OBJECTIVES

: The UK National Health Service (NHS) Prescription Cost Analysis (PCA) provides a national level annual summary of the number and cost of all prescriptions dispensed in the community in England, listed by British National Formulary therapeutic class (www.digital.nhs.uk). These data were used to identify and characterise trends in prescribing that affect the overall cost to the NHS.

METHODS

: Prescription analyses for the past 10 years were collated to identify trends that were inconsistent with the expected rise in numbers of prescriptions and associated costs. The areas that showed reverse trends, which represented savings to the NHS, were further analysed to identify the components of change, in order to facilitate an exploration of the reasons.

RESULTS

: Although there was a clear correlation between the rise in number of items prescribed and the overall cost (r=0.82), with several therapy areas dominating prescribing (central nervous system, endocrine and respiratory), a number showed a downward trend in costs, particularly cardiovascular (CV) disease. Despite the proportion of overall spend on CV drugs remaining fairly constant over the 10 year period at around 30%, the total cost to the NHS fell from 21% to 13%, largely due to the lower cost of generic lipid-regulating and antihypertensive drugs. The analysis also revealed a marked increase in the use of novel oral anticoagulants, displacing the cheaper warfarin for the prevention of venous thromboembolism, in line with NICE guidance. The cost of these agents increased from £14m in 2013 to £357m in 2017, with rivaroxaban and apixaban together contributing over £312m, proving to be the most expensive agents dispensed overall.

CONCLUSIONS

: The PCA is a useful, publicly available tool for conducting analyses on physician preferences and market changes, for identifying trends in public health, to aid the introduction of newer technologies and allocation of healthcare resources, and to facilitate patient access.