signs – erythema , papulation / oedema , excoriation , and lichenification – are assessed using a scale of 0 to 3 . EASI assesses the average lesional intensity within four body regions :
• head and neck
• arms
• trunk
• legs .
Lesional extent is evaluated by estimating the surface area involved of those four body regions ( 1 %– 9 %, 10 %– 29 %, 30 %– 49 %, 50 %– 69 %, 70 %– 89 %, and 90 %– 100 %). Lesional intensity is multiplied by the surface area involved in that region and summed across regions , yielding a total score ranging from 0 to 72 . 9 DLQI consists of 10 queries that assess the patient ’ s perception of the effects of the specific skin condition on their health-related quality of life over the past week . Summing the score of each question resulting in a maximum of 30 and a minimum of 0 . The higher the score , the more quality of life is impaired . 10
The NHS price for dupilumab excluding VAT is £ 1,264.89 for 2x300mg , although a patient access scheme is in place as part of the NICE TA . A patient access scheme or commercial arrangement associated with the NICE guidance is a way for pharmaceutical companies to lower the acquisition cost to the NHS to improve its cost-effectiveness , so enabling patients to gain access to high-cost medicine treatments . High-cost medicines are so named as they are expensive prescribed items , representing a disproportionate cost relative to the total NHS cost of the relevant hospital episode in terms of volume and cost .
The hospital Royal Cornwall Hospitals NHS Trust is a 750-bed acute teaching district general hospital in the south-west of England . The hospital , in conjunction with the local clinical commissioning group ( CCG , now integrated care board ), utilises the Blueteq high-cost drug management system . CCGs were statutory regional NHS bodies responsible for the planning and commissioning of healthcare services for their local area . Many CCGs in England use this Blueteq web-based system which allows clinicians to complete an online proforma for patients prescribed a high-cost medicine and receive automatic approval for funding if the patient meets all the relevant criteria which normally reflect the NICE TA guidance . This ensure that clinicians receive the approval to treat immediately . The Blueteq system retains , as an audit trail , the request history , including patient name , drug , indication , criteria for use , date of request , requesting clinician , and whether the request was granted or not . This enables commissioners to monitor the use of expensive treatment , so that only treatments prescribed in line with NICE guidelines are reimbursed to the hospital .
Aim We aimed to identify whether dupilumab had been used according to the criteria based on the NICE TA .
Methods This was a retrospective , single site study in an acute teaching district general hospital . An extract was downloaded from the Blueteq system for adult patients granted approval to commence dupilumab treatment for moderate to severe atopic dermatitis , and who were then potentially eligible to receive such treatment for more than 16 weeks . Relevant data ( patient demographics and treatment details ) were imported into Excel by a member of the pharmacy team . Dermatology
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24 | Issue 102 | hospitalpharmacyeurope . com