Dispensing patterns and financial costs of glucose‐lowering therapies in the UK from 2000 to 2008*

Abstract

A variety of influences determine prescribing behaviour. The purpose of this study was to characterize the pattern of dispensing for glucose-lowering and monitoring in the UK from 2000 to 2008, inclusively. Open source data were used from the four UK prescription pricing agencies. Historical patterns of dispensing change were analysed in England, thus data are for England unless otherwise stated. Costs were adjusted for price inflation and reported in UK pound at 2008 prices. The total cost in the UK in 2008 was 702 239 000 UK pounds: 22 897 000 pounds (3.2%) for Northern Ireland, 37 681 000 pounds (5.3%) for Wales, 57 146 000 pounds (8.1%) for Scotland and 590 514 000 pounds (83.4%) for England. As a per cent of the overall primary care drug budget for each region, this represented 6.9% overall and then 5.8, 6.5, 5.9 and 7.1%, respectively. In England, diabetes-related dispensing costs increased from 290m to 591m UK pounds. All glucose-lowering drug classes increased in volume, except the alpha-glucoside inhibitors and the prandial glucose regulators. Insulin costs increased from 128m to 286m UK pounds. Insulin glargine metrics increased year-on-year, whereas neutral protamine Hagedorn (NPH) declined. Analogue insulin increased (2.6 million to 33.9 million prescription items), whereas human insulin declined (21.0 million to 10.3 million). The costs of dispensing for diabetes increased markedly between 2000 and 2008 to represent an annual cost to the NHS of 708m UK pounds, or 7% of budget. Costs increased at a higher rate than volume. Changes in prescribing appeared to reflect commercial factors more than clinical evidence. Diabetes dispensing patterns need to be better controlled and costs contained.