A key aspect of NHS England's Medicines Value Programme is consideration of best value medicine choice. We present an innovative approach of collaboration between clinical and medicines optimisation specialists to apply the programme's principle of clinical and cost effectiveness to nutritional products suitable for the management of cow's milk allergy (CMA) available on prescription.
Working with industry, this has led to significant cost savings of £3,818,632 in 2020/2021 for primary care in England (based on 12 month ePACT 2 data). Scotland, Northern Ireland and Wales prescribing data has not been analysed but is likely to also show cost savings. This provides proof of concept that formation of collaborative networks to extend the best value principle to nutritional products is an effective strategy.
Here we discuss this collaboration and demonstrate how co-operation and dietetic leadership in appropriate prescribing has been instrumental in improving value for money for amino acid formula (AAF).
Traditionally there are various challenges in improving the prescribing of AAF:
• Teams such as clinical specialists and Medicines Optimisation traditionally work separately or have limited working relationships
• A lack of forums to develop joint working, shared vision and to question clinical and cost effectiveness of nutritional products for clinical management of food allergy
• Loss leading nutrition supply contracts in secondary care may lead to onward prescribing of the contract brand in Primary Care, regardless of local formulary
• Ongoing educational needs of healthcare professionals on nutrition and food allergy.
• Low rates of breastfeeding, coupled with highly variable support to continue breastfeeding if symptoms suggestive of potential CMA develop
To address these complex challenges, we started collaborating to develop common understanding and shared vision of improved patient experience, best practice allergy treatment pathways, reduced variation and improved value.
