Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
J R Soc Med. 2018 Jun;111(6):203-213. doi: 10.1177/0141076818769408. Epub 2018 May 22.
Objectives NHS England recently announced a consultation seeking to discourage the use of treatments it considers to be low-value. We set out to produce an interactive data resource to show savings in each NHS general practice and to assess the current use of these treatments, their change in use over time, and the extent and reasons for variation in such prescribing. Design Cross-sectional analysis. Setting English primary care. Participants English general practices. Main outcome measures We determined the cost per 1000 patients for prescribing of each of 18 treatments identified by NHS England for each month from July 2012 to June 2017, and also aggregated over the most recent year to assess total cost and variation among practices. We used mixed effects linear regression to determine factors associated with cost of prescribing. Results Spend on low-value treatments was £153.5 m in the last year, across 5.8 m prescriptions (mean, £26 per prescription). Among individual treatments, liothyronine had the highest prescribing cost at £29.6 m, followed by trimipramine (£20.2 m). Over time, the overall total number of low-value prescriptions decreased, but the cost increased, although this varied greatly between treatments. Three treatment areas increased in cost and two increased in volume, all others reduced in cost and volume. Annual practice level spending varied widely (median, £2262 per thousand patients; interquartile range £1439 to £3298). Proportion of patients over 65 was strongly associated with low-value prescribing, as was Clinical Commissioning Group. Our interactive data tool was deployed to OpenPrescribing.net where monthly updated figures and graphs can be viewed. Conclusions Prescribing of low-value treatments is extensive but varies widely by treatment, geographic area and individual practice. Despite a fall in prescription numbers, the overall cost of prescribing for low-value items has risen. Prescribing behaviour is clustered by Clinical Commissioning Group, which may represent variation in the optimisation efficiency of medicines, or in some cases access inequality.
目的
NHS 英格兰最近宣布了一项磋商，旨在劝阻使用被认为低价值的治疗方法。我们旨在制作一个互动数据资源，以显示每个 NHS 全科医生的节省，并评估这些治疗方法的当前使用情况、随时间的使用变化、以及这种规定的范围和变化的原因。
设计
横断面分析。
设置
英国初级保健。
参与者
英国全科医生。
主要结果措施
我们确定了 NHS 英格兰在 2012 年 7 月至 2017 年 6 月的每个月为 18 种治疗方法中的每一种开出的处方的每位患者成本，也汇总了最近一年的情况，以评估实践中的总成本和差异。我们使用混合效应线性回归来确定与处方成本相关的因素。
结果
在过去一年中，在 580 万张处方（平均每张处方 26 英镑）中，低价值治疗的花费为 1.535 亿英镑。在个别治疗中，左甲状腺素的处方费用最高，为 2960 万英镑，其次是曲米帕明（2020 万英镑）。随着时间的推移，低价值处方的总数总体上减少了，但成本增加了，尽管不同治疗方法之间差异很大。三个治疗领域的成本增加，两个领域的数量增加，其他所有领域的成本和数量都减少了。每年实践水平的支出差异很大（中位数为每千名患者 2262 英镑；四分位距为 1439 至 3298 英镑）。65 岁以上患者的比例与低价值处方密切相关，临床委托组也是如此。我们的互动数据工具已部署到 OpenPrescribing.net 上，在那里可以查看每月更新的数字和图表。
结论
低价值治疗的处方非常广泛，但因治疗方法、地理位置和个体实践而异。尽管处方数量有所下降，但低价值药物的整体处方成本有所上升。处方行为由临床委托组聚类，这可能代表药物优化效率的差异，或者在某些情况下代表获得机会的不平等。
