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Healthcare Trust Confirm Results Of Minister’s Request For ‘Clinical Discretion’ W

Added: (Mon Feb 12 2001)

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Issued 9 February 2001

Healthcare Trust Confirm Results Of Minister’s Request For ‘Clinical Discretion’ With NICE Guidelines

Results obtained from the West Cumbria Health Care NHS Trust during the last influenza season (1999 - 2000) confirmed the benefit of exercising ‘clinical discretion’, a concept described by the Minister of State for Health in a recent written response, over guidance, issued by the National Institute for Clinical Excellence (NICE) and the Department of Health (DoH), on the use of Relenza (zanamivir).

During winter 1999 – 2000, amidst the mass of publications about zanamivir, the West Cumbria Health Care NHS Trust examined the use of Lysovir (amantadine), an antiviral available to treat Influenza A but at a tenth of the cost of zanamivir, and its ability to reduce staff absence due to influenza. The results of using Lysovir were considerable. Within 5 days of influenza hitting the Trust, 41 treatment packs had been issued. By the middle of January the number of new cases had fallen sharply although new cases continued to occur until the beginning of March. During the whole 65-day episode, 74 courses of Lysovir treatment were issued. Treatment was “successful” (i.e. reduced absence to 2 days or less) in 59 cases (80%) and “unsuccessful” (i.e. an absence of 3-5 days) in the remaining 15 cases. Perhaps the most striking feature was that 46 cases (78% of responders) required no sickness absence at all.

As Mr Ken Ball, Director of Clinical Support Services at West Cumbria Health Care NHS Trust, explained “…we set out, on the basis of solid, published evidence, to make a difference in one small Trust. This was not a formal clinical trial but an attempt to devise and implement a workable scheme to reduce the impact of influenza on the Trust. The scheme was well-received by the staff and appeared to be effective. We have treated 3 staff successfully so far this year and in the meantime we would encourage others to look at the evidence and consider whether amantadine should be a part of their influenza management strategy…”

The outstanding results from the West Cumbria Health Care NHS Trust reinforce the importance of the comments from The Right Honorable John Denham, Minister of State for Health, when answering parliamentary questions about details and guidance issued by the DoH and NICE. Mr Denham wrote “…the Department issued supplementary implementation guidance to the National Health Service in the light of the potential implications for the delivery of GP services over the winter period. This guidance was not an endorsement of Relenza…We expect general practitioners to exercise their clinical discretion in deciding whether and what to prescribe…The exercise of clinical discretion is not overridden by NICE guidance…”

The confusion and controversy over guidance from NICE and subsequent advice from the DoH has been well documented. Many primary care groups and health authority pharmaceutical advisers have begun to reject the guidance on zanamivir viewing it as fundamentally flawed, lacking clinical evidence and extremely confusing. Concern was raised over the associated cost of zanamivir in the treatment of influenza, which during the annual influenza season Mr Denham confirmed could cost the NHS “…between 2.3 million and 11.7 million…”


For further press information, please contact:

Tony Booley, Alliance Pharmaceuticals Ltd Tel: 01249 466966
Simon Royston, Magellan Medical Communications Tel: 0207 462 5660

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