Cuts 'curb shingles drug'

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The Independent Online
HUNDREDS of patients are being refused an effective treatment for shingles, a painful viral infection, because GPs, who are under government pressure to cut their prescribing costs, say it is too expensive.

There is growing anecdotal evidence from across the country that more doctors are resorting to cheaper and less effective treatments for the illness, which affects one in seven adults.

According to pharmaceutical industry data, only a third of those who develop shingles are prescribed the drug, acyclovir, which costs pounds 113 for a seven-day course. Shingles is caused by the chicken pox virus infecting sensory nerves, and results in severe pain.

David Murfin, a GP at Ammanford, Dyfed, said that early use of acyclovir (also known as Zovirax) meant that patients suffered a few days' discomfort rather than weeks of pain. 'Pressure from the Department of Health to hold down prescribing means that I can only prescribe Zovirax to one in five shingles patients, although I feel that more would benefit from the treatment,' he said. 'We have been warned by the Welsh Office that there will be penalties for heavy over-prescribers.'

Virginia Bottomley, Secretary of State for Health, is committed to reducing the 'soaring' NHS drugs bill, which now stands at pounds 3bn and is increasing by 12 per cent annually.

Like many other doctors contacted by the Independent on Sunday, Dr Murfin prescribes acyclovir only for the most urgent cases of shingles, such as elderly patients who may develop complications, or people at risk of damage to their eyes from the virus.

An Essex doctor, who asked not to be named, said that he was now prescribing the drug for one in 10 patients, compared with four in 10 five years ago. 'As part of our general cost monitoring, we are expected to account for all expensive prescriptions. This sort of treatment would be frowned upon.'

Doctors in the new fund-holding practices, who are accountable for their own drugs bill, also fear that they will have to limit their prescribing costs. James Carne, a GP with a budget-holding practice in Stamford Hill, north London, said his drugs budget for 1993-94 had just been cut back by pounds 11,000 because he made savings during the previous year. There was a 'very serious danger' that cost factors would affect his prescribing habits if the Government continued to reduce his budget, he said.

Some pharmacists are reporting a fall in the number of prescriptions for more expensive drugs overall. Jeffrey Shapiro, who has a pharmacy at Chigwell, Essex, said that in addition to acyclovir for shingles, doctors were refusing to prescribe a new migraine treatment.

The drug, sumatriptan, administered as an injection, worked 'within minutes, and the tablets within half an hour', he said. The injection costs pounds 41.14 and six tablets pounds 48.

'Patients tell me that their doctor will not prescribe it because it is too expensive,' Mr Shapiro said. 'They are being deprived of effective treatment purely on the basis of cost. They are given less effective drugs and have to take time off work. The loss to the economy far exceeds the cost of the drug.'

A spokeswoman for the Department of Health denied yesterday that pressure was being placed on GPs to cut their prescribing costs. However, she added that the prescribing budget was 'unacceptably high and that money saved here could be used elsewhere in the health service'.