Benchmarking Antimicrobial Use
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- Belinda Potter
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1 CPMU Research Evening Symposium Benchmarking Antimicrobial Use Paul Wade Consultant Pharmacist Infectious Diseases Guy s & St. Thomas NHS Foundation Trust 14th March 2013
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3 Disclosures Honoraria, consultancy fees & speakers bureau fees from: Astellas AstraZeneca Cubist Gilead ICNet Merck Novartis Pfizer Wyeth
4 Antibiotics: from the cradle to the grave?
5 Timeline for deployment & resistance
6 European resistance data - Fluoroquinolone (R) E. coli
7 European resistance data - Carbapenem (R) K. pneumoniae
8 European resistance data - MDR-K. pneumoniae Resistant to: 3G-cephalosporins, fluoroquinolones, aminoglycosides
9 What s the real problem in the UK?
10 Closer to home
11 New antibacterials:
12 ? O ü O O Actual data Assumed from MOA? ü ü O? ü ECDC 2009
13 Back to the future?
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15 Pharma / societal drivers Shareholder dividends Pharma is a business Reconfigurations within Pharma Net present value estimated likely costs vs estimated likely profits antimicrobials have low net present value compared to statins, ACE inhibitors, monoclonals, etc. How much are antibiotics worth?
16 What s next? Tremendous press coverage in November 2011 Early Day Motion in House of Commons All-Party Parliamentary Group Petition please sign
17 Data, data, data
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20 What about local data? Antibacterial Consumption: London Acute Teaching Trusts - April 2011-March 2012 Cef uroxime Ciprof loxacin Clarithromycin Clindamycin Trust Attributable CDI DDDs Per 1000 Bed Days CDI Cases Trust Number 0
21 LATTICe Group Antibacterial Consumption: London Acute Teaching Trusts - April 2011-March 2012 Amoxicillin Cef alexin Co-amoxiclav Flucloxacillin Trust Attributable CDI DDDs Per 1000 Bed Days CDI Cases Trust Number 0
22 LATTICe Group Antibacterial Consumption: London Acute Teaching Trusts - April 2011-March 2012 Amikacin Cef tazidime Colistin Meropenem Piperacillin/Tazobactam Trust Attributable CDI DDDs Per 1000 Bed Days CDI Cases Trust Number 0
23 What about *really* local data? GSTT Antibacterial Consumption Cef uroxime Ciprof loxacin Clarithromycin Clindamycin Trust Attributable CDI DDDs Per 1000 Bed Days CDI Cases 0 Q Q Q Q Q Q Q Time Period 0
24 GSTT GSTT Antibacterial Consumption Amoxicillin Cef alexin Co-amoxiclav Flucloxacillin Trust Attributable CDI DDDs Per 1000 Bed Days CDI Cases 0 Q Q Q Q Q Q Q Time Period 0
25 GSTT GSTT Antibacterial Consumption Amikacin Cef tazidime Colistin IV Meropenem Piperacillin/Tazobactam Trust Attributable CDI DDDs Per 1000 Bed Days CDI Cases Q Q Q Q Q Q Q Time Period 0
26 Drilling down even further GSTT Antibacterial Consumption : High Risk Agents Acute Medicine Directorate Amoxicillin C efuroxime C iprofloxacin C larithromycin C lindamycin C o- amoxiclav DDDs Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Month
27 Or drilling for longer GSTT Critical Care Antibacterial Consumption: Gentamicin & Piperacillin/Tazobactam DDDs Per 1000 Bed Days April 2006 July 2006 October 2006 January 2007 April 2007 July 2007 October 2007 January 2008 April 2008 July 2008 October 2008 January 2009 April 2009 July 2009 October 2009 January 2010 April 2010 July 2010 October 2010 January 2011 April 2011 July 2011 October 2011 January 2012 April 2012 July 2012 October 2012 Month
28 Simplifying the process Newly available Purchased by NHS London for all Trusts in SHA Allows direct comparison of Trust drug usage Will calculate DDDs automatically Needs some work to determine validity across Trusts Then needs some work to explain variance
29 Sample data available The generation of data is the easy part Can be done in seconds Very flexible/user-definable Doesn t yet have activity measures built in e.g. bed days, admissions, episodes Doesn t yet have outcome measures built in e.g. C. difficile rates, length of stay The interpretation is where the value lies
30 Final words from CMO report
31 Any questions?
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