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30 November 2009
The NHS Information Centre has issued a report considering expenditure on medicines in hospitals in England in 2008. It includes a table focusing on medicines positively appraised by NICE as well as comparing use of ‘low cost’ medicines that are subject to Better Care, Better Value Indicators, between strategic health authorities.
Action
Although the data have many limitations, it provides useful information for service providers who may wish to assess their prescribing of these medicines.
What did the report find?
The overall NHS expenditure on medicines in 2008 was £11.6 billion, with hospital use accounting for 28.7% of the total cost, up from 25.8% in 2007. The cost of medicines rose by 3.4% overall but by 15.2% in hospitals. Of those positively appraised by NICE, the greatest overall cost within the NHS was for atorvastatin (total estimated cost about £340 million, with £334 million in primary care) but etanercept incurred the greatest cost in hospitals (total estimated cost about £152 million with £145 million in hospitals).
In primary care, the proportion of net ingredient cost of all statins which are ‘low cost’ statins (simvastatin and pravastatin) ranged from 11.3% in the North West Strategic Health Authority (SHA) to 19.7% in the North East SHA. The proportion in hospitals ranged from 15.6% in the North West to 67.6% in the North East.
In primary care, the proportion of net ingredient cost of all proton pump inhibitors (PPIs) which are ‘low cost’ PPIs (omeprazole and lansoprazole, excluding formulations not available generically) ranged from 49.1% in the North West SHA to 61.8% in the London SHA. The proportion in hospitals ranged from 45.9% in London to 70.7% in the West Midlands.
In primary care, the proportion of net ingredient cost of all renin-angiotensin system drugs (RADs) which are ACE inhibitors ranged from 28.1% in the London SHA to 39.3% in the North East SHA. The proportion in hospitals ranged from 35.5% in the Yorkshire and the Humber region to 60.4% in the North East.
So what?
Whilst useful, the data have many limitations and there are caveats around its use, which are outlined in the report. However, it demonstrates variations in prescribing practice and provides useful information to help judge whether NHS resources are being used in line with NICE guidance and according to the Better Care, Better Value Indicators.
A previous report from the NHS Information Centre, which we blogged, assessed the variation in the use of 26 medicines positively approved by NICE in 13 technology appraisals. Although the information in the earlier report is ‘experimental’ in status, it provides useful information for service providers who may wish to review their performance in implementing NICE guidance.
The NPC has produced National Support Materials for the Better Care, Better Value Indicators (statins, PPIs and RADs [which will be updated shortly]) that are available on NPC. These materials include online and downloadable resources, and cover policy and guidance, therapeutics and implementation and monitoring at a local level.
More information on statins can be found on the cardiovascular disease – lipids floor of NPC
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