1. Karen Homan NHS Bedfordshire
Fostair® Switch
Karen Homan
NHS Bedfordshire

2. Fostair® Switch Why the switch? Supporting information
Considerations / limitations
How have we tackled the switch?
Future work

3. Top 10 products (current 12 months)
BNF Name
Total Act Cost
Proprietary Co Enteral Nutrit
£1,448,762
Seretide
£1,235,952
Proprietary Co Foods For Spec Diets
£569,957
Pioglitazone HCl
£496,108
Losartan Pot
£415,929
Clenil Modulite
£341,751
Valsartan
£319,557
Generic Co Prepn Bnf
£262,866
Enzira
£221,755

4. Seretide® use above SHA average

5. Alternatives to Seretide®

6. Project Report Bedfordshire PCT
Project: Fostair use first line
Description: Fostair should be the first line choice of ICS/LABA combination for adults over the age of 18 with asthma
Project Duration
Target:
50.00%
PCT:
1.46%
SHA:
2.41%
National:
2.60%
Compliant Surgery/PCT:
Potential Monthly Savings
Non-Compliant Surgery/PCT: 62
Savings To Target: £
Savings To 100%: £
Start:
28/01/2011
End:
Summary
Nov 2010
Aug 2010
May 2010
Total Packs
6,799
6,345
6,295
Total Spend
£287,718
£269,447
£266,225
Preferred Packs 99 61 28
Preferred Spend
£2,903
£1,789
£821
Restricted Packs
6,700
6,284
6,267
Restricted Spend
£284,815
£267,659
£265,404
Compliance
1.46%
0.96%
0.44%
28 January 2011 Fostair use first line [Bedfordshire PCT] 1/10

7. QIPP
Quality
budesonide, formoterol
opportunity to review asthma management
Productivity – cheaper alternative without compromising quality and may improve quality.

8. Supporting information
British guidelines on the management of asthma
NICE guidance TAG138
Scottish Medicines Consortium
Fostair® Summary of Product Characteristics
Joint Prescribing Committee Bulletin on Fostair®

9. British guidelines on the management of asthma
“…The addition of a long-acting beta2agonist (LABA) should be considered on an individual trial basis (step 3). However, before starting a new drug or stepping up treatment, the patient’s understanding of the role of treatment, adherence to treatment, inhaler technique, and appropriate elimination of trigger factors should be confirmed. Control of asthma should be assessed after an agreed duration, depending on the desire outcome, and the LABA discontinued in the absence of benefit.”

10. NICE guidance TAG138
“…if treatment with an ICS and LABA is considered appropriate, the decision to use a combination device or separate devices should be made on an individual basis, taking into consideration therapeutic need and the likelihood of treatment adherence. If a combination device is chosen, then the least costly device that is suitable for the individual is recommended. For new patients, starting them on the most cost-effective option is the most straight forward way of achieving this.”

11. Scottish Medicines Consortium
Fostair® should be used in patients for whom beclometasone and formoterol are appropriate choices of corticosteroid and LABA, respectively, and for whom a metered dose inhaler is an appropriate delivery device. It has costs similar to other combination products containing corticosteroid and LABA to which it was clinically non-inferior. The 100mcg dose of beclometasone in Fostair® is not bioequivalent to a 100mcg dose of beclometasone in several other inhaler formulations. The Fostair® summary of product characteristics contains information on transferring from these inhalers to Fostair®.

12. Considerations / limitations
Opportunity to review asthma management
Refrigeration
5 month shelf life once dispensed
Spacer – AeroChamber Plus
Extrafine particle size

13. Extrafine particle size
Beclometasone MDI
Non-extra-fine beclometasone equivalent
Fostair® MDI beclometasone/ formoterol maintenance therapy options
Clenil Modulite® 250 micrograms MDI 2 puffs bd
1000 micrograms
Fostair® 100/6
2 puffs bd
Qvar® 100 micrograms MDI 2 puffs bd
micrograms
Clenil Modulite® 100 micrograms MDI 2 puffs bd
400 micrograms
1 puff bd
500 micrograms
Qvar 50 micrograms MDI 2 puffs bd
micrograms

14. Fostair®, Seretide®, Symbicort® comparison –not an exact science!
Starting dose (ICS dose changed to equivalent in non-extra fine BDP as per SPC definition)
500mcg BDP daily
12mcg F daily [Fostair® 100/6 1 puff bd]
400mcg BDP daily
12mcg F daily
[Symbicort® 200/6 Turbohaler 1 puff bd]
100mcg S daily [Seretide® 50 2 puffs bd]
Maximum dose
1000mcg BDP daily
24mcg F daily
[Fostair® 100/6 2 puffs bd]
1600mcg BDP daily
48mcg F daily
[Symbicort® 200/6 Turbohaler 4puffs bd]
2000mcg BDP daily
100mcg S daily
[Seretide® puff bd]
Key: BDP= Non-extra fine beclometasone dipropionate, F=Formoterol fumarate, S=Salmeterol xinafolate

15. The Switch Whole system and team approach
Bedfordshire and Luton Joint Prescribing Committee bulletin Fostair®
PCT Professional Executive Committee
JPC communications
Two hospital Trust DTC approval
PCT / PBC QIPP 2011 Plans

16. JPC Recommendation
“To recommend the use of Fostair® for asthma in new patients who fulfil the licensing and NICE TAG 138 criteria. Patients on existing combination inhalers may be switched if clinically appropriate, but care must be taken as there is potential for error due to dose inequivalencies as the beclometasone in Fostair® is present as extra fine particles and so is not bio or dose equivalent to CFC-containing BDP. In addition, Fostair® has to be stored in a refrigerator prior to dispensing. Once dispensed, a 5 month shelf life is added to the label and the inhaler then does not have to be stored in a refrigerator. The JPC were mindful that this may lead to wastage should prescribers not be aware of this shelf life limitation.”

17. Future work plans QIPP Plans 2011 Monitor usage using Eclipse
Work with Trusts to improve use in new patients
Switching S.O.P.
COPD

18. Fostair® switch