Diabetes prescriptions on the rise compared with overall prescribing
Prescriptions made for diabetes outside hospitals have increased by 80 per cent over the last decade compared with a 46 per cent rise across all primary care prescribing.
That is according to an NHS Digital report published on Tuesday, August 1, but experts say the rise is consistent with the increase in new cases of diabetes and also as type 2 diabetes – which is mainly behind the hike in prevalence – progresses people tend to go onto more treatments.
A total of 52.0 million items were prescribed for diabetes in 2016/17, up from 49.7 million in 2015/16, and 28.9 million in 2006/07, according to Prescribing for Diabetes: England 2006/07 to 2016/17.
But leading diabetes GP, Professor Kamlesh Khunti said the “overall cost of prescribing was small compared to treatment of complication”.
The report shows that in the last year the number of items prescribed for diabetes grew more than twice as fast (4.7 per cent) than the overall increase in prescriptions across primary care (2.0 per cent).
NHS Digital say that for the years where comparable figures are available, “prescribing for diabetes in primary care has grown nearly twice as quickly as the rise in diabetes prevalence across the population”.
The latest prevalence figures (2015/16) available, from the Quality Outcomes Framework, show that there was a 22.6 per cent increase in diabetes prevalence in England between 2009/10 and 2015/16. Prescriptions in primary care for diabetes increased by 40 per cent over the same period and prescriptions for the most commonly prescribed category of diabetes drugs, Biguanides (metformin), rose by by 51.5 per cent over this period.
Looking across the whole of the last decade, prescribing of metformin for diabetes has more than doubled, from 9.4 million items in 2006/07 to 20.8 million items in 2016/17, according to the report.
Cost or Net Ingredient Cost (NIC) is the basic cost of a drug. It does not take account of discounts, dispensing costs, fees or income from prescription charges, so the amount the NHS spent will be slightly different.
In 2016/17, prescription items for diabetes accounted for around £1 in every £9 of the cost of prescription items across primary care. In 2006/07 it was less than £1 in every £14.
The cost of diabetes drugs increased over the last year, compared to the cost of prescriptions across primary care falling overall. Drugs Used in Diabetes accounts for the highest cost of all British National Formulary7 (BNF) therapeutic areas by BNF section. This has been the case since 2007/08.
The number of people diagnosed with diabetes has risen by 54 per cent in the last decade, so it’s no surprise that levels of prescribing have risen by almost the same level. Simon O’Neill, director of health intelligence for Diabetes UK
Between 2015/16 and 2016/17, there was a marginal reduction in the overall cost of prescription items across primary care, with the figure falling below £9bn. But, over this period, there was a £27.0m increase for diabeteswhich totalled £983.7m in 2016/17, NHS Digital said.
A spokesman for the organisation said the report “also shows that drugs classified as ‘other antidiabetic drugs’ – often new products to the market – are the most expensive category of drugs used in diabetes, for the first time overtaking the cost of human analogue insulin”. They account for a low proportion of all items prescribed for diabetes, but that figure is rising.10 In 2016/17 they cost £322.5 million, compared with £103.0 million in 2006/07, according to NHS Digital
Professor Khunti, who is also the co-director of the Leicester Diabetes Centre and Professor of Primary Care Diabetes and Vascular Medicine at the University of Leicester, said: “It’s excellent to see that metformin prescribing has doubled because it has been shown to have clear benefits on micro and macrovascular complications. However, overall cost of prescribing is small compared to treatment of complications. There are also some new exciting medications which have recently shown benefits for hospitalisation for heart failure and for mortality.”
Simon O’Neill, director of health intelligence for Diabetes UK, said: “The number of people diagnosed with diabetes has risen by 54 per cent in the last decade, so it’s no surprise that levels of prescribing have risen by almost the same level.
“But the increase in prescribing at a primary care level is indicative of the hard work doctors are doing to help people living with diabetes keep their blood glucose at safe levels, and preventing devastating, and costly, complications – such as cardiovascular and kidney disease – further down the line.
“It is vital that drugs being prescribed are reviewed regularly to not only ensure patients receive the most effective therapy, but also to reduce waste. Diabetes is one of our biggest health crises, and with 12 million people at risk of developing type 2 diabetes, it’s clear that focusing on prevention is vital to prevent costs rising even higher.”
To read the full report, click here.