The Cost of Prescribing Inhalers With High and Low Carbon Emissions in England in 2021/2022

OBJECTIVES: Breakdown the quantity and cost of prescribed inhalers with high versus low carbon emissions in England in the year 2021/2022.

METHODS: The analysis utilised Prescription Cost Analysis (PCA) data at the presentation level for the year 2021/22, published by NHSBSA. The complete PCA data set was whittled down by first isolating products coded with the British National Formulary (BNF) legacy Chapter 03 (Respiratory System) code, then isolating products that indicate they are an inhaler in the BNF name. Inhalers were grouped according to their BNF active ingredient. The two groups/active ingredients with the highest spending (beclomethasone dipropionate, budesonide) were selected for further analysis. The two groups were divided by products that contained a single or multiple active ingredients. High carbon emission inhalers were defined as those containing a propellant (norflurane [HFA 134a] and apaflurane [HFA 227]), according to the product’s summary of product characteristics.

RESULTS: Amongst the inhalers included in this study, a total of 264 million GBP was spent on high carbon emission inhalers, whilst 146 million GBP was spent on lower carbon alternatives. The total cost of beclomethasone dipropionate high carbon combination inhalers was 202 million GBP. Most of these inhalers had a low carbon alternative that was either cost-equivalent or less expensive.

CONCLUSIONS: For budesonide, almost all spending resulted from low carbon inhalers. For beclomethasone dipropionate inhalers most spending reflected high carbon inhalers, where a cost-neutral or cost saving low carbon alternative exists. From an acquisition cost perspective, there does not seem to be a barrier for switching patients to low carbon alternatives, in fact commissioners may realise a saving. However, commissioners must consider the subgroup of patients who cannot be switched for clinical reasons, and the time and cost of consultations with patients to action the switch.