Advice
Evidence review: economic issues
Cost effectiveness
No studies were identified that compared the cost effectiveness of 0.2% glyceryl trinitrate ointment with 0.4% glyceryl trinitrate ointment for treating chronic anal fissure in adults or children.
Cost
The NHS electronic drug tariff (March 2013) lists 0.2% glyceryl trinitrate ointment under 'arrangements for payment for specials and imported unlicensed medicines'. The price quoted is £57.75 for the minimum 30 g volume and an extra £1.62 for every extra gram above 30 g. The price listed for Rectogesic (glyceryl trinitrate 0.4%, 4 mg/g rectal ointment, ProStrakan) is 46% lower at £34.80 for 30 g.
Current drug usage
Prescription Cost Analysis in England show that over the last year (December 2011 to November 2012) in general practice, 0.4% glyceryl trinitrate ointment (both Rectogesic and generic prescriptions) accounted for 98% (85,176) of the total prescription items for glyceryl trinitrate ointment dispensed for anal fissures (86,852) and for 96% (approximately £3.1 million) of the total cost (approximately £3.2 million). By contrast, 0.2% glyceryl trinitrate ointment accounted for just 1.8% (1,547) of total glyceryl trinitrate ointment items and 3.4% of the cost (approximately £100,000) in the same period (Personal communication. NHS Business Services Authority February 2013).
The remaining strengths of glyceryl trinitrate ointment that may have been prescribed for managing anal fissure (0.02%, 0.05% and 0.1% glyceryl trinitrate ointments) accounted for only about 0.2% of the total items dispensed and 0.6% of the cost (approximately £20,000).
Among the special order products prescribed in primary care in England in the quarter from July to September 2012, glyceryl trinitrate 0.2% ointment is listed as 95th by number of items (353) and 241st by net ingredient cost (£22,312).