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

Brett Doble; Rupert Payne; Amelia Harshfield; Edward C F Wilson

doi:10.1136/bmjopen-2017-019382

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

BMJ Open. 2017 Dec 4;7(12):e019382. doi: 10.1136/bmjopen-2017-019382.

Authors

Brett Doble^{1

2}, Rupert Payne^{1

3}, Amelia Harshfield^{1

4}, Edward C F Wilson¹

Affiliations

¹ Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK.
² Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
³ Department of Population Health Sciences, Bristol Medical School, Centre for Academic Primary Care, University of Bristol, Bristol, UK.
⁴ Department of Public Health and Primary Care, University of Cambridge, Cambridge, 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.

Keywords: health economics; health policy; primary care; therapeutics.

MeSH terms

Chronic Disease
Cohort Studies
Drug Prescriptions / economics*
Drug Prescriptions / statistics & numerical data*
Humans
Practice Patterns, Physicians' / economics*
Practice Patterns, Physicians' / statistics & numerical data*
Prescription Fees / statistics & numerical data*
Primary Health Care / economics
Primary Health Care / methods*
Retrospective Studies
Time Factors
United Kingdom