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Cost of Prostap and Zoladex injections

User
Posted 04 Jul 2018 at 18:00

The cost of Prostap and Zoldex injections has cropped up a number of times over the years. Opinions differ about this but the point to remember is that the cost of these drugs may be different depending on where the drugs are bought and the size of the GP Group which is making the purchase. In other words this may be described as a market place as is the case for other drugs etc.

The starting point for me is the information published by NICE about drug prices which you can see from the links below.

Link:  https://bnf.nice.org.uk/medicinal-forms/leuprorelin-acetate.html

Prostap is priced at £75.24 for the 3.75 mg monthly injection and  £225.72 for the 11.25 mg 3  monthly injection.

Link:  https://bnf.nice.org.uk/medicinal-forms/goserelin.html 

Zoladex is priced at £65.00 for the 3.6 mg  monthly injection and  £235.00 for the 10.8 mg 3  monthly injection.

I understand the cost of Prostap and Zoladex etc comes out of CCG budgets for GP Practices. There is not much difference in the cost of these published figures between Prostap and Zoladex but in practice, as for most things, market influences kick in and costs can change. I was told by a GP Practice Manger some time ago that their practice pays £185 for the 3 month Prostap injection. As mentioned, a reduction in the cost of drugs takes into account the size of the GP Practice and no doubt how much business the Practice has with their supplier. Presumably similar reductions are available for Zoladex and other drugs and medical supplies.  

I don’t think the costs influence consultants too much when they decide whether to start a man on Prostap or Zoladex. I think the clinical experience of consultants in the first place governs, for the most part, whether a man is given Prostap or Zoladex. There may be circumstances when a man’s preference may be taken into account.

My first injection was Zoladex many years ago and my GP suggested switching to Prostap for my second injection and this was  agreed by my hospital Oncology Team. I have no idea how many GPs switch a man from one drug to the other without speaking first to the hospital oncology team. I would never be happy with that.

I hope this is useful.

Alan  

User
Posted 04 Jul 2018 at 18:00

The cost of Prostap and Zoldex injections has cropped up a number of times over the years. Opinions differ about this but the point to remember is that the cost of these drugs may be different depending on where the drugs are bought and the size of the GP Group which is making the purchase. In other words this may be described as a market place as is the case for other drugs etc.

The starting point for me is the information published by NICE about drug prices which you can see from the links below.

Link:  https://bnf.nice.org.uk/medicinal-forms/leuprorelin-acetate.html

Prostap is priced at £75.24 for the 3.75 mg monthly injection and  £225.72 for the 11.25 mg 3  monthly injection.

Link:  https://bnf.nice.org.uk/medicinal-forms/goserelin.html 

Zoladex is priced at £65.00 for the 3.6 mg  monthly injection and  £235.00 for the 10.8 mg 3  monthly injection.

I understand the cost of Prostap and Zoladex etc comes out of CCG budgets for GP Practices. There is not much difference in the cost of these published figures between Prostap and Zoladex but in practice, as for most things, market influences kick in and costs can change. I was told by a GP Practice Manger some time ago that their practice pays £185 for the 3 month Prostap injection. As mentioned, a reduction in the cost of drugs takes into account the size of the GP Practice and no doubt how much business the Practice has with their supplier. Presumably similar reductions are available for Zoladex and other drugs and medical supplies.  

I don’t think the costs influence consultants too much when they decide whether to start a man on Prostap or Zoladex. I think the clinical experience of consultants in the first place governs, for the most part, whether a man is given Prostap or Zoladex. There may be circumstances when a man’s preference may be taken into account.

My first injection was Zoladex many years ago and my GP suggested switching to Prostap for my second injection and this was  agreed by my hospital Oncology Team. I have no idea how many GPs switch a man from one drug to the other without speaking first to the hospital oncology team. I would never be happy with that.

I hope this is useful.

Alan  

User
Posted 21 Feb 2020 at 20:12
There is already a crisis plan in place for schools nationally who have pupils dependant on epilepsy or heart meds that are in shortage. Doctors have been moving children and adults onto alternative epilepsy meds for the last 8 months or so although this transition increases the risk of seizures. If a child's meds run out and cannot be replaced, and those meds are life-critical, the school may have to exclude the child. I understand that HM Gov - rather than providing advice - has been asking the sector for advice :-/
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 21 Feb 2020 at 20:46

Yes Lyn

heres Nov 2019 English Guidance for Shortages

it mentions substitution as one option

https://www.england.nhs.uk/wp-content/uploads/2019/11/a-guide-to-managing-medicines-supply-and-shortages-2.pdf

Hope it works, substituting leuprolin might be difficult if that becomes an issue. 

User
Posted 22 Feb 2020 at 22:54

Don’t apologise, were you in pharmacy or supplies?
Mine was mainly in Scotland but also some time in South West Region in 70s and early 80s. We had some macho managers from outside the NHS in the 80s too. Fortunately the Medicines Act stopped them over riding established procurement arrangements. The fact that most expensive medicines were only made by one supplier meant you couldn’t tender but might get special prices. In fact some manufacturers tried to give hospitals free medicine supplies as they knew the market was mainly in general practice. 
I remember one intravenous fluid contract in the 80s that was split between two manufacturers to prevent one getting a monopoly. In my time generic medicines were cheap as chips, but hardball contracting in recent years has led to losers going out of business, monopolies developing and now some generics are very expensive as a result as it’s a sellers market. The NHS is stuffed if that maker loses its licence to manufacture.

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User
Posted 04 Jul 2018 at 19:08
You would have thought that a properly organized NHS could powerfully negotiate for a lower price rather than leave this aspect to GP surgery level. I bet Tesco and all the other major supermarkets use their large purchasing power centrally to negotiate supplies rather than leave it to individual branches.
Barry
User
Posted 21 Feb 2020 at 11:54

Bit late but Barry be reassured

The real cost is over £500 and double the NHS cost because Government has a Drug Tariff stating what is the maximum price they will pay. 

NHS prices are cheap compared with many other countries.
The down side is that in a supply shortage products may be diverted to non U.K. markets. 


https://bnf.nice.org.uk/medicinal-forms/leuprorelin-acetate.html

Edited by member 21 Feb 2020 at 11:56  | Reason: Not specified

User
Posted 21 Feb 2020 at 13:31
The government introduced temporary regulations in 2019 preventing shortage drugs from going overseas - this included HRT, epilepsy drugs, some cancer drugs and ED treatments.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 21 Feb 2020 at 17:36

The restrictions prevented the wholesalers storing any of these drugs in this country, because they might not have been able to export them again. That didn't help the shortage.

User
Posted 21 Feb 2020 at 18:58

https://www.telegraph.co.uk/news/2019/10/17/ministers-ban-export-erectile-dysfunction-drug-ensure-britains/

 

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 21 Feb 2020 at 19:20

Hi Lyn

That works if medicines are made in the UK. Takeda who make my Prostap are based in Tokyo. So they can choose who in the world to supply and who not if there is a shortage whatever we say.

With Coronavirus impacting on Chinese manufacturing there will be shortages of some medicines, as many raw materials are made there, hopefully not mine or yours. 

 

User
Posted 21 Feb 2020 at 20:12
There is already a crisis plan in place for schools nationally who have pupils dependant on epilepsy or heart meds that are in shortage. Doctors have been moving children and adults onto alternative epilepsy meds for the last 8 months or so although this transition increases the risk of seizures. If a child's meds run out and cannot be replaced, and those meds are life-critical, the school may have to exclude the child. I understand that HM Gov - rather than providing advice - has been asking the sector for advice :-/
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 21 Feb 2020 at 20:46

Yes Lyn

heres Nov 2019 English Guidance for Shortages

it mentions substitution as one option

https://www.england.nhs.uk/wp-content/uploads/2019/11/a-guide-to-managing-medicines-supply-and-shortages-2.pdf

Hope it works, substituting leuprolin might be difficult if that becomes an issue. 

User
Posted 22 Feb 2020 at 13:23

Heenan

No they didn’t for most things, think of storage needs, transport costs etc, but they arranged ( think they still do) central contracts based on estimates of national use and hospitals would then buy their requirements at the contract price.  One contract was for generics which was competitively tendered eg aspirin and Paracetamol. Another list was for medicines only made by one company, where an a NHS discount was offered based on past and predicted use. Similar arrangements applied to non medicines.

in community a Drug Tariff did (still does) the same thing by finding the Best Buy generic and allowing other products to be supplied, but the pharmacy was only reimbursed the cheaper price.

Some products eg some vaccines were bought centrally

User
Posted 22 Feb 2020 at 17:10

Hi Heenan, 

I was responsible for buying medicines dressings, surgical sundries for 21 hospitals in 1983 and even more after 1987 - 1997.
it is highly complex requiring judgement on what you can buy direct from manufacturers which may take weeks to arrive, with having the medicines in a few hours for an urgent problem, or coping when medicines are unavailable. Most were bought on NHS contracts or discounted prices agreed by NHS Supplies organisation. We did negotiate better prices on a few products by therapeutic tendering where products were considered equivalent

Re what you say

In the 70s many medicines eg intravenous fluids, Ward packs of tablets, outpatient packs were made in hospitals for local distribution. It may be newly established Trusts tried to do their own thing in the 80s elsewhere 

User
Posted 22 Feb 2020 at 22:54

Don’t apologise, were you in pharmacy or supplies?
Mine was mainly in Scotland but also some time in South West Region in 70s and early 80s. We had some macho managers from outside the NHS in the 80s too. Fortunately the Medicines Act stopped them over riding established procurement arrangements. The fact that most expensive medicines were only made by one supplier meant you couldn’t tender but might get special prices. In fact some manufacturers tried to give hospitals free medicine supplies as they knew the market was mainly in general practice. 
I remember one intravenous fluid contract in the 80s that was split between two manufacturers to prevent one getting a monopoly. In my time generic medicines were cheap as chips, but hardball contracting in recent years has led to losers going out of business, monopolies developing and now some generics are very expensive as a result as it’s a sellers market. The NHS is stuffed if that maker loses its licence to manufacture.

 
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