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Health economics
Research
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
  1. Brett Doble1,2,
  2. Rupert Payne1,3,
  3. Amelia Harshfield1,4,
  4. Edward C F Wilson1
  1. 1 Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK
  2. 2 Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
  3. 3 Department of Population Health Sciences, Bristol Medical School, Centre for Academic Primary Care, University of Bristol, Bristol, UK
  4. 4 Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
  1. Correspondence to Dr Brett Doble; brett.doble{at}dph.ox.ac.uk

Abstract

Objectives To investigate patterns of early repeat prescriptions and treatment switching over an 11-year period to estimate differences in the cost of medication wastage, dispensing fees and prescriber time for short (<60 days) and long (≥60 days) prescription lengths from the perspective of the National Health Service in the UK.

Setting Retrospective, multiple cohort study of primary care prescriptions from the Clinical Practice Research Datalink.

Participants Five random samples of 50 000 patients each prescribed oral drugs for (1) glucose control in type 2 diabetes mellitus (T2DM); (2) hypertension in T2DM; (3) statins (lipid management) in T2DM; (4) secondary prevention of myocardial infarction; and (5) depression.

Primary and secondary outcome measures The volume of medication wastage from early repeat prescriptions and three other types of treatment switches was quantified and costed. Dispensing fees and prescriber time were also determined. Total unnecessary costs (TUC; cost of medication wastage, dispensing fees and prescriber time) associated with <60 day and ≥60 day prescriptions, standardised to a 120-day period, were then compared.

Results Longer prescription lengths were associated with more medication waste per prescription. However, when including dispensing fees and prescriber time, longer prescription lengths resulted in lower TUC. This finding was consistent across all five cohorts. Savings ranged from £8.38 to £12.06 per prescription per 120 days if a single long prescription was issued instead of multiple short prescriptions. Prescriber time costs accounted for the largest component of TUC.

Conclusions Shorter prescription lengths could potentially reduce medication wastage, but they may also increase dispensing fees and/or the time burden of issuing prescriptions.

  • primary care
  • health policy
  • health economics
  • therapeutics

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjopen-2017-019382

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    Footnotes

    • Contributors BD designed the study protocol; extracted, analysed and interpreted the data; drafted and revised the article; and gave final approval of the version to be published. AH extracted and assisted in organising the data; reviewed and edited the draft article; and gave final approval of the version to be published. RP and ECFW conceptualised the study; assisted with its design and the interpretation of data; critically reviewed and edited the draft article; and gave final approval of the version to be published.

    • Funding This research was supported by a grant from the National Institute for Health Research, Health Technology Assessment funding stream (Grant reference: NIHR HTA 14/159/07). This article presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research or the Department of Health.

    • Disclaimer This study is based on data from the Clinical Practice Research Datalink obtained under license from the UK Medicines and Healthcare Products Regulatory Agency. The interpretation and conclusions contained in this study are those of the authors alone.

    • Competing interests None declared.

    • Ethics approval The protocol (16_117R) forthis study was approved on 21 June 2016 bythe Independent Scientific Advisory Committee (ISAC), the independentbody that approves use of CPRD data (online supplementary appendix VII).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data available.