Increase in prescriptions for diabetes exceeds rise in overall prescribing
*NHS Digital1 must be quoted as the source of these figures
1 August 2017
Prescription items2 for the treatment of diabetes3 in primary care have increased by 80.1 per cent over the last decade, compared with a 46.0 per cent rise across all primary care prescribing, an NHS Digital report published today shows.
And the report - Prescribing for Diabetes: England 2006/07 to 2016/17 - shows that in the last year the number of items prescribed for diabetes grew more than twice as fast (4.7 per cent) as the overall prescriptions across primary care (2.0 per cent).
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.
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 Framework4, 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 40.0 per cent over the same period and prescriptions for the most commonly prescribed category of diabetes drugs, Biguanides (metformin)5, 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.
Cost6 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 cost6 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.
Between 2015/16 and 2016/17, there was a marginal reduction in the overall cost6 of prescription items across primary care, with the figure falling below £9bn. But, over this period, there was a £27.0m increase for diabetes which totalled £983.7m in 2016/17.
Prescribing for Diabetes also shows drugs classified as "other antidiabetic drugs"8 - 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.9 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.
Read the full report:
Notes to editors
1. NHS Digital is the national information and technology provider for the health and care system. Our team of information analysis, technology and project management experts create, deliver and manage the crucial digital systems, services, products and standards upon which health and care professionals depend. During the 2015/16 financial year, NHS Digital published 294 statistical reports. Our vision is to harness the power of information and technology to make health and care better. NHS Digital is the new trading name for the Health and Social Care Information Centre (HSCIC). We provide 'Information and Technology for better health and care'. Find out more about our role and remit at www.digital.nhs.uk
2. Prescription item: Prescribers in the community write prescriptions on a prescription form, known as a FP10. Each single item written on the form is, in this report, counted and considered as a prescription item.
3. BNF section 6.1 Drugs used in diabetes.
4. QOF: The objective of the Quality and Outcomes Framework (QOF) is to improve the quality of care patients are given, by rewarding GP practices for the quality of care they provide to their patients. QOF is therefore an incentive payment scheme, not a performance management tool, and a key principle is that QOF indicators should be based on the best available research evidence. One point GP practices are awarded for is managing some of the most common chronic diseases, such as diabetes.
5. Biguanides are a group of oral type 2 diabetes drugs which prevent the production of glucose in the liver, improving the body's sensitivity towards insulin and reducing the amount of sugar absorbed by the intestines. The only available biguanide medication is Metformin. Metformin is recommended by NICE (National Institute of Health and Care Excellence) as the initial drug treatment type 2 diabetes (i.e. the first option for type 2 diabetics who are unable to control their blood sugars through diet and exercise alone).
6. Cost or Net Ingredient Cost (NIC) is the basic cost of a drug. It does not take account of discounts, dispensing costs, fees or prescription charges income so the amount the NHS spent will be slightly different. Net ingredient cost figures given here are not adjusted for inflation. Standard adjustments for inflation are not considered appropriate as drug prices are subject to controls under the Pharmaceutical Price Regulation Scheme and to other central controls.
7. The British National Formulary (BNF) is a joint publication of the British Medical Association and the Royal Pharmaceutical Society, which aims to provide prescribers, pharmacists, and other healthcare professionals with information on the use of medicines. It includes information on how to select, prescribe, dispense, and administer medicines. Medicines are listed within the BNF by therapeutic groupings. Chapter 6.1 includes insulins, oral antidiabetic drugs, and monitoring devices. This does not include hypodermic equipment, which is recorded in the BNF section "Other appliances".
8. See page 14 of the report for definitions of categories of drugs prescribed to treat diabetes.
9. See Figure 6 in the report.
10. See Figure 5 in the report.
11. Prescribing for Diabetes: England 2006/07 to 2016/17 uses ePACT Data. This information was obtained from the Prescribing Analysis and Cost tool (PACT) system, maintained by NHS Prescription Services, a division of NHS Business Services Authority, which covers prescriptions prescribed by GPs, nurses, pharmacists and others in England and dispensed in the community in the UK. For data at PCT/CCG level, prescriptions written by a prescriber located in a particular PCT/CCG but dispensed outside that PCT/CCG will be included in the PCT/CCG in which the prescriber is based. The data available in PACT is a rolling 60 month dataset. Prescriptions written in England but dispensed outside England are included. Prescriptions written in hospitals /clinics that are dispensed in the community, prescriptions dispensed in hospitals, dental prescribing and private prescriptions are not included in PACT data. It is important to note this as some BNF sections have a high proportion of prescriptions written in hospitals that are dispensed in the community.
For example, BNF chapter 4, "Central Nervous System" has a fair proportion of items written in mental health clinics that are dispensed in the community - these prescriptions are not included in PACT data
12. Other publications (Prescription Cost Analysis, England - 2016 and Prescriptions Dispensed in the Community, England - 2006-2016) use PCA Data. Prescription information is taken from the Prescription Cost Analysis (PCA) system, supplied by NHS Prescription Services, a division of NHS Business Services Authority (BSA), and is based on a full analysis of all prescriptions dispensed in the community i.e. by community pharmacists and appliance contractors, dispensing doctors, and prescriptions submitted by prescribing doctors for items personally administered in England. Also included are prescriptions written in Wales, Scotland, Northern Ireland and the Isle of Man but dispensed in England. The data do not cover drugs dispensed in hospitals, including mental health trusts, or private prescriptions. Prescribers are GPs, hospital doctors, dentists and non-medical prescribers such as nurses and pharmacists.
13. Coherence and Comparability - The NHS Prescription Services data presented here differs from that presented in NHS Digital publications based on the Prescription Cost Analysis system. This is because the PCA database is based on all prescriptions dispensed in England irrespective of where they were written and includes prescriptions written by dentists and hospital doctors. The figures in this publication are based on prescriptions written in primary care in England and dispensed anywhere in the United Kingdom.
14. Figures over 1 million have been rounded to the nearest 100,000. Other figures (including percentages) have been rounded to one decimal place.