Latest figures show the UK's growth in prescribing spending is the fastest of all the major European markets, with an 8% rise in the 12 months to October 2004.

Figures from IMS Health's Retail Drug Monitor show the UK market outstripping growth in Germany (4%), France (6%), Italy (4%) and Spain (7%) with the government figures confirming the trend over a similar period.

Chief executive Sir Nigel Crisp's annual report on the NHS published at the end of last year showed an 8.2% rise in costs from the 12 months to September 2004, reflecting the biggest rise in prescriptions dispensed in ten years.

The rising spending on medicines was hailed by Sir Nigel as a positive sign and a significant contribution to improvements to the health service's record - particularly the spectacular falls in deaths from cardiovascular disease seen in recent years.

NSF drives up prescribing of hypertension drugs

Coronary Heart Disease (CHD) continues to be a top priority for the NHS and more is spent on lipid regulating drugs than any other class of cardiovascular drug.

Introduced in April 2004, the new General Medical Services contract adds strong incentives for GPs to diagnose and treat more patients with coronary heart disease.

The disease area boasts the highest points ratings (121 of the 550 clinical points available), bringing with it the biggest payments to general practices.

The National Service Framework for CHD is the other major factor behind increased prescribing in the area, particularly for statins, which heart czar Dr Roger Boyle has credited with making the major contribution to saving between 4,000 and 6,000 lives every year.

Pfizer's Lipitor is currently the biggest selling drug in the class - and the biggest selling drug in the UK - although the availability of cheap generic simvastatin (Zocor) has helped the NHS increase prescribing in the class by 30% while costs rose just 10%.

Government-enforced price cuts in December 2003 in four of the most commonly prescribed generics - simvastatin, omeprazole, lisinopril and doxazosin - also helped keep costs down throughout the period. A further enforced reduction in the prices of these drugs was introduced in September last year.

The NSF has had a similar effect on hypertension drug spending, which grew 7% to just over £605 million while items prescribed increased at double this rate by 14% to £37.3 million.

This reflects the recent patent expiry of a number of the biggest selling drugs in the class, including Pfizer's Istin (amlodipine) and Aventis' Tritace (ramipril).

New NICE guidelines on hypertension published in August will also help broaden prescribing in the area, although it recommended these older generically available drugs over the newer, still-under-patent drugs in the angiotensin receptor blocker class.

Takeda's Amias, BMS/Sanofi's Aprovel and Novartis' Diovan all compete in the class but are some way behind MSD's market leader Cozaar.

Meanwhile, Sanofi-Aventis' Plavix (clopidogrel) was the drug with the fastest growth of the period, driving up the total spending on the anti-platelets from £102.7 million to £136.4 million, representing a 33% increase in costs, the largest of any category.

Prescribing of anti-platelet drugs has doubled in the last five years in the UK, with aspirin by far the most frequently prescribed, though Plavix accounts for approximately 75% of the costs according to Prescription Pricing Authority figures.

The drug's continued growth comes from its use in a broader range of indications. Brian Hamilton, business director Infopharm, said: "The growth in anti-platelet drugs is almost entirely due to Plavix. Sanofi-Aventis/BMS position it as better than aspirin and their approach is working. Plavix is being used more widely and once GPs prescribe Plavix to patients they stay on it and the average patient shows less adverse reactions, like gastrointestinal effects, than say on aspirin."

Plavix is also increasingly being used for Acute Coronary Syndrome and post-stenting, in co-therapy with aspirin or warfarin, and in the treatment of TIA (transient ischaemic attacks).

In July, NICE recommended Plavix  in combination with low dose aspirin for the management  of non-ST-segment-elevation acute coronary syndrome (ACS) in  patients at moderate to high risk of myocardial infarction (MI) or death.

While this recommendation was excellent news for its manufacturers, the drug lost out in another therapy area, the prevention of occlusive vascular events - the blocking of arteries that lead to heart attacks and strokes.

In the Institute's guidance issued in November, Boehringer Ingelheim's Asasantin Retard (dipyridamole in combination with aspirin) was recommended as the first line choice for the condition while Plavix was recommnended only in patients with genuine intolerance to aspirin.

The rise in UK sales is mirrored worldwide: Plavix the fastest growing of all the leading drugs, achieving growth of 34% in the year to October 2004, according to IMS' Health Retail Drug Monitor.

PCTs get proactive against diabetes

The NSF for Diabetes is the driving force behind the increase in prescribing and costs of drugs used in this disease area. The framework has ambitious targets to diagnose and treat the growing number of people with the condition - there are an estimated 'hidden million' in the UK with undiagnosed diabetes.

The government has promised that by 2006 every patient with diabetes, or at risk of developing it, will be offered regular check-ups and appropriate treatment by doctors, nurses and other health professionals to ensure complications are spotted early.

The NSF has led to a rise in prescribing of newer agents like glitazones and more expensive insulins, such as Sanofi-Aventis' long-acting insulin analogue Lantus.

Sales of the newer generation of drugs, the glitazones - GSK's Avandia and Takeda's Actos - continue to grow, despite NICE guidelines recommending limited prescribing of the drugs.

Slough PCT is one of several trusts to have piloted schemes to identify currently undiagnosed patients through an Action Diabetes Project. The dedicated team of clinicians are also attempting to redress inequalities in accessing care, particularly targeting ethnic minority groups such as South Asians, who suffer from a higher prevalence of the condition.

pharmafocus@wiley.co.uk