A practical guide to switching factor concentrates post tender
By Haemnet
In the UK, since 2004, there has been a national tender system for the purchasing of clotting factor concentrates managed by the Commercial Medicines Unit, a part of NHS England. This has led to significantly lower prices. The outcome of a new contract means that haemophilia centres have to commit to using certain volumes of particular products. Therefore some patients have to switch product. Much of the work of managing the process of switching products falls to haemophilia nurses and this has to be achieved within a timeframe that allows the target volumes to be reached.
An Advisory Board of senior haemophilia nurses, along with an invited operational services manager, met on 24 November 2017 to discuss the management of product switches in light of the pending outcome of a national recombinant factor VIII tender. This was organised and funded by Novo Nordisk, although the discussions and output were not product-specific.
In discussing their experiences, the nurses recognised that initially they had regarded product switches to be a burden but found the workload easier with subsequent rounds of switching. They felt that they had learnt from past experiences and would have benefitted from some practical guidance and checklists when they started. As a result, they decided to put together the attached brief guide primarily for new staff who have not experienced a significant product switch before.There are also some observations from talking to patients about the contract and switching product and some of the sensitive issues that can arise. They have also included sample templates of a checklist (provided by Julie Vowles, Newcastle) and a patient letter (provided by Angela Westoby, Leeds) that may be helpful for individual centres to adapt.
References
Harrington C, et al. Switching factor products: selecting patients and managing the process. Journal of Haemophilia Practice 2014.
Hay CRM, et al. The incidence of factor VIII inhibitors in severe haemophilia A following a major switch from full length to B-domain-deleted factor VIII: a prospective cohort comparison. Haemophilia 2015;21:219–26.
Hay CRM, et al, Purchasing factor concentrates in the 21st century through competitive tendering. Haemophilia 2013;5:660–7.
Santagostino E, et al. Switching treatments in haemophilia: is there a risk of inhibitor development? Eur J Haem 2014;94:284–89.
