11.3 million. Short Acting Beta2 Agonists & Budesonide Dry Powder Market Analysis. impact500

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1 impact500 October 2017 Market Update: Pulmicort Turbohaler & Bricanyl Turbohaler Price Increase Short Acting Beta2 Agonists & Budesonide Dry Powder Market Analysis ENABLING SAVINGS FOR THE NHS OF 11.3 million Realising Your Potential Analysis was undertaken using October 2017 tariff and July 2017 Epact Data PAGE 1

2 If no action is taken CCGs will see an increase of up to 20% on Pulmicort Turbohaler and Bricanyl Turbohaler prescribing costs. Pulmicort 100 Turbohaler % Increase Pulmicort 200 Turbohaler % Increase Pulmicort 400 Turbohaler % Increase Bricanyl Turbohaler 100 dose % Increase For a more in depth analysis please visit the impact500 Easyhaler project issued April 2017: library.impact500.org.uk/docs/impact500-easyhaler.pdf Analysis was undertaken using October 2017 tariff and July 2017 Epact Data PAGE 2

3 Short Acting Beta2 Agonists JULY 2017 EPACT & OCTOBER DRUG TARIFF MARKET SUMMARY COST & PACKS BY MONTH COST TO NHS IN JULY ,712,506 PACKS PRESCRIBED IN JULY ,369,746 6, 360,000 5,360,000 4,360,000 3,360,000 2,360,000 1,360,000 3,000,000 2,500,000 2,000,000 1,500,000 1,000, ,000 COST & PACKS / JULY 2017 PRESCRIBING DATA 360, 000 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 0 DRUG COST PACKS Salbutamol MDI 41% 55% Ventolin Evohaler 24% 32% Unspecified 12% 4% Bricanyl / Terbutaline 9% 3% COST PACKS Salamol Easi-Breathe 6% 2% Other 9% 5% COST-EFFECTIVE CHOICE MDI Generic Salbutamol MDI Ventolin Evohaler MDI Salamol Dry Powder Easyhaler Salbutamol Cost-Effective Choices - Cost per Actuation MDI Generic Salbutamol 0.01 Ventolin Evohaler 0.01 Salamol 0.01 Dry Powder/Breath Actuated Easyhaler Salbutamol 0.02 Analysis was undertaken using October 2017 tariff and July 2017 Epact Data PAGE 3

4 SHORT ACTING BETA2 AGONISTS DRY POWDER/BREATH ACTUATED INHALERS - COST PER ACTUATION - LOW DOSE Easyhaler Salbutamol Asmasal Clickhaler Airomir Autohaler Salamol Easi-Breathe Unspecified Salbutamol Inhaler SHORT ACTING BETA2 AGONISTS DRY POWDER/BREATH ACTUATED INHALERS - COST PER ACTUATION - HIGH DOSE Easyhaler Salbutamol Ventolin Accuhaler Bricanyl / Terbutaline Analysis was undertaken using October 2017 tariff and July 2017 Epact Data PAGE 4

5 Budesonide Dry Powder JULY 2017 EPACT & OCTOBER DRUG TARIFF MARKET SUMMARY COST & PACKS BY MONTH COST TO NHS IN JULY ,079 PACKS PRESCRIBED IN JULY , , , , , , , , , , , , ,000 35,000 30,000 25,000 20,000 15, ,000 5, Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 COST & PACKS / JULY 2017 PRESCRIBING DATA DRUG COST PACKS Pulmicort 86% 86% Easyhaler Budesonide 14% 14% COST PACKS Easyhaler Budesonide Cost-Effective Choices - Cost per Actuation Easyhaler Budesonide 100mg Easyhaler Budesonide 200mg Easyhaler Budesonide 400mg Analysis was undertaken using October 2017 tariff and July 2017 Epact Data PAGE 5

6 TARIFF COST PER DOSE - 100MG Easyhaler Budesonide 100mg 0.04 Pulmicort 100mg 0.07 TARIFF COST PER DOSE - 200MG Easyhaler Budesonide 200mg 0.09 Pulmicort 200mg 0.14 TARIFF COST PER DOSE - 400MG Easyhaler Budesonide 400mg 0.18 Pulmicort 400mg 0.29 Analysis was undertaken using October 2017 tariff and July 2017 Epact Data PAGE 6

7 Top CCG Potential Annual Savings July Dry Powder/Breath Actuated savings by switching to Easyhaler Salbutamol July Budesonide Dry Powder savings by switching to Easyhaler Budesonide CCG NAME BUDESONIDE POTENTIAL SABAS POTENTIAL TOTAL POTENTIAL NATIONAL 1,791,451 9,552,362 11,343,813 LIVERPOOL CCG 14, , ,409 NORTH, EAST, WEST DEVON CCG 22, , ,772 CAMBRIDGESHIRE AND PETERBOROUGH CCG 19, , ,452 BIRMINGHAM CROSSCITY CCG 16, , ,275 DORSET CCG 22, , ,037 SHEFFIELD CCG 19, , ,445 EAST LANCASHIRE CCG 16, , ,101 CUMBRIA CCG 28,869 99, ,028 NORTHUMBERLAND CCG 27,900 99, ,212 LEEDS WEST CCG 16,182 91, ,153 EAST AND NORTH HERTFORDSHIRE CCG 23,302 84, ,079 DONCASTER CCG 15,341 91, ,387 KERNOW CCG 17,864 88, ,120 BLACKPOOL CCG 12,882 91, ,494 WAKEFIELD CCG 18,772 84, ,036 SOUTHERN DERBYSHIRE CCG 16,247 86, ,695 GLOUCESTERSHIRE CCG 18,125 84, ,558 STOCKPORT CCG 16,246 84, ,322 WIGAN BOROUGH CCG 17,153 81,629 98,782 LEEDS SOUTH AND EAST CCG 9,904 87,214 97,118 SOUTH TEES CCG 13,464 83,629 97,093 SANDWELL AND WEST BIRMINGHAM CCG 8,803 87,756 96,559 VALE OF YORK CCG 21,878 74,623 96,501 TRAFFORD CCG 15,601 80,487 96,088 NENE CCG 15,922 79,867 95,789 SUNDERLAND CCG 11,846 81,094 92,939 BARNSLEY CCG 12,363 79,880 92,243 ROTHERHAM CCG 10,098 81,633 91,731 BOLTON CCG 10,292 81,016 91,308 COASTAL WEST SUSSEX CCG 17,477 72,832 90,309 COVENTRY AND RUGBY CCG 14,500 74,570 89,070 HERTS VALLEYS CCG 23,498 65,496 88,993 NORTH KIRKLEES CCG 14,110 74,509 88,619 BLACKBURN WITH DARWEN CCG 12,233 75,436 87,669 DURHAM DALES, EASINGTON AND SEDGEFIELD CCG 15,148 72,512 87,660 EAST RIDING OF YORKSHIRE CCG 13,076 72,871 85,946 NORTH TYNESIDE CCG 22,139 62,815 84,954 WEST HAMPSHIRE CCG 11,587 73,062 84,649 HARTLEPOOL AND STOCKTON-ON-TEES CCG 11,716 72,839 84,555 LINCOLNSHIRE EAST CCG 12,945 71,517 84,462 CCGs with highest available savings CCGs with intermediate available savings CCGs with lower available savings Analysis was undertaken using October 2017 tariff and July 2017 Epact Data PAGE 7

8 CCG NAME BUDESONIDE POTENTIAL SABAS POTENTIAL TOTAL POTENTIAL NATIONAL 1,791,451 9,552,362 11,343,813 GREATER HUDDERSFIELD CCG 14,565 68,648 83,213 SOMERSET CCG 11,068 70,705 81,773 NORTH MANCHESTER CCG 9,127 72,279 81,406 HEYWOOD, MIDDLETON AND ROCHDALE CCG 8,609 72,748 81,357 NOTTINGHAM CITY CCG 10,356 70,141 80,498 BRADFORD DISTRICTS CCG 8,415 70,893 79,307 FYLDE & WYRE CCG 14,500 64,548 79,048 WIRRAL CCG 7,703 70,262 77,965 NORTH DURHAM CCG 15,276 62,200 77,476 TAMESIDE AND GLOSSOP CCG 12,234 61,477 73,711 SHROPSHIRE CCG 9,968 63,709 73,676 HULL CCG 8,092 65,058 73,150 WALSALL CCG 8,351 63,424 71,774 BEDFORDSHIRE CCG 10,486 61,221 71,707 WILTSHIRE CCG 8,674 62,883 71,558 GREATER PRESTON CCG 13,983 56,395 70,378 NORTH EAST ESSEX CCG 8,674 60,707 69,381 WOLVERHAMPTON CCG 8,868 60,415 69,283 OLDHAM CCG 7,120 60,745 67,865 NORTH DERBYSHIRE CCG 12,751 54,977 67,728 WEST LEICESTERSHIRE CCG 9,386 56,203 65,589 ST HELENS CCG 7,898 57,679 65,576 SALFORD CCG 4,854 60,391 65,245 SOUTH MANCHESTER CCG 8,480 55,589 64,068 LEICESTER CITY CCG 5,955 57,998 63,953 SOUTH WORCESTERSHIRE CCG 7,185 56,204 63,389 CROYDON CCG 9,709 52,847 62,556 LINCOLNSHIRE WEST CCG 6,602 55,496 62,098 HAMBLETON, RICHMONDSHIRE AND WHITBY CCG 17,672 44,412 62,084 IPSWICH AND EAST SUFFOLK CCG 8,414 52,755 61,170 BRISTOL CCG 8,609 51,776 60,385 CHORLEY AND SOUTH RIBBLE CCG 11,716 47,874 59,589 SOUTH WARWICKSHIRE CCG 10,422 49,041 59,462 WEST KENT CCG 9,191 49,071 58,262 DUDLEY CCG 9,709 47,683 57,392 CALDERDALE CCG 11,523 45,725 57,248 WEST ESSEX CCG 5,826 51,107 56,933 WARRINGTON CCG 8,739 48,159 56,898 GATESHEAD CCG 10,163 46,194 56,357 BRENT CCG 9,257 46,863 56,119 NORTH WEST SURREY CCG 9,191 46,006 55,197 BURY CCG 4,854 50,143 54,997 SOUTHWARK CCG 12,040 42,848 54,888 LEEDS NORTH CCG 9,062 45,714 54,776 CENTRAL MANCHESTER CCG 8,091 46,450 54,541 AIREDALE, WHARFDALE AND CRAVEN CCG 5,891 48,048 53,939 STOKE ON TRENT CCG 5,049 48,651 53,700 Analysis was undertaken using October 2017 tariff and July 2017 Epact Data PAGE 8 CCGs with highest available savings CCGs with intermediate available savings CCGs with lower available savings

9 CCG NAME BUDESONIDE POTENTIAL SABAS POTENTIAL TOTAL POTENTIAL NATIONAL 1,791,451 9,552,362 11,343,813 SOUTH DEVON AND TORBAY CCG 8,220 44,865 53,086 HARROGATE AND RURAL DISTRICT CCG 12,623 40,403 53,026 BIRMINGHAM SOUTH AND CENTRAL CCG 5,761 45,926 51,687 SOUTH SEFTON CCG 6,150 44,541 50,690 BRIGHTON AND HOVE CCG 9,774 40,664 50,438 OXFORDSHIRE CCG 13,399 36,847 50,246 NOTTINGHAM NORTH AND EAST CCG 8,026 42,119 50,145 EASTBOURNE, HAILSHAM AND SEAFORD CCG 10,228 39,862 50,090 LANCASHIRE NORTH CCG 5,631 43,949 49,581 EASTERN CHESHIRE CCG 12,558 37,021 49,578 BARNET CCG 9,710 39,703 49,413 LAMBETH CCG 7,379 40,939 48,318 MID ESSEX CCG 6,084 42,074 48,158 EALING CCG 11,004 36,577 47,580 SOLIHULL CCG 5,243 42,236 47,479 DARTFORD, GRAVESHAM AND SWANLEY CCG 7,573 39,581 47,153 LEWISHAM CCG 7,056 39,882 46,938 REDDITCH AND BROMSGROVE CCG 4,402 42,065 46,466 ISLE OF WIGHT CCG 4,595 41,761 46,356 WEST SUFFOLK CCG 7,444 38,833 46,277 BROMLEY CCG 7,379 38,298 45,678 HALTON CCG 4,337 40,866 45,202 EAST LEICESTERSHIRE AND RUTLAND CCG 4,790 40,406 45,195 NORTH LINCOLNSHIRE CCG 5,567 39,280 44,847 WEST CHESHIRE CCG 7,574 37,224 44,798 NORTH STAFFORDSHIRE CCG 6,796 37,934 44,730 MANSFIELD AND ASHFIELD CCG 5,049 38,850 43,899 CHILTERN CCG 15,795 27,715 43,509 WANDSWORTH CCG 7,121 36,277 43,397 SOUTH EAST STAFFS AND SEISDON PENINSULAR CCG 8,026 34,740 42,767 NEWCASTLE NORTH AND EAST CCG 11,067 30,433 41,499 GREAT YARMOUTH AND WAVENEY CCG 5,373 35,166 40,538 HASTINGS AND ROTHER CCG 5,632 34,032 39,663 MILTON KEYNES CCG 6,666 32,503 39,169 SURREY DOWNS CCG 8,221 30,834 39,054 HARROW CCG 12,493 26,555 39,049 SOUTH WEST LINCOLNSHIRE CCG 7,185 31,787 38,972 SOUTH TYNESIDE CCG 6,343 31,935 38,278 MEDWAY CCG 3,301 34,785 38,086 KNOWSLEY CCG 2,719 34,986 37,705 SOUTH LINCOLNSHIRE CCG 4,725 32,838 37,563 SOUTH CHESHIRE CCG 8,869 28,625 37,494 BASILDON AND BRENTWOOD CCG 7,185 29,741 36,926 NEWCASTLE WEST CCG 5,761 31,006 36,768 BASSETLAW CCG 4,143 32,603 36,746 SCARBOROUGH AND RYEDALE CCG 9,451 27,268 36,719 CCGs with highest available savings CCGs with intermediate available savings CCGs with lower available savings Analysis was undertaken using October 2017 tariff and July 2017 Epact Data PAGE 9

10 CCG NAME BUDESONIDE POTENTIAL SABAS POTENTIAL TOTAL POTENTIAL NATIONAL 1,791,451 9,552,362 11,343,813 WEST NORFOLK CCG 4,337 31,243 35,579 HIGH WEALD LEWES HAVENS CCG 6,149 28,502 34,652 GREENWICH CCG 4,078 30,087 34,165 SOUTHAMPTON CCG 4,401 29,306 33,707 HORSHAM AND MID SUSSEX CCG 6,537 27,165 33,702 HEREFORDSHIRE CCG 6,862 26,785 33,647 SOUTH GLOUCESTERSHIRE CCG 4,725 28,920 33,645 WARWICKSHIRE NORTH CCG 5,566 27,939 33,505 NORTH SOMERSET CCG 5,049 28,094 33,143 TELFORD AND WREKIN CCG 3,690 29,387 33,077 HILLINGDON CCG 8,739 24,117 32,856 SOUTH KENT COAST CCG 6,020 26,736 32,756 PORTSMOUTH CCG 3,560 29,155 32,715 WALTHAM FOREST CCG 5,114 27,456 32,570 CANNOCK CHASE CCG 4,208 28,129 32,336 BEXLEY CCG 2,395 29,935 32,329 NORTH HAMPSHIRE CCG 6,149 25,826 31,974 SOUTH EASTERN HAMPSHIRE CCG 5,049 26,732 31,780 NORWICH CCG 5,113 26,503 31,616 HAVERING CCG 5,502 25,107 30,608 TOWER HAMLETS CCG 6,991 23,300 30,291 EAST STAFFORDSHIRE CCG 2,784 27,277 30,060 CAMDEN CCG 6,019 23,944 29,963 STAFFORD AND SURROUNDS CCG 5,308 24,542 29,850 REDBRIDGE CCG 7,315 22,059 29,374 RUSHCLIFFE CCG 5,438 23,809 29,247 NEWARK & SHERWOOD CCG 4,337 24,727 29,064 ENFIELD CCG 5,826 23,123 28,948 BRADFORD CITY CCG 2,977 25,586 28,564 CANTERBURY AND COASTAL CCG 3,690 24,753 28,443 NEWHAM CCG 6,538 21,856 28,394 CASTLE POINT AND ROCHFORD CCG 5,243 22,635 27,878 NOTTINGHAM WEST CCG 3,819 24,017 27,836 FAREHAM AND GOSPORT CCG 3,496 24,170 27,665 HOUNSLOW CCG 6,214 21,361 27,576 SUTTON CCG 3,366 24,200 27,566 NORTH EAST LINCOLNSHIRE CCG 3,172 23,832 27,004 NORTH NORFOLK CCG 4,596 22,374 26,969 SOUTHEND CCG 4,725 22,171 26,896 BATH AND NORTH EAST SOMERSET CCG 4,919 21,689 26,608 KINGSTON CCG 4,725 21,052 25,777 SOUTH NORFOLK CCG 3,755 21,907 25,662 HARDWICK CCG 3,431 21,395 24,826 BARKING AND DAGENHAM CCG 3,366 21,071 24,437 VALE ROYAL CCG 6,085 18,272 24,357 DARLINGTON CCG 3,754 20,477 24,231 CCGs with highest available savings CCGs with intermediate available savings CCGs with lower available savings Analysis was undertaken using October 2017 tariff and July 2017 Epact Data PAGE 10

11 CCG NAME BUDESONIDE POTENTIAL SABAS POTENTIAL TOTAL POTENTIAL NATIONAL 1,791,451 9,552,362 11,343,813 WEST LONDON (K&C & QPP) CCG 5,373 18,518 23,890 SWINDON CCG 2,589 21,259 23,848 HARINGEY CCG 5,955 17,891 23,846 EAST SURREY CCG 6,667 17,150 23,817 NORTH EAST HAMPSHIRE AND FARNHAM CCG 4,790 18,649 23,438 CRAWLEY CCG 3,366 19,338 22,705 MERTON CCG 3,625 18,814 22,438 CITY AND HACKNEY CCG 4,984 17,366 22,350 SOUTHPORT AND FORMBY CCG 3,819 18,474 22,293 THANET CCG 3,366 18,922 22,288 LUTON CCG 2,977 18,974 21,951 WEST LANCASHIRE CCG 4,985 16,416 21,401 ISLINGTON CCG 4,466 16,351 20,817 EREWASH CCG 2,589 18,155 20,744 RICHMOND CCG 7,250 13,053 20,303 HAMMERSMITH AND FULHAM CCG 4,208 15,929 20,136 WYRE FOREST CCG 2,266 17,774 20,040 CENTRAL LONDON (WESTMINSTER) CCG 3,495 15,609 19,104 GUILDFORD AND WAVERLEY CCG 2,589 16,124 18,712 AYLESBURY VALE CCG 5,243 12,375 17,618 WOKINGHAM CCG 4,272 12,649 16,921 THURROCK CCG 4,143 11,954 16,097 CORBY CCG 2,071 13,601 15,673 ASHFORD CCG 2,848 12,511 15,359 SWALE CCG 1,036 12,737 13,773 WINDSOR, ASCOT AND MAIDENHEAD CCG 3,884 9,848 13,732 SLOUGH CCG 3,236 10,267 13,503 NORTH & WEST READING CCG 2,266 10,787 13,052 NEWBURY AND DISTRICT CCG 2,071 10,734 12,805 BRACKNELL AND ASCOT CCG 4,207 8,271 12,479 SURREY HEATH CCG 2,136 9,425 11,561 SOUTH READING CCG 1,165 9,862 11,028 CCGs with highest available savings CCGs with intermediate available savings CCGs with lower available savings Analysis was undertaken using October 2017 tariff and July 2017 Epact Data PAGE 11

12 Dr. Julian Brown Clinical Editor Julian Young Publishing Editor Stephen Harrington Data Editor Renewals Helpline: Safe Dispenser Ltd 2 Regis Place King s Lynn England PE30 2JN Company No: Data Protection Registration Number: Z Except as provided by the Copyright Designs and Patents Act 1988, no part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means without the prior written permission of the publisher. I/EAZ/121017/NTL/GB/B The target product within this Impact500 project has been identified by CCG Prescriber and represents optimum value for the NHS at the time of publication (OCTOBER 2017). This optimisation project will be reviewed on an annual cycle. Safe Dispenser Ltd may benefit directly from utilisation of the product identified within the Impact Projects. Accredited NHS England Risk Stratification Supplier Analysis was undertaken using October 2017 tariff and July 2017 Epact Data PAGE 12