How Specials Can Deliver Value to the NHS | Page 11

While it is hard for the GP to avoid such a problem, advice could be sought
from the original prescriber or pharmacist to ensure that the child receives
the most appropriate unlicensed medicine (or licensed medicine if available).
They should also be prepared to closely monitor the patient and warn
patients/carers that symptom control may vary when swapping between
products that are not licensed. Changing preparations may impact on
symptom control and result in adverse events.
Please also refer to Assessing clinical need on page 6.

Cost-effectiveness and quality of life improvements
Whilst it is difficult to measure and attribute a cost to increased fits and
quality of life, it is intuitive to suggest the child’s quality of life would improve
significantly with fewer fits. The same would go for the carers and parents.
In this particular example, a licensed option is now available but there is no
doubt that at the time, the use of an unlicensed Special prevented a further
increase in the child’s fits and a potential spell in hospital.
Significant costs could have been incurred if the fitting was not controlled
in primary care; many parents would present to Accident & Emergency
departments and the child could at this stage have been admitted. The
2013/2014 tariff cost is £1,37115 which does not include transport costs to the
hospital and out-patient follow-up. In other words, ensuring the child had a
preparation which released the anti-epileptic drug effectively was a highly
cost-effective approach in this particular case. That is the nature of unlicensed
Specials; a bespoke preparation for specific patient circumstances where
there is no licensed alternative.

CASE STUDY 2

Assessing clinical need – additional advice

Child with
epilepsy
where an
extemporaneous
product resulted
in increased fits

There could also have been significant GP time involved, including
follow-ups post-discharge to ensure the fits were controlled. This is more
difficult to cost accurately due to multi-disciplinary support, such as practice
nurse involvement. There is certainly an opportunity cost which
was prevented, freeing up appointments for other ill patients.
Since this case study was produced, a licensed product is now available.
There is a duty to use a licensed product, of course, if such a product
is available.

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15. 2013-14 tariff – admitted patient care & outpatient procedures – PA02A-01. APC & OPROC [date accessed Feb 2014]