Probiotics that have been removed from the drug tariff

Below are the database queries which are used to create this measure. These are run against a copy of the BSA prescribing data which we store in Google BigQuery. We're working on making our BigQuery tables publicly available at which point it will be possible to run and modify these queries yourself. But even where code and database queries are not directly useable by others we believe it is always preferable to make them public.

Description Cost of VSL#3 and Vivomixx per 1000 patients
Why it matters

The Advisory Committee on Borderline Substances (ACBS) is responsible for assessing and recommending products applying for listing in Part XV of the Drug Tariff. The ACBS recently reviewed some products listed in Part XV to ensure they are still clinically effective and appropriate to be listed. They considered the probiotics VSL#3 and Vivomixx and advised the Secretary of State for Health and Social Care to remove these products. The Secretary of State accepted this recommendation and removed the products from the Drug Tariff in November 2018. This is consistent with NHS England guidance that recommends probiotics should no longer be routinely prescribed.

The ACBS concluded that the evidence did not sufficiently demonstrate that the products are clinically effective. Additionally the ACBS & MHRA consider the presentation of a product to prevent a clinical condition such as pouchitis as a specific medicinal claim. Therefore these products now fall within the definition of a medicine (not a borderline substance) and should be regulated as such.

Importantly this means that they are also allowed on prescription, despite not currently being licensed as a medicine, and having been removed from the drug tariff as the evidence does not support them meeting the threshold for Part XV of the Drug Tariff.

Tags Standard, Cost Saving, Efficacy, Nutrition
Implies cost savings Yes
Authored by brian.mackenna
Checked by richard.croker
Last reviewed 2020-03-05
Next review due 2020-06-05
History View change history on GitHub →

Numerator SQL

SELECT
     CAST(month AS DATE) AS month,
     practice AS practice_id,
     SUM(actual_cost) AS numerator
 FROM hscic.normalised_prescribing
 WHERE bnf_code IN ("091104000BBNMA0", "091104000BBNUA0", "091104000BBNVA0")
 GROUP BY month, practice_id

Denominator SQL

SELECT
     CAST(month AS DATE) AS month,
     practice AS practice_id,
     SUM(total_list_size / 1000.0) AS denominator
 FROM hscic.practice_statistics
 GROUP BY month, practice_id