Long-Term Costs and Health Consequences of Issuing Shorter Duration Prescriptions for Patients with Chronic Health Conditions in the English NHS
The National Health Service (NHS) in England spends over £9 billion on prescription medicines dispensed in primary care, of which over two-thirds is accounted for by repeat prescriptions. Recently, GPs in England have been urged to limit the duration of repeat prescriptions, where clinically appropriate, to 28 days to reduce wastage and hence contain costs. However, shorter prescriptions will increase transaction costs and thus may not be cost saving. Furthermore, there is evidence to suggest that shorter prescriptions are associated with lower adherence, which would be expected to lead to lower clinical benefit. The objective of this study is to estimate the cost-effectiveness of 3-month versus 28-day repeat prescriptions from the perspective of the NHS.
We adapted three previously developed UK policy-relevant models, incorporating transaction (dispensing fees, prescriber time) and drug wastage costs associated with 3-month and 28-day prescriptions in three case studies: antihypertensive medications for prevention of cardiovascular events; drugs to improve glycaemic control in patients with type 2 diabetes; and treatments for depression.
In all cases, 3-month prescriptions were associated with lower costs and higher QALYs than 28-day prescriptions. This is driven by assumptions that higher adherence leads to improved disease control, lower costs and improved QALYs.
Longer repeat prescriptions may be cost-effective compared with shorter ones. However, the quality of the evidence base on which this modelling is based is poor. Any policy rollout should be within the context of a trial such as a stepped-wedge cluster design.
The authors wish to thank the authors of the decision models for allowing us to use their work in our analysis. The models were originally developed by the NICE internal guideline team and the National Guideline Centre (NGC) (case studies 1 and 2) and the National Collaborating Centre for Mental Health (NCCMH) (case study 3). The authors of this paper are responsible for the adaptations to the decision models. The authors also wish to thank Rachel Elliot (University of Manchester), Catherine Meads (Anglia Ruskin University), Jon Sussex (Cambridge Centre for Health Services Research, RAND Europe) and other colleagues at the Cambridge Centre for Health Services Research (RAND Europe and University of Cambridge) for providing valuable input and advice. The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR or the Department of Health.
Data Availability Statement
The decision models used in this study were developed and shared with the authors by third parties (NGC and NCCMH). Whilst not publicly available, they were provided to the journal’s peer reviewers for their reference when reviewing this paper and may be requested from the corresponding author [AM].
All authors contributed to the conception and design of this study. Adam Martin and Edward Wilson led the adaptations of the decision models and the reporting of results. All authors were involved in drafting and commenting on the paper and have approved the final version. Adam Martin is the guarantor of the study.
Compliance with Ethical Standards
Conflict of interest
Adam Martin, Rupert Payne and Edward Wilson declare that they have no conflict of interest.
This research was supported by a grant from the National Institute for Health Research (NIHR), Health Technology Assessment funding stream (Grant Reference: NIHR HTA 14/159/07).
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