Prescribing of Statins

Summary

A request for detailed data on statin prescribing, costs, and patient volumes in the Isle of Man was partially fulfilled, with information provided for primary care and hospital outpatients but withheld for inpatients and specific cost breakdowns due to data limitations.

Key Facts

• The Department of Health and Social Care provided data on statin products and dosages for Primary Care (GPs) and Noble's Hospital Outpatients.
• Information on Noble's Hospital Inpatient prescriptions was withheld because compiling it would require substantial research into individual patient records.
• Total cost data for the last three financial years could not be provided as the Pharmaceutical Advisor's data is not processed to allow for such extrapolation.
• Data regarding dental prescriptions and costs per care home was not held by the authority.
• Noble's Hospital Pharmacy dispenses inpatient medication based on a specific contract brand formulary rather than individual prescriptions.

Data Disclosed

• 28 February 2017
• 25 September 2017
• 5 pages
• IM100-487i
• Rosuvastatin

Exemptions Cited

• S11(3)(b) - Substantial compilation or collation of information
• S11(3)(a) - Information not held or cannot be found after reasonable steps

Data Tables (2)

Full Response Text

Department of Health and Social Care

Rheynn Slaynt as Kiarail y Theay

Page 1 of 5 FOIA/DHSC/rvsd/01

Chief Executive: Malcolm Couch

By email:

Freedom of Information Team Department of Health & Social Care Chief Executive’s Office Crookall House Demesne Road Douglas Isle of Man, IM1 3QA Tel: Email: Website: Date: FOI Reference: (01624) 642621 foi.dhsc@gov.im www.gov.im/dhsc 25 September 2017 IM100-487i Dear

REQUEST UNDER THE FREEDOM OF INFORMATION ACT 2015 (“the Act”) Thank you for your request to the Department of Health and Social Care, dated 28 February 2017 Your request You asked for: Question 01: “What different branded/generic statin products/dosages were prescribed in the most recently available financial year?” Question 02: “What was the total cost of statin prescriptions to patients in the most recently available three financial years and the total cost by each different department funded site i.e. GP practice, hospital pharmacy, dentist, etc but ideally also with the total cost per care home (prescriptions from any site)?”
Question 03: “How many different patients were prescribed statins by each different department funded site?” Question 04: “What was the total volume of statins by each branded/generic product/dosage prescribed in the most recent available financial year?” Response to your request While our aim is to provide information whenever possible, in this instance we are unable to provide some of the information you have requested; the reasons are shown as part of the corresponding answers below. Question 01: What different branded/generic statin products/dosages were prescribed in the most recently available financial year Please find the Department’s response to Question 01 in Appendix 01 for the most recent data for Primary Care (GPs), and the most recent data for Noble’s Hospital Outpatients.

Page 2 of 5 FOIA/DHSC/rvsd/01 Please note however, the data in Appendix 01 does not include a breakdown of Noble’s Hospital Inpatients prescriptions. This is because to answer this request would require the Department of Health and Social Care to undertake substantial compilation or collation of information that it holds and undertake research into, or analysis or, information that it holds, which the Department is not required to do under the Act (S11(3)(b)), by searching the patient records of individuals admitted during the required timeframe. However, you may find it helpful to know that for patients staying in Noble’s Hospital, it does not matter what brand it prescribed as the Hospital Pharmacy will only ever dispense according to the Noble’s Contract Brand based on the Noble’s Hospital Formulary. The Noble’s Hospital Formulary is a list of the only medication and therapies that can be prescribed and dispensed to inpatients based on the treatment’s cost, efficiency and efficacy. Question 02: What was the total cost of statin prescriptions to patients in the most recently available three financial years and the total cost by each different department funded site i.e. GP practice, hospital pharmacy, dentist, etc. but ideally also with the total cost per care home (prescriptions from any site)? Please find some of the information you are requesting for Question 02 in Appendix 01. In relation to the first part of Question 02, while our aim is to provide information whenever possible, in this instance the public authority does not hold or cannot, after taking reasonable steps to do so, find the information that you have requested (S11(3)(a) of the Act). This is because the prescribing data held by the Department’s Pharmaceutical Advisor is not processed in such a way that would allow for extrapolation of this data. In relation to the second part of Question 02, while our aim is to provide information whenever possible, in this instance the public authority does not hold or cannot, after taking reasonable steps to do so, find the information that you have requested(S11(3)(a) of the Act). This is because the prescribing data held by the Department’s Pharmaceutical Advisor does not include data for dental prescriptions or a breakdown of where the patient lives, i.e. a care home.
While the Noble’s Hospital Pharmacy would be able to provide a list of all the medication supplied to each ward it would not be able to determine which and how much medication was provided to an individual patient without substantial searches of each patient’s medical record. This is because Noble’s Hospital Pharmacy provides supplies of medication to each ward as stock to hold on the ward, not necessarily to be directly administered to a particular patient. In addition, patients are able to bring their own medication from home onto the ward and have their medication administered from their own supply. In this case for example, the Noble’s Hospital Pharmacy do not stock Rosuvastatin, therefore the data they hold will not include figures for it despite it being prescribed by patients who will use their own supply. Question 03: How many different patients were prescribed statins by each different department funded site In response to Question 03, while our aim is to provide information whenever possible, in this instance, complying with your request for information would require the Department of Health and Social Care to undertake substantial compilation or collation of information that it holds and undertake research into, or analysis or, information that it holds, which the Department is not required to do under the Act (S11(3)(b)).

Page 3 of 5 FOIA/DHSC/rvsd/01 Question 04: What was the total volume of statins by each branded/generic product/dosage prescribed in the most recent available financial year? Please find the Department’s response to Question 04 in Appendix 01. For Noble’s Hospital data, the Noble’s Hospital Pharmacy, as with question 02, would be able to provide the amounts of statins supplied to each ward, but to identify the total volume prescribed would require substantial compilation and collation of information held within individual patient’s medical records, and this is something the Department is not required to do under the Act (S11(3)(b)). Your right to request a review
If you are unhappy with this response to your Freedom of Information request, you may ask us to carry out an internal review of the response, by completing a complaint form and submitting it electronically or by delivery/post to the FOI Co-ordinator, Department of Health & Social Care, Chief Executive’s Officer, Crookall House, Demesne Road, Douglas, Isle of Man, IM1 3QA. An electronic version and paper version of our complaint form can be found by going to our website www.gov.im/about-the-government/freedom-of-information/how-to- make-a-freedom-of-information-request/ .
Your review request should explain why you are dissatisfied with this response, and should be made as soon as practicable. We will respond as soon as the review has been concluded. If you are not satisfied with the result of the review, you then have the right to appeal to the Information Commissioner for a decision on:

1. Whether we have responded to your request for information in accordance with Part 2 of the Freedom of Information Act; or
2. Whether we are justified in refusing to give you the information requested.
   In response to an application for review, the Information Commissioner may, at any time, attempt to resolve a matter by negotiation, conciliation, mediation or another form of alternative dispute resolution and will have regard to any outcome of this in making any subsequent decision.
   Further information about Freedom of Information requests can be found on the Information Commissioner’s website at: www.inforights.im/information-centre/freedom-of-information. Should you have any queries concerning this letter, please do not hesitate to contact us. Yours Sincerely

Freedom of Information Team Department of Health and Social Care

Page 1 of 5 FOIA/DHSC/rvsd/01 Appendix 01a - Prescriptions issued for all generic and branded statins in Primary Care (all GP practices only)

*As at 31-Aug-17

Statin Type BNF Name 2014-15 Total 2015/16 Total 2016/17 Total 2017/18 Total* Items Act Cost Items Act Cost Items
Act Cost Items Act Cost Generic Atorvastatin 25,467 £70,531.34 28,866 £79,056.48 32,994 £73,465.66 8,756 £18,030.78 Fluvastatin
70 £773.71 73 £872.15 77 £821.17 21 £362.13 Pravastatin
5,739 £19,313.39 5,167 £13,857.40 4,754 £9,195.20 1,115 £2,009.29 Rosuvastatin
2,297 £72,455.20 2,205 £69,289.01 2,359 £72,775.01 622 £19,087.95 Simvastatin 40,246 £66,983.23 37,175 £60,548.39 33,883 £46,440.97 8,078 £12,799.13 Simvastatin & Ezetimibe 205 £11,700.55 173 £9,927.80 134 £7,837.43 33 £2,054.24 Generic Totals 74,024 £241,757.42 73,648 £233,551.23 40,318 £210,535.44 81,625 £54,343.52 Branded Crestor 13 £463.29 50 £556.96 60 £481.04 16 £97.78 Dorisin 0 £0.00 0 £0.00 0 £0.00 0 £0.00 Inegy 6 £370.68 6 £370.98 7 £433.38 2 £123.81 Lescol 4 £225.51 5 £282.39 3 £226.08 2 £169.70 Lipitor 235 £8,054.59 211 £7,209.20 203 £6,708.63 45 £1,579.88 Luvinsta 0 £0.00 0 £0.00 0 £0.00 0 £0.00 Nandovar XL 0 £0.00 0 £0.00 0 £0.00 0 £0.00 Pinmactil 0 £0.00 0 £0.00 0 £0.00 0 £0.00 Simvador 0 £0.00 1 £0.97 1 £2.86 0 £0.00 Zocor 32 £953.86 11 £413.03 3 £164.98 0 £0.00 Branded Totals 290 £9,114.07 284 £8,833.53 277 £8,016.97 65 £1,971.17

Page 1 of 5 FOIA/DHSC/rvsd/01 Appendix 01b - Prescriptions issued for all statins to Noble’s Hospital Outpatients

Prescriber Name BNF Name 2014/15 Total 2015/16 2016/17 Items Cost Items Cost Items Cost RDC Hospital Atorvastatin 20 £33.03 19 £29.23 20 £26.71 Pravastatin
5 £9.31 7 £11.23 3 £4.11 Rosuvastatin
1 £6.44 4 £88.10 3 £55.38 Simvastatin 42 £42.19 31 £31.71 26 £23.22 Diabetic Centre Atorvastatin 31 £56.74 41 £92.62 74 £108.78 Pravastatin
4 £6.77 3 £8.94 4 £5.30 Rosuvastatin
10 £236.01 21 £686.31 21 £717.20 Simvastatin 34 £43.96 36 £56.98 29 £33.23 Emergency Medicine Atorvastatin 4 £11.13 4 £55.04 9 £14.76 Rosuvastatin
3 £131.37 1 £64.39 0 £0 Simvastatin 5 £5.14 13 £10.37 13 £8.77 Hospice IOM Atorvastatin 3 £6.51 0 £0 0 £0 Rosuvastatin
1 £18.03 0 £0 0 £0 Simvastatin 1 £0.90 0 £0 1 £0.84 Medical Directorate Atorvastatin 126 £560.30 146 £375.26 249 £401.97 Fluvastatin
2 £3.78 2 £5.10 0 £0 Pravastatin
23 £32.94 14 £18.02 8 £8.39 Rosuvastatin
21 £499.37 5 £108.18 10 £191.80 Simvastatin 200 £240.98 112 £115.55 103 £96.26 Simvastatin & Ezetimibe 1 £33.42 1 £66.84 0 £0 Noble’s Hospital Atorvastatin 5 £25.67 0 £0 0 £0 Orthopaedics Atorvastatin 4 £6.21 4 £3.92 7 £9.86 Pravastatin
0 £0 0 £0 1 £1.20 Rosuvastatin
1 £9.02 0 £0 0 £0 Simvastatin 4 £3.38 5 £5.24 6 £3.84 Psychiatry Atorvastatin 7 £4.45 36 £100.81 7 £4.93 Pravastatin
3 £3.34 0 £0 0 £0 Rosuvastatin
1 £18.03 0 £0 0 £0 Simvastatin 22 £8.86 15 £9.99 25 £10.57 Surgical Directorate Atorvastatin 11 £95.27 15 £170.62 20 £127.64 Pravastatin
3 £2.88 1 £0.73 3 £1.85 Rosuvastatin
0 £0.00 2 £63.11 1 £52.04 Simvastatin 9 £5.03 8 £5.48 9 £5.51 Women & Children Directorate Atorvastatin 8 £114.17 3 £2.17 1 £1.09 Pravastatin
1 £0.44 1 £0.80 0 £0 Rosuvastatin
7 £330.98 4 £180.30 6 £252.42 Simvastatin 0 £0 6 £5.62 5 £4.29 Generic Totals 623 £2,606.05 560 £2,372.66 664 £2,171.96