General Practice Prescribing Trends in England and Wales
An analysis of prescribing trends provides credible insight into changes in clinical practice and can facilitate the identification of spending patterns and cost-saving opportunities for the NHS. Given this value, the Cogora Insight & Market Access team have carried out an analysis of primary care prescribing in England and Wales for the 2016 calendar year.
Prescriptions for diabetes drugs, respiratory corticosteroids, analgesics, antiepileptics and oral nutrition products were associated with the highest spend on prescriptions for 2016. Together, the total Net Ingredient Cost (NIC) for these therapy areas amounted to £3.3bn, making up 35.1% of the total NIC for all prescriptions in all general practices in England and Wales in 2016 (£9.5bn). Furthermore, compared to 2015, there was an increase in the quantity of prescriptions for diabetes drugs and antiepileptics whereas analgesics, respiratory corticosteroids and oral nutrition products witnessed a fall in the number of prescriptions relative to 2015.
There was a 5.2% rise in the NIC spend for diabetes drugs, from £992.9m in 2015 to £1.0bn in 2016, perhaps a sign of the increasing burden of diabetes on the NHS. Of the aforementioned five therapy areas, diabetes drugs were associated with the highest NIC spend. Similar to 2015, the largest proportion of NIC spend associated with diabetes in 2016 was observed in The Midlands and East England (29.6% of total NIC) while North England was reported to have the lowest proportion (27.7% of the total NIC).
Although prescriptions for respiratory corticosteroids were responsible for the second highest spend in 2016, in terms of associated NIC, the number of units prescribed appears to have plateaued relative to earlier years (1.2% fall compared with 2015). Our analysis also revealed an 8.5% decrease in the number of units prescribed generically, which corresponds with official guidelines stating that generic prescribing of inhalers should be avoided – due to the risk of patients being unfamiliar with devices and using an incorrect inhalation technique.
Analgesics were one of three therapy areas that witnessed a drop in NIC spend relative to 2015. The number of prescriptions was however relatively unchanged. Approximately one-third (34.6%) of analgesics prescriptions were for opioids, with Morphine as the single most-prescribed opioid (819.5m units, increasing by 8.6% compared with 2015). The North of England was, for the third year running, responsible for the greatest proportion (33.7%) of the total spend on analgesic prescriptions in England and Wales.
We carried out an analysis to identify the top performing branded pharmaceuticals in terms of the percentage increase in total NIC between 2015 and 2016. The top two performers were drugs used in diabetes (Performa®and Toujeo®). Four of the top-ten drugs in the list were indicated for diabetes, making this the most prominent therapy area. In terms of the highest numerical increase in total NIC in 2016 relative to 2015, Lyrica®, for the second year in a row, experienced the largest numerical increase (increased by £30.6m). This may, at least in part, be due to the High Court ruling made in February 2015, according to which all prescriptions of pregabalin (active ingredient) for neuropathic pain must be made under the branded name Lyrica®.