BNF on cobalamin

[Gambit62]

Prompted by an earlier post on BNF in relation to patients with neurological symptoms I decided to do a general search for items on hydroxocobalamin.

Was really shocked to see that the BNF quotes the net cost of an ampoule as £2.41.

evidence.nhs.uk/formulary/b...

Anyone got any ideas how they are working that one out? It costs me around 70p to purchase - the price quoted is about 3.5 times that. Doubt it is including nursing time administering as that would push it up even more. So is this just purchasing inefficiencies or is someone making a shed load of money at the expense of tax-payers?

Also have to say that the formulary leaves a lot to be desired in terms of treating B12 deficiency - that on going confusion with macrocytosis - which we all know isn't among the first symptoms in around 30% of cases.

Sometimes I really worry about the NHS. Who am I kidding - I always worry about the NHS

[helvella]

The BNF prices used to be acknowledged as inaccurate. They have (it is claimed) put in quite a lot of effort to reflect real prices but who knows whether that has had some untoward effects?

Over on Thyroid UK the discussion is often of liothyronine. Not many years ago the UK product was around £12 to 15 for 28 25 microgram tablets. It is now close to £200. While foreign supplies (e.g. Greece and Turkey) can be had as low as a few pounds. Even the premium USA brands are not as expensive. So it clearly is not a world-wide price increase in the basic medicine. BNF is, more or less, right on this.

[Hidden in reply to helvella]

Yup, I'm on liothyronine as well as b12 injections. The chemist told me my 28 tablets cost £150+.

[JudithML in reply to helvella]

The NHS is being heavily overcharged by the drug companies for medicines. I've heard that there's an online campaign about it, but don't have details.

[Frodo]

I've been thinking about this too re. 'the confusion with macrocytosis' I've just experienced this again talking with a GP who had seemed to understand previously. I think the difficulty as usual is 'evidence'. It's difficult to 'prove' you have neurological or other symptoms (unless very advanced perhaps) so it rests on the GP believing you and diagnosing the cause correctly as B12 deficiency. A lot of the symptoms could be another disorder. Whereas enlarged blood cells would presumably prove the case.

[helvella in reply to Frodo]

There also seems to be ignorance of the interaction of iron-deficiency anaemia and PA - where the actual sizes of the red blood cells are within range due to the two issues "cancelling each other out".

Red-blood cell Distribution Width can help here - but is by no means perfect.

[Laura5 in reply to helvella]

Red blood cell distribution width is very raised in iron deficiency anaemia alone though too.

[helvella in reply to Laura5]

True - but at least sometimes with a somewhat low value for its mean.

[Gambit62 Administrator in reply to Frodo]

B12 D isn't the only cause of macrocytosis just a particularly likely one.

Continuing to rely upon macrocytosis as a way of identifying B12 is at best dangerous and at worst perpetuation of ignorance and bad practice.

Yes, there is overlap with other conditions but its also true that having a B12 deficiency doesn't make you immune to the other conditions and vice-versa.

Following test results is not exercising professional judgement. Test results are part of the toolkit but there tends to be too much reliance upon them.

[fbirder]

Well, the NHS price has dropped to £10.90 for 5 ampoules since January - nhsbsa.nhs.uk/PrescriptionS... - which is £2.18 each.

Hydroxocobalamin as a Category M medicine when it comes to NHS pricing. The price is re-evaluated every Quarter and is set taking into account the charge the manufacturers normally make, the amount dispensed and a reasonable profit for the makers.

But I still don't see how they could possibly get to over £2 a pop.

[Gambit62 Administrator in reply to fbirder]

Sorry - not sure I totally understand your reply in relation to markup - what is the difference between manufacture and maker?