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  1. Posted
    Categories
    • TrialsTracker

    Making the FDAAA TrialsTracker even better than current ClinicalTrials.gov data

    When you produce online tools from data, you often get useful feedback that helps you improve the outputs. (Send us feedback any time!). Additionally, when you use data, you learn about interesting glitches in it, some of which can be entirely undocumented. Here we share one example of helpful feedback, and how we used it to improve our tool.

    First some background. Trial reporting is a huge problem in medicine: the results of clinical trials are routinely withheld from doctors, researchers, and patients. We think all trials should be reported. The WHO agrees. A US law called the FDA Amendments Act requires some trials to report their results on ClinicalTrials.gov: this law has many loopholes, but it’s an important start. Since the results reporting requirements of FDAAA came into full force, our FDAAA TrialsTracker has been identifying the individual trials that have breached it. You can read our paper on how the tool works: we also blogged about our methods for identifying overdue trials. Staff in universities who manage trial reporting are already telling us that they find our tool useful.

  2. Posted
    Categories
    • Policy Insights

    Why is this trial due to report?

    Now that we’ve launched our FDAAA TrialsTracker, we plan on occasionally taking a closer look at some of the trials that go unreported. Our first blog was about a trial examining 2 drug combinations for managing pain during labor (NCT01846221).

    So why do we think this specific trial is due to report? While we go through how we established our criteria and set up our database in detail in our preprint paper on Biorxiv, we wanted to walk you through exactly what fields matter on ClinicalTrials.gov and how we used them to build our tracker. We think we were able to do this well, but are open to feedback and will amend our paper and methods as necessary.

  3. Posted
    Categories
    • TrialsTracker

    Tool 'names and shames' hidden drug trials

    “Institutions that fail to report the results of their drug and medical trials will be named on a new website.”

    In this BBC article, Chris Foxx, highlights the FDAAA TrialsTracker. Quoting Bennett Institute Director, Ben Goldacre, “I’m not interested in naming and shaming people in order to criticise them. This project is being done to nudge institutions to prioritise trial reporting.”

  4. Posted
    Categories
    • TrialsTracker

    The FDAAA TrialsTracker is Live!

    This week, we launched our FDAAA TrialsTracker which gives you a live look at whether individual sponsors and trialists are meeting their responsibility to report the results of clinical trials on ClinicalTrials.gov. A lot of work went into the tracker and making sure we got it right. You can read all about our methods, in detail, here but the short version goes like this…

    Certain trials registered on ClinicalTrials.gov, the US trial registry run by the National Institutes of Health (NIH), are required to report their results. This requirement began with the passing of the FDA Amendment Act of 2007 (FDAAA) but different interpretations of the broad requirements laid down under FDAAA led to some confusion over who was required to report and when. In September of 2016, a “Final Rule” was published by the NIH that clarified and expanded how the reporting requirement under FDAAA would operate moving forward. The Final Rule came into effect on January 18, 2017.

  5. Posted
    Categories
    • OpenPrescribing

    Price Concessions - starting to reduce? UPDATED

    The latest price concession information for January has been released by the PSNC (in fact, two sets of data in quick succession). The PSNC have also stated that they are “still in discussion with the DHSC regarding further January 2018 price concessions”. Therefore we have made some calculations based on what we know at the moment - as soon as there are changes we will update this blog. UPDATE: We’ve now updated the data, both with the final concessions list for January 2018, and the actual cost data for December 2017.

  6. Posted
    Categories
    • OpenPrescribing

    Omega-3 isn't very effective: using prescribing data to explore the impact of trials, reviews, and guidelines

    We’ve been thinking in the Bennett Institute about doing stories, using our prescribing data, to go with landmark clinical trials and systematic reviews. Here’s an example.

    A new systematic review published this week in JAMA shows that Omega-3 “fish oil” pills don’t really help improve cardiovascular health. As a systematic review, it’s a very useful overview of previous existing research. Perhaps reassuringly, as that evidence accumulated over time, clinicians were already changing their prescribing behaviour. Here’s the long-term NHS prescribing data from our database: NHS doctors gradually began to reduce prescribing of omega-3 a long time ago. Peak omega-3 was 2011!

  7. Posted
    Categories
    • OpenPrescribing

    OpenPrescribing January 2018 Newsletter

    New Year - same Price Concessions issues…

    Everyone at the Bennett Institute wishes you a very Happy New Year!

    Unfortunately, the NHS is still having the same problems in sourcing generics. The PSNC announced the latest list of price concessions for December 2017, slightly smaller than November’s, with 86 lines. However, we still estimated a monthly impact for the NHS in December of £27 million, bringing the total excess cost for the nine months to December to £285 million:

  8. Posted
    Categories
    • OpenPrescribing

    New Year - same Price Concessions issues…

    Everyone at the Bennett Institute wishes you a very Happy New Year!

    Unfortunately, the NHS is still having the same problems in sourcing generics. The PSNC have just announced the latest list of price concessions for December 2017. The list was slightly smaller than November’s, with 86 lines,but we are still estimating an monthly impact for the NHS in December of £27 million. This brings the total excess cost for the nine months to December to £285 million:

  9. Posted
    Categories
    • OpenPrescribing

    Trends and variation in gluten-free food prescribing

    Many people I’ve spoken to aren’t aware that gluten-free foods can be prescribed, but it happens quite extensively in an effort to help patients with coeliac disease adhere to a gluten-free diet.

    Below is a chart showing the rate of gluten-free product prescribing since 1998, where there is a gradual increase until 2011, when guidance changed to recommend only prescribing of staple foods such as bread and flour. Recently there has been a sharper decline.

  10. Posted
    Categories
    • Open Working

    2017 Round-Up

    In our second full year of existence we produced even more exciting outputs and continued to grow. You can see the team on our website: Emma-Jane has been our project manager since the Spring; we have two new part-time coders working for us; and researchers Alex, Nick, Daniel and Karolina all started this year. We’ve delivered a range of great new features on OpenPrescribing, got great progress on numerous pre-launch projects, and have a nice portfolio of papers submitted.

  11. Posted
    Categories
    • OpenPrescribing

    Price Concessions - why are the excess costs lower in November than October 2017?

    We’ve taken a quick look at the data to see why, despite the number of price concession lines have increased to 91 in November, the estimated total excess cost has reduced. (Reminder - we’ve used September prescribing data to estimate the effects, as that’s the latest data available).

    The full table is below, but here are some highlights:

    1. Some of the price concessions have reduced since October. For example, olanzapine 10mg tabs have dropped considerably, from £62/box to under £27/box - although the tariff price has increased from just over £1/box at the beginning of the year. The same applies for gabapentin and amlodipine 10mg tablets.
    2. Some items, such as pramiprexole 88mcg tablets have been removed as a price concession, although once again the tariff price has increased significantly.
    3. Although there are eight new chemicals listed in price concessions, these haven’t a huge impact: topiramate being the largest new cost pressure at around half a million pounds estimated in November.

    As always, you can find our Drug Tariff viewer at www.openprescribing.net/tariff. We’d love to know what you think about the work we’re doing, or anything to do with the OpenPrescribing tool. Please let us know on Twitter, our Facebook page, or via email at feedback@openprescribing.net.

  12. Posted
    Categories
    • OpenPrescribing

    Price Concessions Estimate for November 2017 - CCG data

    The PSNC has published the list today of Price Concessions for November 2017. The list is the biggest yet, at 91 lines.

    We’ve taken a first stab at calculating the estimated effect for CCGs, using September 2017 prescribing data. The Google Sheet can be found here. (edit) - the Google Sheet now also contains national calculations per presentation and all CCG presentation data.

    A couple of calculation changes:

    1. The PSNC spreadsheet had a typo, listing the Zolmitriptan 2.5mg tablets as “$.69”. Therefore until this is corrected we’ve used the October 2017 price concession which is £18.00 for 6 tablets. (edit) - this has now been corrected, and the data below refreshed.
    2. We added in an estimated “Actual Cost” calculation - which is close to what CCGs actually pay, rather than the Net Ingredient Cost. This estimate is used by taking the National average discount percentage from here for October 2017 (7.43%)

    The total for England (actual cost) for November is £38.5m. We’ll do some further calculations when we get the chance. It’s less of an impact than we were expecting - possibly as some of the “big excess” items have been removed. We’ll take another look tomorrow!(edit) - we’ve taken a quick look - and here are some of the reasons why the total cost of price concessions is lower.

  13. Posted
    Categories
    • OpenPrescribing

    Price concessions data for CCGs, including October 2017 estimate

    We have been writing a lot recently about the effect of price concessions on the NHS primary care drugs bill, and on the problems community pharmacy are facing.

    We’ve been asked for some CCG-level data, and so here it is; both for the confirmed data for April-September 2017, and for an estimate for October, which is based on October price concession data with September’s prescribing data.

    (edit) We’ve also been asked how the costs were calculated. We calculate the difference in the unit cost, i.e. (price concession cost per pack - DT cost per pack)/pack size and then multiply by the prescription quantity for each affected presentation. Please note that these calculations are based on Net Ingredient Cost (NIC) not Actual Cost, and so the impact to CCGs will be slightly lower (about 7%).

  14. Posted
    Categories
    • Open Working

    Getting the data for the Drug Tariff tool (*sigh*)

    Today we’ve released our new Drug Tariff viewer. It was a dataset that we previously didn’t hold, but thought that it would be useful to turn into a graphical viewer for people to use to see how the reimbursement price on drugs changes over time, and also to use as the basis of the effect that price concessions are having on the NHS.

    However, obtaining and normalising the data proved to be a bit of a challenge.

  15. Posted
    Categories
    • OpenPrescribing

    New interactive OpenPrescribing tool: Explore Changes in the Drug Tariff (and out of stock medicines) back to 2010!

    The Drug Tariff, published on behalf of the Department of Health and updated monthly, is a strange and mysterious document, written largely in legalese, and understood by pharmacists and almost no-one else. Ask a GP where they find out the cost of the drug, and they’ll say either their computer system or the BNF. For pharmacists, it’s usually the Drug Tariff (or the Tariff). And that’s usually where the most accurate price will be found.

  16. Posted
    Categories
    • OpenPrescribing

    Drug shortages and "Price Concessions" - how much is it costing the NHS?

    There has been an interesting and concerning story in The Times today regarding shortages on a number of commonly-used medicines and a corresponding increase in the costs.

    Here at OpenPrescribing we have been taking a look at these data as well, and trying to estimate to the cost to the NHS this year.

    As the Times article suggested, the excess costs are now hitting £50m per month, with £175m extra spent in primary care by September:

  17. Posted
    Categories
    • OpenPrescribing

    OpenPrescribing December 2017 Newsletter

    New: Analyse page no longer needs a denominator

    One of the most common requests we receive is to be able to use the analyse page without needing to select a denominator, so that you can simply see how much of a drug is being prescribed in each CCG or practice. We’ve now made this feature available. When creating an analysis, simply select “nothing” in the versus dropdown, and you can then see raw monthly data for each practice or CCG.

  18. Posted
    Categories
    • OpenPrescribing

    OpenPrescribing November 2017 Newsletter

    We have created a new interactive tool for exploring the national Prescribing Cost Analysis (PCA) data, allowing you to investigate prescribing trends over 19 years from 1998 to 2016.

    We’ve done a huge amount of hard work to make this tool simple and easy. For example, lots of drug names have changed over time, treatments have moved between Chapters of the BNF, or been assigned new codes. We have “normalised” the data (by hand!) to take account of all this, so we can show each drug according to its current position in the latest BNF dictionary. We have also taken account of changes in national population, and even corrected all prescribing costs to 2016 pounds sterling!