I am writing to you today to request information relating to use of Luteinising Hormone-Releasing Hormone Analogue (LHRHa) treatments for Prostate Cancer
1. Do you currently have any enhanced (non GMS or PMS) service contracts involving prostate cancer and/or Luteinising Hormone-Releasing Hormone Analogue (LHRHa) administration with GP practices?
The CCG has a service for Gonadorelin analogues in prostate cancer. Leuprorelin and triptorelin are also included within our amber drugs local service specification for endometriosis, fibroids (leuprorelin) and triptorelin (precocious puberty).
2. Does this service involve payments for the administration of the following LHRHA’s please indicate which?
i) Zoladex (Goserelin) – Yes.
ii) Prostap (Leuprorelin) – Yes.
iii) Decapeptyl (Triptorelin) – Not currently as has not been product initiated locally for prostate cancer but will be added at next review in line with updated prostate cancer shared care guideline.
3. What is the frequency of payment?
4. What is the payment amount?
Prostate cancer service – £43.54 per patient.
Amber drugs, dependent on service level:
Level 1 £2.64 per patient
Level 2 £23.06 per patient
Level 3 £25.04 per patient
5. Does the service include other factors such as: PSA, symptom questionnaires, patient review follow ups?
See relevant information pasted from shared care guideline below:
- PSA – ‘PSA monitoring according to local shared care service arrangements (as communicated by hospital specialist)’.
- Symptom questionnaires – ‘Monitor for adverse effects of drug therapy and assessment of risk factors for potential adverse effects eg. cardiovascular disease, fractures & diabetes’.
- Patient review follow ups.
- Monitor for adverse effects of drug therapy:
- Patients with diabetes may require more frequent monitoring of blood glucose.
- PSA every 3 months, or as specified by hospital specialist. (Responsibility for PSA monitoring as per local shared care service arrangements). Patient to be reviewed by Uro-oncology service if:
- patient has symptoms
- if PSA doubles from baseline levels
- if there are 2 consecutive increases in PSA
- if PSA > 20μg/L
- U&Es including LFTs and FBC every 6 months. Contact the hospital specialist if potassium, serum creatinine (unless known to have chronic renal failure) or LFTs are significantly raised.
6. Is there a specific payment for this?
The payment includes all monitoring and follows up as per shared care guideline for the drugs and other requirements of the service specification.