Looking back at an unprecedented time in the history of the NHS, what impression did the pandemic have on the prescription pattern? Oli Hudson of Wilmington Healthcare unveils the new State of the Nation report to reveal the NHS transformed by the impact of COVID on services and routes.
The prescription provides a unique view of the NHS at any given time and reveals its many challenges, priorities, and prejudices. So what can we learn from the prescribing patterns of the pandemic’s heyday?
That’s our new one State of the nation The report will try to find it. Using a wealth of data from the entire primary and secondary health care over the last two years, we draw an extraordinary picture of what really happened in one of the most turbulent times in NHS history.
First and foremost, this report highlights the scale and immediacy of change in delivery across the NHS. Services have been dramatically modified as restrictions and emergency protocols have forced the NHS to modify care routes at a rapid rate.
Analysis of NHS Hospital Episode Statistics (HES) data shows that inpatient spells have changed from 17.3m on 2019/20 to 12.8m on 2020/21 as the NHS has taken dramatic steps to minimize the patient’s feet. It has been shown to have collapsed. In outpatient care, activities have also been significantly redrawn, with face-to-face appointments reduced by 39% and telemedicine appointments increased by more than a factor of five.
Hospitalizations decreased each year in 2020/21 in all areas of treatment, except for infectious diseases that increased for obvious reasons. All spells in oncology, gastroenterology, musculoskeletal system, respiratory and ophthalmology were reduced in 2020/21, restoring historic growth. Genitourinary and cardiovascular hospitalizations were also reduced, but not as rapidly as in other major therapeutic areas.
Overall, our cost analysis shows that 2020/21 NHS spending is 12-51% less than the previous year in all therapeutic areas.
Source: Hospital Episode Statistics (HES); NHS Digital
This operational shock also left a mark on the prescription pattern. In secondary care, mucolytics saw the most rapid cost increase in 2020/21, partly due to increased prescriptions for cystic fibrosis drugs. Ivacaftor.. Meanwhile, spending on ophthalmic products decreased by 14.6%. This is because the problems of maintaining regular eye appointments in secondary care have affected spending on high-value treatments for wet AMD.
As antibiotic prescriptions continued to decline, antibiotics also declined sharply, which could be exacerbated by a decline in inpatients, which meant a reduction in nosocomial infections not associated with COVID. The oncology and immunology-related drug fields provide the largest source of prescription spending and show a significant cost burden on the NHS budget. The cost of cytotoxic drugs increased 9.0% in 2020/21 to £ 1.8 billion, making it by far the largest single section in terms of prescribing costs.
Source: NHS Business Services Authority; Prescription Cost Analysis
On the other hand, in primary care, diabetes was the largest area of spending, accounting for £ 1.2 billion in prescribing costs in 2020/21. However, the largest increase in spending is related to antidepressants, which increased by two-thirds (66%) to £ 371 million in 2020/21. This probably reflects the sacrifice that the pandemic has made to the country’s mental health.
Source: NHS Business Services Authority; Prescription Cost Analysis
Winners and losers
Digging into specific drugs, despite the pandemic, the use of innovative therapies in secondary medicine remained strong. The main products are specialty drugs such as monoclonal antibody therapies, many of which are used to treat cancer and immunological indications. The NHS’s commitment to providing innovative therapies to address the needs of unmet patients is illustrated by the treatment of cystic fibrosis. Ivacaftor, 2020/21 spending more than tripled to £ 393.9 million. Other recently approved products, Emicizumab Hemophilia A and Asphotase alpha The cost of hypophosphatosis also increased by more than 200% in 2020/21.
In primary care, another story unfolds. Unlike secondary care, the main primary care products were primarily in the respiratory, cardiovascular and diabetes treatment areas. There were also many generic products.Anticoagulant therapy such as Apixaban, Rivaloxaban When Edoxaban Respiratory products such as asthma and inhalation treatment for COPD were also important spending areas, breaking the spending chart.
However, the most dramatic changes in primary care prescribed in 2020/21 were related to antidepressants. Sertraline, More than 4 times growth (305%) was seen.Statin etc. AtorvastatinAnd GERD drugs Omeprazole There was also a significant increase. All suggest the tensions that pandemics have put on people’s lifestyles and their ability to manage their condition.
It is also worth noting the types of medicines that have seen the greatest depression. In particular, at the peak of the pandemic, there was a noticeable decline in prescribing new high-value medicines in primary care. You can only guess why this is. Perhaps some of these medications are likely to require an acute sponsor that may have been more difficult during periods of restricted access to outpatient treatment. It is also possible that GP and / or the regional prescribing committee has made it more modest to prescribe new medications during times when primary care was unable to make regular direct contact with the patient.
The two final datasets should feed pharmaceutical companies with thought. The first is the Round-trip (RTT) waiting list, which has grown from 4 million incomplete routes before the pandemic to over 7 million routes in November 2021. Great pressure on the medical services we provide.
The other is regional differences in per capita spending on prescriptions, which are above £ 400 per person in the areas with the highest spending and slightly over £ 200 per person in the areas with the lowest spending. Many factors can be behind this, including demographics, patient requirements and expectations, clinical choices, differences in interpretation of guidelines, and levels of bureaucratic burden and financial stress within the system.
Whatever the cause, the magnitude of the variability underscores the ongoing disparities in the health care of the population within the NHS. While the importance of prescribing in managing both chronic and acute health is well known, there are still significant differences in prescribing practice. That is, where you live will continue to define your treatment.
For both pharmaceutical companies and Integrated Care Systems, there are many things that need to be considered to prepare for the future.
Download the national status report at https://wilmingtonhealthcare.com/state-of-the-nation/
Secondary medical data is obtained from the English Hospital Episode Statistics (HES) database created by NHS Digital. Copyright © 2022, NHS Digital. Reused with the permission of NHS Digital. all rights reserved.
Prescribe in the Age of COVID: State of National Review
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