Cost of low-value prescribing increasing despite fall in items

Researchers from the Nuffield Department of Primary Care Health Sciences at the University of Oxford found there were almost one million fewer prescriptions for low-value items between July 2016 and June 2017, compared with the previous year. However, costs increased by £4.5 million from 2016/17 to 2015/16.

Low-value treatments are those deemed by NHS England to be ineffective, over-priced and of low clinical value.

The researchers found that while the cost per item has remained stable for most low-value treatments, for three items identified by NHS England, liothyronine, trimipramine and the unlicensed drug co-proxamol, the cost has risen dramatically, by £73, £168 and £71 per prescription, respectively.

Lead researcher Dr Ben Goldacre said: 'Co-proxamol, liothyronine and trimipramine illustrate a concerning phenomenon, where despite successful efforts to limit prescribing numbers, costs have risen sharply.'

Giving co-proxamol as an example, Dr Goldacre explained: 'It’s expensive because it was removed from the drug tariff, meaning that any prescriptions for it have to be sourced as a ‘special’ order. There is limited regulation of the cost of such special orders, making real world cost savings on such drugs difficult until there are a very small number of total prescriptions.'

The researchers found a strong association between practices with a higher proportion of patients over 65 and low-value prescribing. They also found prescribing behaviour clustered by CCG.

In addition to the national results presented in the paper, the researchers also shared all data on prescribing at all individual NHS practices. This is published through an interactive website, OpenPrescribing.net, which can be used by GPs, local commissioners, and even patients, to see where there are possible savings opportunities for individual prescribers.