Systems and strategies for managing the drugs budget in Glasgow

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Abstract
The proportion of NHS expenditure allocated to pharmaceutical products has risen annually for the past five years to 13.6% in 1997 (£4.7 billion).1 Reasons for this include greater spending on disease prophylaxis, the high cost of new products for previously untreatable diseases, demands of an ageing population, greater public expectations, and increased pressure on prescribers from the pharmaceutical industry. The need for efficient use of resources, which has spawned the new discipline of pharmacoeconomics, is constantly emphasised.2Many prescribers view economic evaluation of drugs with suspicion, seeing it as an unacceptable intrusion into their right to make the “best” decisions for patients on clinical grounds. Alternatively, economic analyses carried out by the pharmaceutical industry are sometimes seen as thinly veiled marketing strategies.3 Furthermore, when new medicines have not been widely used by doctors because of limited evidence of their effectiveness, the media have been quick to accuse them of “rationing.” 4 However, not controlling the introduction of expensive new drugs has had a major impact on health expenditure in Spain.5 The idea of cost effectiveness addresses the more useful concept of obtaining value for money from prescribed drugs within the limited budget of the NHS. Viewed in this way, it would be unethical not to consider the economic consequences of decisions on drug treatment. In this paper we discuss the systems and strategies that are evolving in Glasgow to help manage the drugs budget. ### Summary points Purchasers and providers work closely in Glasgow to manage an annual drugs budget of around £130 million Particular emphasis is placed on the Glasgow Formulary and a series of prospective pragmatic outcome studies Decisions are inevitably compromises based on evidence, clinical need, and availability of funding The programme involves many doctors in hospital and general practice and promotes a “seamless” approach to …

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