Trends and variation in Prescribing of Low-Priority Medicines Identified by NHS England: A Cross-Sectional Study and Interactive Data Tool in English Primary Care
Background: Routine accessible audit of prescribing data presents significant opportunities to identify cost-saving opportunities. NHS England recently announced a consultation seeking to discourage use of medicines it considers to be low-value. We set out to produce an interactive data resource to show savings in each NHS general practice, and to assess the current use of these medicines, their change in use over time, and the extent and reasons for variation in such prescribing. Methods: We determined the cost per thousand patients for prescribing of each of 18 different medications identified by NHS England, for each month from July 2012 to June 2017, and also aggregated over the most recent year to assess total cost and variation amongst practices. We used mixed effects linear regression to determine factors associated with cost of prescribing. Results: The total NHS spend on all low-value medicines identified by NHS England was GBP153.5m in the last year, across 5.8m prescriptions (mean GBP26 per prescription). Among individual medications, liothyronine had the highest prescribing cost at GBP29.6m, followed by trimipramine (GBP20.2m) and gluten-free foods (GBP18.7m). Over time, the overall total number of low-value prescriptions decreased, but the cost increased, although this varied greatly between medications. Annual practice level spending varied widely (median, GBP2,262 per thousand patients, IQR GBP1,439 to GBP3,298). The proportion of patients over 65 showed the strongest association with low-value prescribing; CCG was also strongly associated. Our interactive data tool was deployed to OpenPrescribing.net where monthly updated figures and graphs can be viewed. Conclusions: Prescribing of low-value medications is extensive but varies widely by medication, geographic area and individual practice. Despite a fall in prescription numbers, the overall cost of prescribing for low-value items has risen. Prescribing behaviour is clustered by CCG, which may represent variation in medicines optimisation efficiency, or in some cases access inequality.
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