Switching children and young people’s medication from liquid formulations to pills or tablets could save the NHS ‘up to £40,000 per year per patient for some drugs’, according to a new project underway at Great Ormond Street Hospital (GOSH) as part of its Green Plan.
The hospital’s endocrinology team has found that the switch could ‘transform their lives’ of many young patients who are prescribed liquid formulations of medicines despite children aged four and over being able to safely learn how to swallow tablets.
They identified congenital hyperinsulinism as a condition in which children could benefit from the medicine switch from liquid diazoxide to the tablet form, which can deliver the same therapeutic benefit.
Affecting one in every 30,000-40,000 children, this rare condition results in high levels of insulin being produced. Multiple doses of diazoxide must be taken each day, depending on insulin and glucose levels.
Quality of life benefits from formulation switches
During the project, the research team recruited 19 patients, all of whom were aged seven or older, and each was switched from liquid diazoxide to the tablet form of the drug.
The patients were monitored to ensure their blood glucose levels remained stable and were asked about how the medication formulation switch had impacted them.
A multidisciplinary approach was used, with the hospital’s play team and psychologists working with the patients as they switched formulation and using learning materials to help those who struggled with taking tablets.
Over a year on, all 19 patients have been permanently switched to the tablet form with no negative effects on their blood glucose levels, the team said.
The quality-of-life benefits noted by patients during the formulation switch included better taste; much improved convenience, as the liquid has to be stored in a glass bottle, carefully handled and drawn up into a syringe for each dose; better control over the condition; and greater independence.
Diazoxide tablets also cost over 10 times less than the liquid counterpart, with the tablets costing £1.15 per 50mg, while the liquid costs £15.50 per 50mg.
‘This equates to a saving of approximately £40,000 per patient per year,’ the researchers said.
Involving patients in their care
Clinical nurse specialist Kate Morgan, who led the project, said: ‘We knew the potential this trial had for savings, but the scale of the quality-of-life improvements for children and their families we are seeing is something we didn’t anticipate.
‘Children are so much more than their diagnoses – they have full lives and families and their illnesses affects everyone, so it is very important we do all we can to make simple, positive changes that impact everyone for the better.’
Based on the project’s success, optimising medicine formulations for more patients is a priority for the team, with consultant of paediatric endocrinology and diabetes Dr Antonia Dastamani, who also led the project, saying: ‘It is common practice to ask patients how they’re finding treatment, or how they feel when they have injections, but we never thought to ask patients about the taste of medicines and whether they like them.
‘This has shed a light on key questions we now want to ask children and young people about their care and treatment so they can be more involved and have more independence in their lives.’
The team is now looking to move younger patients onto the diazoxide tablets, which will expand the numbers of patients who make the switch and increase the cost savings, as well as investigating other drugs for their potential to switch formulations.