5 million. Tramadol Modified Release. Market Analysis. impact500. February ENABLING POTENTIAL SAVINGS FOR THE NHS OF

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1 impact500 February 2018 Tramadol Modified Release Market Analysis ENABLING POTENTIAL FOR THE NHS OF 5 million Realising Your Potential Analysis was undertaken using February 2018 tariff and November 2017 Epact Data PAGE 1

2 Page 03 Page 08 Market Analysis CCG Savings Table Analysis was undertaken using February 2018 tariff and November 2017 Epact Data PAGE 2

3 Tramadol Modified Release NOVEMBER 2017 EPACT & FEBRUARY 2018 DRUG TARIFF MARKET SUMMARY TRAMADOL COST TO NHS IN NOVEMBER ,105,255 PACKS PRESCRIBED IN NOVEMBER ,493 COST & PACKS BY MONTH 1,600,000 1,400,000 1,200,000 1,000, , , , ,000 0 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 84,000 82,000 80,000 78, , ,000 72,000 70,000 68,000 66,000 64,000 COST & PACKS / NOVEMBER 2017 PRESCRIBING DATA DRUG COST PACKS Unspecified 31% 19% Marol 22% 36% Zamadol SR 17% 18% Tramquel SR 16% 9% COST PACKS Tramulief SR 8% 13% Other 6% 5% MOST COST-EFFECTIVE CHOICES Marol MR Zytram SR Analysis was undertaken using February 2018 tariff and November 2017 Epact Data PAGE 3

4 Top Drugs in Market 100MG DRUG COST / NOV 2017 PACKS / NOV 2017 POTENTIAL MONTHLY Unspecified 204,250 10, ,302 Zamadol SR 186,296 12,843 96,706 Marol 120,611 17,378 Tramulief SR 41,044 5, Zydol SR 13, ,113 Maxitram 10, ,288 Mabron 3, ,663 Tradorec XL 2, ,751 Tramquel SR 1, Zeridame SR Tilodol SR Maneo Mabron TOTAL 583,562 46, , MG DRUG COST / NOV 2017 PACKS / NOV 2017 POTENTIAL MONTHLY Tramquel SR 39,666 1,825 20,654 Unspecified 32,203 1,225 20,827 Marol 28,101 2,704 Tramulief SR 11,454 1, Maxitram 2, ,258 Zydol SR 2, ,665 Zamadol SR 1, Mabron Zamadol 24Hr Zydol XL Tilodol SR Oldaram Zeridame SR TOTAL 120,591 7,309 45, MG DRUG COST / NOV 2017 PACKS / NOV 2017 POTENTIAL MONTHLY Tramquel SR 134,457 4,647 68,502 Unspecified 101,709 2,796 62,435 Marol 94,541 6,663 Tramulief SR 35,598 2, Zydol SR 13, ,985 Maxitram 9, ,914 Zamadol SR 4, ,301 Tradorec XL 2, Mabron 1, Zamadol 24Hr 1, Zydol XL 1, Zeridame SR Tilodol SR Maneo Dromadol Invodol SR TOTAL 401,102 17, ,402 Analysis was undertaken using February 2018 tariff and November 2017 Epact Data PAGE 4

5 Most Cost-Effective Choices Marol MR 100mg - 60 tablets Marol MR 150mg - 60 tablets Marol MR 200mg - 60 tablets Zytram SR 100mg - 60 tablets Zytram SR 150mg - 60 tablets Zytram SR 200mg - 60 tablets COST PER 60 X 100MG TABLETS Marol Zytram SR Maneo Tramulief SR Maxitram Zamadol SR Tramquel SR Mabron Tilodol SR Zeridame SR Tramadol MR Brimisol PR Zydol SR Tramadol SR (Unspecified) Oldaram Tradorec XL Invodol SR Analysis was undertaken using February 2018 tariff and November 2017 Epact Data PAGE 5

6 COST PER 60 X 150MG TABLETS Marol Zytram SR Maneo Tramadol MR Tramulief SR Maxitram Zamadol SR Tramquel SR Zamadol 24Hr Mabron Tilodol SR Zydol XL Zeridame SR Tramadol SR (Unspecified) Zydol SR Oldaram Invodol SR Analysis was undertaken using February 2018 tariff and November 2017 Epact Data PAGE 6

7 COST PER 60 X 200MG TABLETS Marol Zytram SR Maneo Tramulief SR Maxitram Dromadol Zamadol SR Tramquel SR Tradorec XL Zamadol 24Hr Mabron Tilodol SR Zeridame SR Zydol XL Tramadol MR Tramadol SR (Unspecified) Zydol SR Oldaram Invodol SR Analysis was undertaken using February 2018 tariff and November 2017 Epact Data PAGE 7

8 CCG Potential Annual Savings November 2017 prescribing of Tramadol 100mg, 150mg and 200mg by switching from high cost brands to cost-effective brands CCG ANNUAL PACKS ANNUAL SPEND POTENTIAL ANNUAL NATIONAL 879,198 13,226,509 5,032,223 AIREDALE, WHARFDALE AND CRAVEN CCG 2,756 31,119 6,953 ASHFORD CCG 4,231 46,051 8,491 AYLESBURY VALE CCG 1,459 27,353 14,652 BARKING AND DAGENHAM CCG 2,454 35,312 13,941 BARNET CCG 2,984 43,748 17,337 BARNSLEY CCG 2,864 36,011 9,346 BASILDON AND BRENTWOOD CCG 3,816 44,634 10,402 BASSETLAW CCG 2,572 50,825 16,733 BATH AND NORTH EAST SOMERSET CCG 2,013 29,215 12,272 BEDFORDSHIRE CCG 4,131 53,108 14,370 BEXLEY CCG 2,494 41,740 21,215 BIRMINGHAM CROSSCITY CCG 15, ,867 71,089 BIRMINGHAM SOUTH AND CENTRAL CCG 4,249 57,808 24,135 BLACKBURN WITH DARWEN CCG 4,037 54,739 16,593 BLACKPOOL CCG 6,266 91,447 30,314 BOLTON CCG 6, ,883 28,635 BRACKNELL AND ASCOT CCG ,625 8,304 BRADFORD CITY CCG 3,106 50,059 19,482 BRADFORD DISTRICTS CCG 10, ,651 56,579 BRENT CCG 2,484 42,583 23,642 BRIGHTON AND HOVE CCG 3,178 36,233 6,637 BRISTOL CCG 7,293 81,218 15,642 BROMLEY CCG 1,988 43,788 20,657 BURY CCG 4,403 82,241 44,323 CALDERDALE CCG 3,333 42,542 13,534 CAMBRIDGESHIRE AND PETERBOROUGH CCG 12, ,634 32,195 CAMDEN CCG 1,137 22,552 10,780 CANNOCK CHASE CCG 2,406 45,280 24,019 CANTERBURY AND COASTAL CCG 5,735 64,800 11,172 CASTLE POINT AND ROCHFORD CCG 4,879 58,950 13,661 CENTRAL LONDON (WESTMINSTER) CCG 2,906 30,980 6,610 CENTRAL MANCHESTER CCG 2,448 35,815 16,305 CHILTERN CCG 1,386 25,111 13,877 CHORLEY AND SOUTH RIBBLE CCG 3,139 39,394 12,647 CITY AND HACKNEY CCG 1,797 30,014 17,077 COASTAL WEST SUSSEX CCG 5, ,012 56,774 CORBY CCG ,384 2,222 COVENTRY AND RUGBY CCG 7,179 96,393 30,820 CRAWLEY CCG 1,691 29,885 15,030 CROYDON CCG 2,752 50,852 28,364 CCGs with highest available savings CCGs with intermediate available savings CCGs with lower available savings Analysis was undertaken using February 2018 tariff and November 2017 Epact Data PAGE 8

9 CCG ANNUAL PACKS ANNUAL SPEND POTENTIAL ANNUAL NATIONAL 879,198 13,226,509 5,032,223 CUMBRIA CCG 8, ,814 83,961 DARLINGTON CCG ,137 8,417 DARTFORD, GRAVESHAM AND SWANLEY CCG 2,967 46,921 20,304 DONCASTER CCG 3,981 76,167 39,065 DORSET CCG 5, ,177 61,361 DUDLEY CCG 9, ,910 77,608 DURHAM DALES, EASINGTON AND SEDGEFIELD CCG 2,997 65,222 35,097 EALING CCG 1,652 31,189 15,140 EAST AND NORTH HERTFORDSHIRE CCG 5,428 82,597 32,173 EAST LANCASHIRE CCG 12, , ,040 EAST LEICESTERSHIRE AND RUTLAND CCG 3,559 47,676 17,190 EAST RIDING OF YORKSHIRE CCG 8,106 87,317 11,299 EAST STAFFORDSHIRE CCG 2,505 40,077 16,280 EAST SURREY CCG 1,968 22,348 7,590 EASTBOURNE, HAILSHAM AND SEAFORD CCG 4,472 88,884 46,304 EASTERN CHESHIRE CCG 4,034 43,704 7,733 ENFIELD CCG 1,806 42,628 13,945 EREWASH CCG 1,040 14,918 4,301 FAREHAM AND GOSPORT CCG 3,535 36,788 7,086 FYLDE & WYRE CCG 3,688 45,409 13,406 GATESHEAD CCG 1,868 19,713 4,779 GLOUCESTERSHIRE CCG 7, ,164 79,830 GREAT YARMOUTH AND WAVENEY CCG 12, ,740 50,316 GREATER HUDDERSFIELD CCG 3,938 55,220 20,515 GREATER PRESTON CCG 2,672 36,389 15,017 GREENWICH CCG 4,568 56,440 18,717 GUILDFORD AND WAVERLEY CCG 2,104 35,535 20,571 HALTON CCG 2,546 49,878 17,289 HAMBLETON, RICHMONDSHIRE AND WHITBY CCG 2,352 25,975 5,570 HAMMERSMITH AND FULHAM CCG 2,144 24,587 8,117 HARDWICK CCG 1,554 16,159 2,499 HARINGEY CCG 1,314 23,965 12,172 HARROGATE AND RURAL DISTRICT CCG 1,754 21,291 5,537 HARROW CCG 1,146 12,959 3,868 HARTLEPOOL AND STOCKTON-ON-TEES CCG 3,253 80,748 38,063 HASTINGS AND ROTHER CCG 3,108 59,704 35,096 HAVERING CCG 3,361 39,349 12,593 HEREFORDSHIRE CCG 1,945 28,306 14,417 HERTS VALLEYS CCG 2,594 35,400 12,858 HEYWOOD, MIDDLETON AND ROCHDALE CCG 5,391 71,154 23,406 HIGH WEALD LEWES HAVENS CCG 1,772 22,877 6,931 HILLINGDON CCG 1,428 24,399 13,281 HORSHAM AND MID SUSSEX CCG 1,377 22,285 10,082 HOUNSLOW CCG 2,131 26,805 10,644 HULL CCG 5,685 77,946 21,686 CCGs with highest available savings CCGs with intermediate available savings CCGs with lower available savings Analysis was undertaken using February 2018 tariff and November 2017 Epact Data PAGE 9

10 CCG ANNUAL PACKS ANNUAL SPEND POTENTIAL ANNUAL NATIONAL 879,198 13,226,509 5,032,223 IPSWICH AND EAST SUFFOLK CCG 7, ,968 47,151 ISLE OF WIGHT CCG 4,816 58,398 14,608 ISLINGTON CCG 1,107 20,524 10,354 KERNOW CCG 12, , ,031 KINGSTON CCG ,755 8,573 KNOWSLEY CCG 4,054 50,508 12,095 LAMBETH CCG 2,729 55,558 23,909 LANCASHIRE NORTH CCG 2,554 35,068 11,005 LEEDS NORTH CCG 3,640 45,293 8,969 LEEDS SOUTH AND EAST CCG 7, ,113 34,760 LEEDS WEST CCG 7, ,409 37,920 LEICESTER CITY CCG 3,069 52,087 25,540 LEWISHAM CCG 3,482 68,750 37,120 LINCOLNSHIRE EAST CCG 7, ,430 69,571 LINCOLNSHIRE WEST CCG 5,738 88,423 48,477 LIVERPOOL CCG 18, ,591 69,965 LUTON CCG 1,748 33,082 10,519 MANSFIELD AND ASHFIELD CCG 2,585 27,861 4,191 MEDWAY CCG 8, ,818 30,547 MERTON CCG ,370 9,926 MID ESSEX CCG 6, ,793 60,704 MILTON KEYNES CCG 1,115 24,710 12,661 NENE CCG 3,275 40,600 10,165 NEWARK & SHERWOOD CCG 1,322 16,670 3,169 NEWBURY AND DISTRICT CCG ,987 6,626 NEWCASTLE NORTH AND EAST CCG 464 5,609 1,147 NEWCASTLE WEST CCG ,775 5,303 NEWHAM CCG 2,004 40,531 19,809 NORTH & WEST READING CCG ,519 6,707 NORTH DERBYSHIRE CCG 3,821 41,847 8,666 NORTH DURHAM CCG 2,562 50,868 30,427 NORTH EAST ESSEX CCG 10, ,174 41,525 NORTH EAST HAMPSHIRE AND FARNHAM CCG 1,629 26,549 12,763 NORTH EAST LINCOLNSHIRE CCG 1,483 24,033 11,405 NORTH HAMPSHIRE CCG 3,422 47,505 13,070 NORTH KIRKLEES CCG 6,629 77,944 14,326 NORTH LINCOLNSHIRE CCG 2,882 46,588 22,085 NORTH MANCHESTER CCG 3,918 54,119 18,355 NORTH NORFOLK CCG 4,993 63,686 19,477 NORTH SOMERSET CCG 2,366 32,005 10,482 NORTH STAFFORDSHIRE CCG 6,453 86,007 30,011 NORTH TYNESIDE CCG 1,853 39,122 23,091 NORTH WEST SURREY CCG 6,168 70,044 16,377 NORTH, EAST, WEST DEVON CCG 7,446 90,032 21,180 NORTHUMBERLAND CCG 1,493 30,102 16,906 NORWICH CCG 6,214 69,271 11,461 CCGs with highest available savings CCGs with intermediate available savings CCGs with lower available savings Analysis was undertaken using February 2018 tariff and November 2017 Epact Data PAGE 10

11 CCG ANNUAL PACKS ANNUAL SPEND POTENTIAL ANNUAL NATIONAL 879,198 13,226,509 5,032,223 NOTTINGHAM CITY CCG 4,885 71,199 26,226 NOTTINGHAM NORTH AND EAST CCG 2,338 32,778 10,355 NOTTINGHAM WEST CCG 1,570 17,159 2,926 OLDHAM CCG 4,323 85,413 45,541 OXFORDSHIRE CCG 3,973 74,701 43,059 PORTSMOUTH CCG 2,326 39,190 20,594 REDBRIDGE CCG 1,905 22,408 7,255 REDDITCH AND BROMSGROVE CCG 2,010 27,484 9,657 RICHMOND CCG 577 9,319 5,325 ROTHERHAM CCG 3,036 50,420 22,750 RUSHCLIFFE CCG 1,003 11,780 2,369 SALFORD CCG 7, ,484 68,238 SANDWELL AND WEST BIRMINGHAM CCG 12, ,592 53,418 SCARBOROUGH AND RYEDALE CCG 3,156 34,968 7,718 SHEFFIELD CCG 13, ,206 57,518 SHROPSHIRE CCG 4, ,739 49,777 SLOUGH CCG ,404 6,821 SOLIHULL CCG 3,386 56,153 30,195 SOMERSET CCG 5,245 66,827 22,465 SOUTH CHESHIRE CCG 6,117 72,403 19,352 SOUTH DEVON AND TORBAY CCG 1,777 39,694 19,953 SOUTH EAST STAFFS AND SEISDON PENINSULAR CCG 3,586 53,868 19,806 SOUTH EASTERN HAMPSHIRE CCG 2,099 22,777 4,601 SOUTH GLOUCESTERSHIRE CCG 5,201 64,170 13,940 SOUTH KENT COAST CCG 7,406 85,170 21,127 SOUTH LINCOLNSHIRE CCG 5, ,887 65,636 SOUTH MANCHESTER CCG 4,969 63,761 10,134 SOUTH NORFOLK CCG 5,554 75,203 28,793 SOUTH READING CCG 1,308 19,892 9,890 SOUTH SEFTON CCG 5,004 70,815 25,450 SOUTH TEES CCG 4, ,149 56,805 SOUTH TYNESIDE CCG 1,213 21,493 13,385 SOUTH WARWICKSHIRE CCG 2,430 38,669 20,555 SOUTH WEST LINCOLNSHIRE CCG 2,716 51,609 22,147 SOUTH WORCESTERSHIRE CCG 5,189 69,763 20,346 SOUTHAMPTON CCG 10, ,537 23,412 SOUTHEND CCG 6,057 84,767 21,865 SOUTHERN DERBYSHIRE CCG 5,440 77,922 25,779 SOUTHPORT AND FORMBY CCG 2,334 30,396 8,833 SOUTHWARK CCG 3,099 64,877 34,309 ST HELENS CCG 8, ,865 21,536 STAFFORD AND SURROUNDS CCG 1,573 32,540 18,517 STOCKPORT CCG 3,153 45,183 18,168 STOKE ON TRENT CCG 9, ,688 30,158 CCGs with highest available savings CCGs with intermediate available savings CCGs with lower available savings Analysis was undertaken using February 2018 tariff and November 2017 Epact Data PAGE 11

12 CCG ANNUAL PACKS ANNUAL SPEND POTENTIAL ANNUAL NATIONAL 879,198 13,226,509 5,032,223 SUNDERLAND CCG 5, ,208 60,810 SURREY DOWNS CCG 1,953 32,362 15,443 SURREY HEATH CCG 558 7,061 2,479 SUTTON CCG ,522 10,110 SWALE CCG 3,075 35,035 10,377 SWINDON CCG 3,804 85,213 42,978 TAMESIDE AND GLOSSOP CCG 4,614 80,393 32,395 TELFORD AND WREKIN CCG 4,307 55,553 19,619 THANET CCG 6,973 81,706 20,111 THURROCK CCG 2,953 37,864 9,006 TOWER HAMLETS CCG 2,393 43,816 23,312 TRAFFORD CCG 3,680 72,861 31,725 VALE OF YORK CCG 4,850 57,057 15,444 VALE ROYAL CCG 2,676 28,236 5,057 WAKEFIELD CCG 10, ,938 43,620 WALSALL CCG 5,636 89,463 35,379 WALTHAM FOREST CCG 2,457 45,169 26,292 WANDSWORTH CCG 1,886 34,294 18,725 WARRINGTON CCG 4,635 55,653 12,057 WARWICKSHIRE NORTH CCG 3,808 75,094 29,297 WEST CHESHIRE CCG 5, ,342 68,572 WEST ESSEX CCG 4,213 53,247 17,496 WEST HAMPSHIRE CCG 10, ,972 72,784 WEST KENT CCG 6,322 69,407 19,429 WEST LANCASHIRE CCG 1,183 15,538 3,791 WEST LEICESTERSHIRE CCG 3,300 37,822 11,361 WEST LONDON (K&C & QPP) CCG 1,940 23,578 6,576 WEST NORFOLK CCG 2,924 39,136 17,548 WEST SUFFOLK CCG 4,116 54,683 21,450 WIGAN BOROUGH CCG 8, ,027 99,134 WILTSHIRE CCG 7, ,039 41,706 WINDSOR, ASCOT AND MAIDENHEAD CCG ,648 10,212 WIRRAL CCG 16, ,399 27,577 WOKINGHAM CCG ,561 8,981 WOLVERHAMPTON CCG 4,028 69,883 39,232 WYRE FOREST CCG 1,445 20,784 7,328 CCGs with highest available savings CCGs with intermediate available savings CCGs with lower available savings Analysis was undertaken using February 2018 tariff and November 2017 Epact Data PAGE 12

13 Dr. Julian Brown Clinical Editor Julian Young Publishing Editor Stephen Harrington Data Editor Renewals Helpline: 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/MAR/161017/NTL/GB 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 (February 2018). 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 February 2018 tariff and November 2017 Epact Data PAGE 13