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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Publication Date
2017-12-04Journal Title
BMJ open
ISSN
2044-6055
Publisher
BMJ Publishing Group
Volume
7
Issue
12
Pages
e019382
Language
eng
Type
Article
This Version
VoR
Physical Medium
Electronic
Metadata
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Doble, B., Payne, R., Harshfield, A., & Wilson, E. (2017). 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, 7 (12), e019382. https://doi.org/10.1136/bmjopen-2017-019382
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 United Kingdom.
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 were 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
Humans, Chronic Disease, Retrospective Studies, Cohort Studies, Time Factors, Prescription Fees, Primary Health Care, Drug Prescriptions, Practice Patterns, Physicians', United Kingdom
Sponsorship
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).
Identifiers
External DOI: https://doi.org/10.1136/bmjopen-2017-019382
This record's URL: https://www.repository.cam.ac.uk/handle/1810/276577
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