A junior-doctor-led approach to cost-effective prescribing

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Objectives: The NHS drugs budget is huge. How can we be more cost-effective when it comes to inpatient prescribing? KCH spends over £11 million pounds a year. When resources are limited, giving one patient an expensive drug with no added value when cheaper alternatives exist stops other patients getting treatments they need. We wanted to analyse the potential for drug substitution in our hospital and ask the question: Are there best practice approaches to prescribing habits that would include a move to the use of more generic/cheaper alternative medications where clinically appropriate?

Method: We surveyed the drug charts for a population of 100 randomly selected in-patients. We calculated the costs of their current therapeutic regimen (on a daily per patient basis), then using the BNF, MIMS and clinical judgement we looked to see the potential cost savings available by replacing the more expensive/branded medications with cheaper generic or similarly efficacious agents.

Results: The average in-patient drug cost bill per patient was £8.72. Forty percent of the medications in this population were found to be suitable for adjustment to a cheaper alternative and this represented an average saving of £2.24 per patient (a 26% reduction in cost). Scaled up to the whole in-patient population this would potentially represent a saving of £2.8 million per year.

Discussion: Medications management committees and hospital in-patient teams need to reconsider prescribing policy taking medication cost into account. One potential approach is for individual firms to have virtual medication budgets, for cost information to be included on electronic prescribing charts, also for ward-based pharmacists to review medication charts with a view to enforced generic prescribing and for medical teams to agree to medication change if and when clinically appropriate. The advantage of this approach is that it creates an awareness and a culture of responsibility for cost control amongst healthcare professionals and especially junior doctors who undertake the majority of prescribing activity, commonly with little or no appreciation of cost.

Document Type: Research Article

Publication date: December 1, 2012

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