Could North Cumbria save money on haemorrhoid cream?

Last week, a pharmacist from NHS North Cumbria CCG got our attention by mentioning OpenPrescribing on Twitter. He had just received a letter about a product for treating haemorrhoids called Uniroid. It’s a 50/50 mixture of Cinchocaine and Hydrocortisone, and is also available as Proctosedyl (made by Sanofi), and as a generic (i.e. unbranded) product.

The maker of Uniroid wants North Cumbria to start prescribing Uniroid-branded products, on the grounds it will save the CCG about £11,000 per year.

As it happens, we know a bit about cost savings through switching (for example, here’s some cost-saving opportunities for North Cumbria that we update each month; this is how we do it), so we thought we’d take a closer look at that claim.

The claim

The specific claim in the letter is that in the period July 2015 - June 2016:

• £3.9 million was spent on Proctosedyl in the UK;
• that switching to Chemidex’s Uniroid brand would have saved the NHS in the UK £2.34m;
• with a £11,368 saving to North Cumbria.

Our findings

The aggregate data for these products can be downloaded from OpenPrescribing here, and the data for Uniroid here.

Uniroid products are significantly cheaper for the NHS to buy than the status quo: GPs are recommended to prescribe products as generics, which have a cost (fixed by the Department of Health) that is around twice the price of Uniroid.

However, the total possible savings for North Cumbria in that period was actually £9,980. And if you take the most recent year’s data, that figure drops to £7,390.

Yet if you look at our savings tool for North Cumbria, you’ll see that we show no potential savings for Cinchocaine / Hydrocortisone. Why? Implementing savings takes quite a degree of effort, and is not worthwhile when the savings are small. We exclude the possible monthly saving to North Cumbria of £550, because no individual practice would save more than £50 per month by implementing it.

How did the manufacturers of Uniroid come up with the figure of £11,368?

We can’t know for sure, but we noticed that £11,368 is £2.34m (the total possible claimed savings of switching to Uniroid HC) divided by 206, a number that is close to the total number of CCGs in England (there are currently 195 CCGs in England). This would be a bad approach to use, as CCGs vary massively in size: there are around 324,000 patients in North Cumbria, whereas the largest CCGs have more than a million.

---

P.S. We couldn’t assess claim about the total savings to the NHS, as the letter refers to prescribing in the UK, and we only have NHS England data (we’d love to cover all the UK, but we need more funding to do so). But for the record, Chemidex seem to have underestimated total savings (it would be interesting to know why). In 2015/16, we found that NHS England spent £5.2m on Proctosedyl, and could have saved £2.9m at today’s prices. This possible saving reduced to £2.1m in 2017/18, and drops to £650,000 if you only consider individual cost savings of more than £50 per month.