New measure coding #6-10

[richiecroker]

6. Prescribing of immediate release quetiapine

quetiapine.json

Area

Cost-effectiveness

Numerator

bnf_code LIKE '0402010AB%AB' -- Quetiapine_Tab 25mg [branded and generic] --  
OR bnf_code LIKE '0402010AB%AC' -- Quetiapine_Tab 100mg [branded and generic] --  
OR bnf_code LIKE '0402010AB%AD' -- Quetiapine_Tab 200mg [branded and generic] --  
OR bnf_code LIKE '0402010AB%AF' -- Quetiapine_Tab 150mg [branded and generic] --  
OR bnf_code LIKE '0402010AB%AK' -- Quetiapine_Tab 300mg [branded and generic] --

Denominator

  bnf_code LIKE '0402010AB%AB' -- Quetiapine_Tab 25mg [branded and generic] --
  OR bnf_code LIKE '0402010AB%AC' -- Quetiapine_Tab 100mg [branded and generic] --
  OR bnf_code LIKE '0402010AB%AD' -- Quetiapine_Tab 200mg [branded and generic] --
  OR bnf_code LIKE '0402010AB%AF' -- Quetiapine_Tab 150mg [branded and generic] --
  OR bnf_code LIKE '0402010AB%AK' -- Quetiapine_Tab 300mg [branded and generic] --
  OR bnf_code LIKE '0402010AB%AV' -- Quetiapine_Tab 50mg M/R [branded and generic] --
  OR bnf_code LIKE '0402010AB%AW' -- Quetiapine_Tab 200mg M/R [branded and generic] --
  OR bnf_code LIKE '0402010AB%AX' -- Quetiapine_Tab 300mg M/R [branded and generic] --
  OR bnf_code LIKE '0402010AB%AY' -- Quetiapine_Tab 400mg M/R [branded and generic] --
  OR bnf_code LIKE '0402010AB%BA' -- Quetiapine_Tab 150mg M/R [branded and generic] --

Why it matters

There is a huge difference in cost between immediate and extended release preparations of quetapine. The extended release preparations should ideally be reserved for patients who cannot tolerate the IR version, or for whom compliance may be an issue.

What is good

High

7. Topical treatment of fungal nail infections

fungal.json

Area

Clinical effectiveness

Numerator

bnf_code LIKE '1310020A0%' -- Amorolofine Hydrochloride
OR bnf_code LIKE '1310020T0%AA' --Ticonazole_Medic Nail Lacquer 283mg/ml [branded and generic]

Numerator

List size

Why it matters

These treatments have a low cure rate, and treatment is required for three to six months. Consideration should be given as to whether this is an effective treatment.

What is good

Low

8. Prescribing of methotrexate 10mg tablets

methotrexate.json

Area

Safety

Numerator

bnf_code LIKE '1001030U0%AC' -- Methotrexate_Tab 10mg [branded and generic' --

Denominator

 bnf_code LIKE '1001030U0%AB' -- Methotrexate_Tab 2.5mg [branded and generic] --
 OR bnf_code LIKE '1001030U0%AC' -- Methotrexate_Tab 10mg [branded and generic] --

Why it matters

The BNF states: To avoid error with low-dose methotrexate, it is recommended that:
the patient is carefully advised of the dose and frequency and the reason for taking methotrexate and any other prescribed medicine (e.g. folic acid); only one strength of methotrexate tablet (usually 2.5 mg) is prescribed and dispensed;

What is good

Low

9. Prescribing of pregabalin

pregabalin.json

Area

Cost effectiveness / clinical effectiveness

Numerator

bnf_code LIKE '00408010AE%'

Denominator

List size

Why it matters

Pregabalin is a relatively new drug, which is increasingly used in neuropathic and other types of pain. However, it is expensive when compared to other NICE receommended treatments, and costs are increasingly rapidly in the NHS. Patients should be regularly review to ensure continued benefit, and that side effects are not troublesome.

What is good

Neutral

10. Prescribing of dipyridamole

dipyridamole.json

Area

Clinical effectiveness / cost effectiveness

Numerator

 bnf_code LIKE '0209000L0%' -- Dipyridamole --
 OR bnf_code LIKE '0209000V0%' -- Dipyridamole & Aspirin --

Denominator

bnf_code LIKE '0209000L0%' -- Dipyridamole --
OR bnf_code LIKE '0209000V0%' -- Dipyridamole & Aspirin --
OR bnf_code LIKE '0209000C0%' -- Clopidogrel --

Why it matters

Although the 2010 NICE Technology Appraisal recommends dipyridamole for the prevention of further occlusive events in patients who have had a Transient Ischaemic Attack (TIA), 2016 guidance from the Royal College of Physicians states: "the Working Party considers that a unified approach to the treatment of TIA and ischaemic stroke is more appropriate. Whilst clopidogrel does not have a licence for use after TIA, the Working Party considers that the benefits of recommending this drug first-line outweigh any disadvantages. For long-term vascular prevention in people with ischaemic stroke or TIA without paroxysmal or permanent atrial fibrillation:

• clopidogrel 75mg daily should be the standard antithrombotic treatment;
• aspirin 75 mg daily with modified-release dipyridamole 200 mg twice daily should be used for those who are unable to tolerate clopidogrel;
• aspirin 75mg daily should be used if both clopidogrel and modified-release dipyridamole are contraindicated or not tolerated;
• modified-release dipyridamole 200 mg twice daily should be used if both clopidogrel and aspirin are contraindicated or not tolerated."

What is good

Low