Introduction and objectives New data from the US IPFNET PANTHER Study1 has failed to demonstrate efficacy of NAC in adult IPF patients with mild to moderate disease. However, use of NAC in adults with Idiopathic Pulmonary Fibrosis (IPF) is commonplace in the UK2 despite weak clinical evidence and limited support from clinical guidelines. NICE recently estimated that between 30 and 45% of patients with moderate IPF are treated with NAC monotherapy at an annual cost of £158 per patient3. We wanted to estimate the cost burden of NAC prescribing in England based on the actual acquisition cost to the NHS.
Methods We obtained the actual prices of NAC at a dose of 600 mg TDS from 11 different sources in England including IPF specialist centres, UK Medicines Information and guidance from Area Prescribing Teams and applied the average price into the NICE IPF costing template assuming 45% of moderate IPF (just over 3000 patients) patients receive NAC and 90% are still taking treatment at 52 weeks.
Results The average annual cost of NAC from 11 different sources was £675.63 (425% greater than NICE cost assumptions) with costs ranging from £144–£1078 per annum. This equates to an estimated annual cost of NAC in England of £2,070,266.
Conclusion NAC is unlicensed with a recent trial demonstrating limited benefit in treating IPF. The estimated annual cost burden of NAC to the NHS in England is very high. In light of the current financial position of the NHS more should be done to reduce the use of ineffective treatments that offer poor value for money. Physicians should re-evaluate the use of NAC in the management of IPF.
Raghu G et al The Idiopathic Pulmonary Fibrosis Clinical Research Nertwork. Randomized Trial of Acetylcysteine in Idiopathic Pulmonary Fibrosis. The New England Journal of Medicine 2014;370:2093–2101
Kausar et al. Practise Patterns in Idiopathic Pulmonary Fibrosis: Results of a UK Physician Survey. Thorax 2012;67:A117-A118 doi:10.1136/thoraxjnl-2012-202678.411
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