Rapid rise in bisphosphonate scrips

High uptake supports NICE's claim of 'significant impact' for its guidance.

Rates of bisphosphonate prescribing have risen faster than predicted by NICE, showing high levels of adherence by PCTs to its guidance.

Data on the uptake of NICE-appraised medicines in England, released last week by the NHS Information Centre, show that 256,691 doses of bisphosphonates were prescribed in 2008. This is 42,774 more than the level predicted by NICE.

NICE guidance recommends the generic drug alendronate as the first-line treatment option for patients with osteoporosis.

However, the drug has been linked to increased AF risk, and research has found it cannot be tolerated by one in four patients.

The NHS Information Centre data do not show which bis-phosphonates were prescribed, but experts warned patients may be at risk if PCTs pressure prescribers to use the first-line generic to cut costs.

Nick Rijke, public and external affairs director at the National Osteoporosis Society, said that implementing 'very poor' drug appraisals from NICE could cut the number of people eligible for treatment.

'NICE needs to go back to the drawing board and conduct a fresh appraisal that considers the latest evidence, includes all the current treatment options and which also covers men.

'Nearly 14,000 people a year die as a consequence of hip fractures, yet many hip fractures could be prevented with effective treatment.'

Elsewhere, the data revealed that GPs are issuing more scrips for cholinesterase inhibitors for Alzheimer's sufferers and ezetimibe for patients with cardiovascular disease than predicted by NICE.

However, prescribing rates of orlistat, sibutramine and rimonabant for the treatment of obesity in adults were lower than expected.

Andrew Dillon, chief executive of NICE, said the figures showed that NICE guidance is having a 'significant impact' on the treatment and care that patients receive from the NHS.

'It is also a recognition that NICE and its guidance is seen to represent value for money.

'As the NHS moves into a period of financial stringency, it is being asked to focus not just on quality care but on increasing productivity and innovation. It is important that what NICE does continues to reflect those priorities.'

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