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Retrospective, multicohort analysis of the Clinical Practice Research Datalink (CPRD) to determine differences in the cost of medication wastage, dispensing fees and prescriber time of issuing either short (<60 days) or long (≥60 days) prescription lengths in primary care for common, chronic conditions in the UK
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  • Published on:
    Authors' reply to Kumar: Limitation of Results
    • Brett Doble, Researcher in Health Economics University of Oxford
    • Other Contributors:
      • Rupert Payne, Consultant Senior Lecturer in Primary Health Care
      • Edward CF Wilson, Senior Research Associate in Health Economics

    Kumar raises concerns about the interpretation of our study examining the cost savings of different repeat prescription durations, and argues monthly dispensing should be maintained. We thank Mr Kumar for his comments and interest in our article and respond below.

    In response to Kumar's first point, our study suggests that with shorter prescription lengths, the cost savings due to reductions in waste are more than offset by the additional dispensing fees; these fees can therefore not be considered "nominal". White1 further highlights the non-nominal impact of additional dispensing fees due to short prescriptions lengths, estimating an additional cost of £700 million if all prescription items issued by the NHS in England were issued as 28-day repeat-dispensing items.

    We are also not aware of any evidence that increased frequency of contact with the community pharmacist (or indeed “indirect contact" with the GP authorising a prescription) due to shorter prescription lengths impacts in a valuable way in terms of patient outcomes as implied, either from a clinical or cost effectiveness perspective. Work by Elliott et al.2 has shown the pharmacy-based New Medicines Service to be cost-effective at improving adherence. However, un-targeted clinical pharmacy services, more generally, lack conclusive evidence of their effect on medication adherence and prescription appropriateness.3 Indeed, in many cases, the contact between patient and pharmacist...

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    Conflict of Interest:
    None declared.
  • Published on:
    Limitation of Results

    The research result has emphasized that increase medicines waste with longer intervals. Also, increase Prescribing cost for shorterter intervals. These findings should lead to The authors of this article suggesting:
    - Shorter intervals save significant medicines waste in comparison to nominal dispensing fee and offers Very valuable patient contact with a healthcare professional.
    - Authors has totally ignored the e-Repeats and eRDS (EPS most important automation already in place in almost all GP surgeries & Pagrmacies) to save Significant Prescribing cost. That was the main one of the main purpose of EPS; authorities should look into using the existing Tools to savings on both Prescribing cost and reducing costly mesicine waste by keeping Monthly dispensing intervals.

    I hope, authorities use the existing wheels; rather than trying to reinvent / disbalance the existing wheels.

    Conflict of Interest:
    None declared.