108  UK multiple sclerosis service and DMT audit of 70 centres: variation in DMT prescribing

IntroductionThe UK MS service audit builds upon GIRFT’s recommendation for disease-specific data. Here, we address MS disease modifying treatment (DMT) prescribing.AimTo document MS Teams’ DMT prescribing.MethodsWe asked all MS services to share their MS DMT prescribing for the 2018/2019 financial year. We computed: the proportion of people living with MS (PLwMS) on DMTs; drugs prescribed, ratios of higher- to-lower potency drugs, costs to the NHS.ResultsTo date, 49/70 (70%) services have shared data (none declined our request). They treated >21,000 people with DMTs. The proportion of PLwMS on DMTs varied 5.5-fold (range=14.6% to 79.4%; mean=39%).Most services (34/49; 69%) had unrestricted prescribing. These services varied 5-fold (9% to 50%) in the proportion of people prescribed monoclonal antibodies (alemtuzumab, natalizumab, ocrelizumab).The total annual spend from 49 services exceeded £261 million (extrapolated to £373million from 70 services). Mean DMT spend/patient was £12,096 but varied 3.6-fold (£7,116 to £25,833).NHSE quote the total annual increase in DMT spend was 10% in 2019/2020.ConclusionsDMT prescribing variations are expected, but important, if associated with differing outcomes. We recommend the substantial DMT spend and its increase, demands UK investment to: maximise processes (full data reporting to prescribers) and outcome measurement (including dashboard of longi- tudinal and peer-benchmark prescribing practice, eg induction vs escalation approaches and sequenc- ing) to provide optimal real world evidence to guide prescribing.AcknowledgementsNeurology Academy david.rog@srft.nhs.uk79