Narcolepsy (part 10)

… continued from previous nine articles on narcolepsy, where in the recent one the ethical issue with prescribing Sodium Oxybate (Xyrem®) as well as arguments for and against were mentioned.

However, I will now move onto mentioning the cost of the pharmacological treatments for narcolepsy.

In this week’s article, I will mention the cost of two pharmacological treatments; Modafinil and Sodium Oxybate.

Cost of pharmacological treatments:

In the UK, not all the medicines used to treat the systems associated with narcolepsy are licensed, nor are they funded by the NHS. General Practitioners or specialists can prescribe modafinil, dexamphetamine, methylphenidate and antidepressants as well.

In my research, I found that one of the hospitals would fund the initial prescription for up to 8 weeks maximum. However, the General Practitioner or the Primary Care Trust must take the responsibility to continue providing the prescription.

‘The unit price for Sodium Oxybate Oral Solution 500 mg / ml (Xyrem®) is £360 per 180 ml bottle. Cost per annum: 4.5 g/ day £6,570,  6 g / day £8,760 and 9 g / day £13,140 inclusive of V.A.T.’ (1)

Cost of Modafinil:

The cost of Modafinil with the dose range 100mg–400mg per day can cost £640 – £2,560 per year (2)

Cost of Sodium Oxybate:
The cost of treating one patient per year is nearly £13,000. Additionally, the treatment of ‘…3-4 patients per year (numbers given by Papworth for Hertfordshire population) the total approximate spend would be up to £52,000’ (3)
Furthermore, a Xyrem® 180ml bottle containing 500 mg per ml which is 90 mg per bottle, costs £360 (£423 including VAT). Since the licensed the maximum licensed dose is 9 g daily, one whole bottle would last for 10 days. So, the annual cost for the maximum dose would be around £13,000 (£15,400 including VAT). Some studies that had a longer term use of Xyrem® showed the mean daily doses to be ‘6.5 g (n = 117 with 12 months follow-up) and 6.8 g (n = 55 with 21 months follow-up, range 7 to 44 months).’ (4)
The median was calculated for both and the doses calculated were 6 g and 7.5 g. This would lead to an average dose of 7 g daily would be used in order to calculate the cost analyses.
However, this doesn’t correspond to an actual licensed dose.

‘The annual cost of treatment at this dose is about £10,000 (£12,000 incl VAT). UK sales data for Xyrem® indicates that actual mean doses used in practice are lower than this at about 5 g daily.’ (4)

To be continued…

References:
(1). Sodium Oxybate (Xyrem®) SCG: For the treatment of narcoleptic patients with cataplexy. (2006). 1st ed. [pdf] p.5. Available at: http://www.ipswichandeastsuffolkccg.nhs.uk/Portals/1/Content/Members%20Area/Clinical%20Area/Medicine%20managment/Clinical%20guidelines/Shared%20care/SODIUM_2.PDF [Accessed 12 Apr. 2016].
(2). MODAFINIL (PROVIGIL ® ) – RECOMMENDED FOR RESTRICTED USE. (2011). 1st ed. [pdf] HERTFORDSHIRE: HERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE. Available at: http://hertsvalleysccg.nhs.uk/uploads/file/Pharmacy/Local%20Decisions/Modafinil%20Indications%20-%20201109%28HMMC%29.pdf [Accessed 12 Apr. 2016].
(3). SODIUM OXYBATE FOR CATAPLEXY IN ADULT PATIENTS WITH NARCOLEPSY – NOT RECOMMENDED. (2010). 1st ed. [pdf] HERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE. Available at: http://hertsvalleysccg.nhs.uk/uploads/file/Pharmacy/Local%20Decisions/Sodium%20Oxybate%20for%20Cataplexy%20-%20Narcolepsy%20-%20201007%28HMMC%29.pdf [Accessed 12 Apr. 2016].
(4). Horsley, W. (2009). Sodium oxybate (Xyrem ® ) in the management of narcolepsy with cataplexy. 1st ed. [pdf] NHS North East Treatment Advisory Group, p.11. Available at: http://ntag.nhs.uk/docs/app/Sodium%20Oxybate%20%28Xyrem%29%20NETAG-Appraisal-Report.pdf [Accessed 12 Apr. 2016].

 

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