6 Implications for the NHS
6.1 Information is not readily available on current prescribing patterns of topical corticosteroids in patients with atopic eczema. There is also limited information on the quantity of product used per treatment regimen. Consequently, it is not possible, with any certainty, to establish baseline information on which to base estimates of the resource impact of changes in prescribing between preparations of different acquisition costs. Furthermore, such cost savings will be relatively small at the patient level, and issues related to pack size and product waste can easily erode any potential cost saving. However, given the large patient group with atopic eczema, there may be opportunities for significant savings to the NHS on products prescribed, particularly at a primary care level, because this is where most prescribing of topical corticosteroids is likely to occur.
6.2 An illustrative scenario is explored below. The estimate is based on a number of assumptions used in the calculations, and so should be interpreted cautiously. The underlying assumptions are that patients have two to four flare-ups a year, that they throw away any unused products after each flare-up, and that patients applying topical corticosteroids once daily would use either 50% or 75% of the amount they would use if they were applying the product twice daily. These potential savings assume that all the patient prescription costs are met by the NHS. In practice, however, many patients may receive only one prescription per year, because they may not discard their unused products. Consequently, the figures in the scenario below are likely to be an estimate of the maximum cost savings to the NHS.
6.3 Where a prescribing practice of one of the newer once-daily-only products can appropriately be altered to twice-daily use of one of the older, cheaper topical corticosteroids of the same potency, cost savings have been estimated to range from £300,000 to £600,000 (excluding VAT) for a patient group of 100,000 people with atopic eczema.