How Specials Can Deliver Value to the NHS | Seite 13

Whilst it may be difficult for the GP in this situation, 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 any reduction in symptom control could occur. Changing
preparations may impact on symptom control and result in adverse events. It
is also important to minimise, wherever possible, administration error risks.
Please also refer to Assessing clinical need on page 6.

Cost-effectiveness and quality of life improvements
It is difficult to quantify pain and the individual suffering of a patient. It is
unlikely any robust measurement would have been taken to assess the child’s
pain; symptoms would have been reported. Whilst unnecessary suffering
was caused, the child’s pain due to arthritis could have been excruciating.
This may have incurred GP call-out visits or presentation to an Accident &
Emergency department. The case study does not share for how long the pain
was experienced but for chronic pain of this nature, any deterioration in pain
control would adversely affect the child’s quality of life.
The management of childhood pain brings significant direct and indirect
costs from healthcare utilization and lost wages due to taking time off work
to care for the child, American studies have found.16,17
The key issue here is not so much the potential cost to the health economy
but the unnecessary pain a young child experienced. How does society
put a cost on the increase in pain which is chronic, caused by arthritis at an
individual patient level? This case study demonstrates that Specials have a
role to play where licensed formulations are not available.

16. Ho, I. K., Goldschneider, K. R., Kashikar-Zuck, S., Kotagal, U., Tessman, C., & Jones, B. (2008), Healthcare utilization and indirect burden
among families of pediatric patients with chronic pain, Journal of Musculoskeletal Pain, 16(3), 155–164.
17. Sleed, M., Eccleston, C., Beecham, J., Knapp, M., & Jordan, A. (2005). The economic impact of chronic pain in adolescence:
Methodological considerations and a preliminary costs-of-illness study. Pain, 119(1-3), 183–190.

CASE STUDY 3

Assessing clinical need – additional advice

A child where
the adult
dose was not
appropriate

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