GP prescribing budgets under pressure as anticoagulation costs soar 60%

Increased use of new oral anticoagulants (NOACs) put unprecedented pressure on GP prescribing budgets last year, contributing to a huge 60% rise in anticoagulant drug spending, analysis shows.

Over £222m was spent on 'anticoagulants and protamine' prescriptions dispensed in 2015 – £84m more than 2014, GPonline comparison between Health and Social Care Information Centre (HSCIC) Prescription Cost Analysis reports from 2015 and 2014 reveals.

The figures, which only cover prescriptions dispensed in the community in England, show the number of prescriptions dispensed went up by a much more conservative 11%.

GP leaders warned that NOACs have become the first-line treatment for many patients diagnosed in hospital, and primary care was having to pick up the bill to continue paying for patients’ treatments.

The rise was by far the highest proportional rise in spending for any drug group – totalling over 20% of the overall increase in drug spending for 2015.

GP prescribing

It follows revisions made to NICE AF guidance in June 2014, which urged healthcare professionals to consider wider use of NOACs – including apixaban, dabigatran etexilate and rivaroxaban – as alternatives to warfarin.

NOACs do not require regular monitoring like warfarin does, and NICE said they could be a better option for patients who struggled with dosage control.

But these drugs can cost up to three times the amount warfarin, excluding monitoring costs, leading to concerns when the guidance was launched that primary care prescribing costs could rocket.

Dr Andrew Green, chairman of the GPC clinical and prescribing subcommittee, said wider use of NOACs was behind the disproportionate cost increase of anticoagulants.

He said: ‘The real interest here is in the anticoagulant figures. We welcome the increase in anticoagulant prescriptions which reflects the growing awareness of the importance of protecting patients with AF from the complication of stroke, combined with implantation of the NICE guidance on this subject.

‘The disproportionate cost increase is indeed due to the increased use of NOACs, and it would appear that they are becoming the agents of first choice for patients diagnosed in hospitals, and my personal experience is that these patients may have not been advised as to the alternative options available.

‘This can have a very significant effect on the prescribing budget which GPs will have to manage, even though they are not responsible for the cause of the deficit.’

Diabetes drugs

The overall cost of drugs dispensed in the community last year was £9.2bn, £413m (5%) more than the year before. The number of prescription items dispensed rose 2% over this period to 1.1bn.

Diabetes drugs once again took up the lion’s share of spending, amounting to 10% of the total. This was followed by corticosteroids (respiratory) at 8% of the overall spend, analgesics at 6%, antiepileptics at 5% and oral nutrition and bronchodilators at 4% each.

The anticoagulant spend contributed 2% of the overall net ingredient cost for drugs in the community.

The amount spent on thyroid and antithyroid drugs saw the second highest proportional increase in 2015, rising 25% – a £33m increase on last year.

The figures also show that GPs’ efforts to cut down on antibiotics prescribed helped reduce overall items prescribed by 6% on last year. Despite this drop, spending on antibiotics rose 9%.

Photo: iStock

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