RT Journal Article
SR Electronic
T1 Differing commissioning arrangements may contribute to geographic variation in clinical management of digital ulcers in systemic sclerosis
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 343
OP 345
DO 10.7861/clinmed.2020-0031
VO 20
IS 3
A1 Elizabeth Reilly
A1 Randa Alshakh
A1 Celia Beynon
A1 Matthew Cates
A1 Dhivya Das
A1 Shuja Majeed
A1 Ahsan Memon
A1 Patrick O’Beirn
A1 James Ritchie
A1 John D Pauling
YR 2020
UL http://www.rcpjournals.org/content/20/3/343.abstract
AB Phosphodiesterase inhibitors (such as sildenafil) and endothelin receptor antagonist, bosentan, are effective for digital ulcer disease in systemic sclerosis (SSc-DU) and are endorsed in international treatment recommendations. Commissioning of high-cost drugs, such as bosentan, however, differs across devolved nations of the UK. We report a multicentre service evaluation project to examine ‘real world’ management of SSc-DU before and following the 2015 UK Scleroderma Study Group (UKSSG) guidance, across south-west (SW) England and Wales. Results showed that iloprost and sildenafil use for SSc-DU was higher in patients in Wales prior to 2015. Between 2015–2017, sildenafil use for SSc-DU increased in SW England while remaining stable in Wales. Bosentan use for SSc-DU after 2015 in SW England increased, while remaining stable and proportionately lower in Wales. These findings demonstrate that differing commissioning guidance across devolved nations of the UK seems to contribute to geographic variation in patient care.