ࡱ> NPM5@ +bjbj22 ](XX? 3$$$$HP`t,H:9:;:;:;:;:;:;:$<R?L_:$ | _:bt:X"X"X" R9:X" 9:X"X""5"Q9 V!py8H9:0:8R?!vR?Q9HHR?$Q9DbX"|x_:_:HH ,<"HH, 15 October 2007 Erin Murphy Pharmac Level 14, Cigna House, 40 Mercer Street, Wellington Dear Erin Thank you for the opportunity to comment on the proposal to fund hypertonic saline for use by cystic fibrosis patients in their nebulisers. This topic has been discussed by the Pharmacists Special Interest Group (SIG) of the Paediatric Society of NZ. The following is an email from one of the pharmacists: In just funding the amps of both 4mmol/ml Sodium Chloride and WFI, I think Pharmac has overlooked some rather important logistical and cost issues. The proposal implies that each patient/caregiver would have to break open the amps andmake up the req'd dilution just prior to use. This would involve the patient/caregiver needing filter needles and syringes to fulfil this task. Will these be funded?. Also it would require education re volumes of each ingredientto "mix" together - it would have to be made clear to everyone that this would be mandatory. In terms of cost: - for a bd dosage, it would cost $11.66/day for the sodium chloride amps (would have to open a new amp each dose)+ $0.46/day for the WFI amps = $84.84 per week ex GST If Pharmac agreed to pay for the community pharmacy to extemp compound it on a weekly basis (and hopefully they would also agree re some reimbursement for filter needles, syringes etc), then, using the same ingredients it would cost approx $ 16.00 per week ex GST. These comments were voiced by several of the group. Current situation: There are a variety of procedures being carried out in the community for these paediatric patients: 7 grams of salt added to previously boiled water & given an expiry of 1 week (stability unproven). Parents get script for sodium chloride 23.4% amps x 10 mls and use the whole ampoule with a set volume of Water for Injection to prepare final strength solutions of 4.7%, 5.9%, 7.1%, 7.8%. The parents are expected to use sterile technique in preparing these solutions and store the prepared solution in a syringe in the fridge for 7 days. Twice daily aliquots are used for the doses. (Again stability unproven). Proposal: Consultation with Dr Cass Byrnes (Respiratory Consultant, Starship Childrens Health) confirmed that the ideal strength required is sodium chloride 7%, with an additional but smaller requirement for a 4% solution. The children are dosed twice daily and a volume of 4 ml is required for each dose. We suggest two options: Option 1: Ideally Biomed could be approached to manufacture syringes or ampoules (preferably plastic) of sodium chloride 7% & 4%. There is a possibility that Biomed are already preparing these solutions for other purposes. Option 2: Community Pharmacies prepare the solutions and pack them into capped syringes (eg. 20 mls) for fridge storage with an expiry of 7 days. The community pharmacies would need reimbursement for filter needles, syringes & syringe caps. For both options the patient would need access to funded syringes for drawing the 4 ml dose from the packed syringes. Option 3: The Pari Company (U.S.) are producing sodium chloride nebules 7 % and 3.5% and this could be a possibility also. Thank you for the opportunity to comment on the funding of hypertonic saline for cystic fibrosis children. Brenda Hughes On behalf of the Paediatric Society of New Zealand Pharmacy Special Interest Group. THE PAEDIATRIC SOCIETY OF NEW ZEALAND Project Manager: Email:Robyn Liddell P O Box 22 234 Wellington Tel: (03) 548 4254 Mobile: 0274 455 796 robyn.psnz@xtra.co.nz  Health of our children: Wealth of our nation $*+` # $ 7 8 {|&>?@Afghުުޟsch&g&5B*CJ(OJQJphh&g&5B*CJ$OJQJphh&g&5OJQJ%jh&g&5OJQJUmHnHuhmh&g&B*phh zCB*phhjB*phhmh>*B*phhCJX6B*phhth6B*phhmhmB*phhB*phhmhB*phh!#+CVabcdnop : z gdm?* JJKU{|m-lmn>gdm>?Aghyz{|}  $If  $If  !Sn#$If !Sn#$If$ x$Ifa$  $Ifgdmh*+hmh&g&B*phh zCjh&g&UmHnHuh&g&h&g&5B*CJOJQJphh&g&B*CJOJQJph ()*w $ !a$gdm $ !n#a$ !ekd$$If\u+#a *+gdm(&P . A!"#$%n1 0&P :pm. 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The Paediatric Society believes all children and youth should, by right, attain optimal physical, mental and social health and wellbeing.  By working as a coordinated national network of health professionals the Society dedicates its efforts and resources to making official submissions to both Government and Non-Government organisations on issues that will impact on the health and wellbeing of children and young people.

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