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Walker, Alex J; Curtis, Helen J; Bacon, Seb; Croker, Richard; Goldacre, Ben
2018 Journal of the Royal Society of Medicine
doi: 10.1177/0141076818769408pmid: 29787684
ObjectivesNHS England recently announced a consultation seeking to discourage the use oftreatments it considers to be low-value. We set out to produce an interactive dataresource to show savings in each NHS general practice and to assess the current use ofthese treatments, their change in use over time, and the extent and reasons forvariation in such prescribing.DesignCross-sectional analysis.SettingEnglish primary care.ParticipantsEnglish general practices.Main outcome measuresWe determined the cost per 1000 patients for prescribing of each of 18 treatmentsidentified by NHS England for each month from July 2012 to June 2017, and alsoaggregated over the most recent year to assess total cost and variation among practices.We used mixed effects linear regression to determine factors associated with cost ofprescribing.ResultsSpend on low-value treatments was £153.5 m in the last year, across 5.8 m prescriptions(mean, £26 per prescription). Among individual treatments, liothyronine had the highestprescribing cost at £29.6 m, followed by trimipramine (£20.2 m). Over time, the overalltotal number of low-value prescriptions decreased, but the cost increased, although thisvaried greatly between treatments. Three treatment areas increased in cost and twoincreased in volume, all others reduced in cost and volume. Annual practice levelspending varied widely (median, £2262 per thousand patients; interquartile range £1439to £3298). Proportion of patients over 65 was strongly associated with low-valueprescribing, as was Clinical Commissioning Group. Our interactive data tool was deployedto OpenPrescribing.net where monthly updated figures and graphs can be viewed.ConclusionsPrescribing of low-value treatments is extensive but varies widely by treatment,geographic area and individual practice. Despite a fall in prescription numbers, theoverall cost of prescribing for low-value items has risen. Prescribing behaviour isclustered by Clinical Commissioning Group, which may represent variation in theoptimisation efficiency of medicines, or in some cases access inequality.
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