / 65 / £2,646.40 / £1738
RIPON SPA SURGERY / 244 / £7,736.41 / £5081
SPRINGBANK SURGERY / 72 / £2,273.65 / £1493
STOCKWELL ROAD SURGERY / 98 / £3,888.58 / £2554
THE LEEDS ROAD PRACTICE / 226 / £7,095.47 / £4660
THE MOSS PRACTICE / 373 / £13,478.72 / £8852
THE SPA SURGERY / 179 / £7,093.49 / £4658
TOTALS / 2,893 / £101,067.65 / £66374

OurPrescribing Support Team is available to help practices with this work if required.HaRD versions of OptimiseRx and SystmOne and EMIS formularies will be amended to incorporate these recommendations.

Local community pharmacies have been e-mailed to inform them that practices will be undertaking this switch. As the timings of the switch will vary between practices it is advisable that each practice notifies its local pharmacies in advance of the switch to enable effective management of stock.

Yours sincerely,

The Medicines Management Team, HaRD CCG.

References

1. eBNF accessed 8.9.16

2. Guidelines for the diagnosis and management of HDFT:

Spiriva Handihaler

Monthly briefing/letter – Oct 16Page 1 of 2HaRD Medicines Management Team