Abstract
ObjectiveTo investigate the relative impact of generic entry and National Institute for Health and Care Excellence clinical guidelines on prescribing using statins as an exemplar.DesignRetrospective analysis of statin prescribing in primary care and cost simulation model.SettingRoyal College of General Practitioners Research and Surveillance Centre (RCGP R&SC) database and Prescription Cost Analysis (PCA) database.ParticipantsNew patients prescribed statins for the first time between July 2003 and September 2018.Main outcome measuresShares of new patients prescribed one of the five statins available in the British National Formulary, and cost of prescribing statins to new and existing patients in primary care in England.ResultsGeneral trends of statin’ prescriptions were largely driven by a decrease in acquisition costs triggered by patent expiration, preceding NICE guidelines which themselves did not seem to affect prescription trends. Significant heterogeneity is observed in the prescription of the most cost-effective statin acrossGPs. A cost simulation shows that, between 2004 and 2018, the NHS could have saved £2.8bn (around 40% of the £6.3bn spent on statins during this time) if all GP practices had prescribed only the most cost-effective treatment.ConclusionsThere is potential for large savings for the NHS if new and, whenever possible, ongoing patients are promptly switched to the first medicine that becomes available as generic within a therapeutic class as long as it has similar efficacy to still-patented medicines.
Highlights
In a context where national health systems of all high- and medium-income countries are confronted! The Royal Society of Medicine 2021Article reuse guidelines: sagepub.com/journals-permissions by ballooning costs of caring for an ageing population and an increase in prevalence of long-term conditions, promoting cost-effective prescribing represents an important part of controlling healthcare expenditure.[1,2] In the English National Health Service (NHS), the National Institute for Health and Care Excellence (NICE) publishes national guidance aimed at promoting clinical and cost-effective evidence-based recommendations for the clinical management of different conditions
Under the assumption that general practitioners cannot consistently anticipate whether a new patient would benefit from starting treatment with any given statin different from the one recommended by NICE, we evaluated prescription decisions according to a cost-minimisation criterion
Migration from simvastatin to atorvastatin started soon after a generic became available in May 2012, despite the fact that atorvastatin was only recommended as the preferred treatment in the updated NICE guideline two years afterwards
Summary
In therapeutic markets where treatments have similar safety and effectiveness, NICE recommendations may vary over time following changes in acquisition costs, e.g. due to patent expirations and the ensuing entry of generics. Persistence of prescribing habits and prescribers’ lack of awareness of medicines’ actual cost may mean that the uptake of NICE recommended medicines can vary substantially across general practitioners and practices, despite efforts at local level, including Clinical Commissioning Groups (CCG), to encourage more cost-effective prescribing.[3,4,5,6,7] Since low responsiveness to adopt NICE recommendations can substantially undermine NHS efforts to contain drug expenditure, it is important to understand the pervasiveness of such behaviour.
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