Wastage of prescription drugs in NHS primary and community care in England cost £300 million in 2009, out of a total drugs bill for the sector of nearly £8 billion, says a new study.
The total wasted last year includes £90 million worth of unused prescription medicines stored in individuals' homes at any one time, £110 million returned to community pharmacies over the course of a year and up to £50 million worth of NHS supplied medicines that are disposed of annually by care homes, says the study, by the York Health Economics Consortium and the University of London School of Pharmacy.
However, the NHS is managing the problem of drug wastage more robustly than ever before, say the researchers, who add that the net savings possible from investing further resources in reducing NHS waste are likely to be less than half the full figure of £300 million.
This is partly because much of the waste identified was not caused by failures on the part of either patients or professionals, but by factors such as illnesses progressing and treatment changes being required.
Savings opportunities are also limited by the extra costs of interventions intended to further reduce waste which could, if not carefully controlled, exceed the gains generated, they caution. The average primary care prescription medicine today costs the NHS £10 for a full month's supply, yet medical, pharmaceutical and other professional labour typically costs the Service from £25 to up to £100 an hour, including overheads.
“Many health professionals and members of the public believe that the physical waste of NHS medicines is a major issue. We should do everything we can cost effectively to reduce it. But we have not found that the NHS has a systemic problem with drug wastage which marks it out from other health services,” said report co-author Professor Paul Trueman.
“In value terms there is more to be gained from helping people to take their medicines more effectively, even though this may increase the overall volume of drugs paid for,” he added.
In fact, the study says that up to £500 million of extra value could be generated in just five therapeutic areas - asthma, diabetes, raised blood pressure, vascular disease and the care of people with schizophrenia - if medicines were used in an optimal manner.
“Our evidence indicates that most NHS users are already highly responsible,” said Professor David Taylor of The School of Pharmacy, University of London. “Unfairly blaming patients or professionals is counterproductive, as are suggestions that multi-faceted social and clinical problems like medicines wastage could simply be solved by measures like charging NHS patients more for their treatments,” he added.
“Increased charges can reduce medicines taking adherence by discouraging people from obtaining treatments that will protect their health, and so reduce pressures on NHS resources,” Prof Taylor cautioned.
The study finds a number of opportunities for making savings, including:
- providing targeted medicines-taking adherence support for patients starting new therapies, and for those on unusually costly and/or difficult-to-take treatments;
- encouraging the flexible and informed use of 28-day and, where it benefits patients, other longer or shorter prescribing periods;
- targeting Medicines Use Reviews (MURs) conducted by pharmacists more towards groups and individuals at special risk of having difficulties with their medicines-taking, and of developing problems like “treatment hoarding,” This includes providing better-quality home care for isolated people and individuals developing memory problems;
- caring better for groups such as “treatment-resistant patients,” who may not be taking their medicines correctly;
- auditing the use of monitored dosage system (MDS) medicines-taking aids, which help some patients but in other instances cause avoidable waste; and
- further enhancing hospital and primary care liaison in contexts such as improving the quality of medicines management at around the time of hospital admission and discharge.
Commenting on the study, the Royal Pharmaceutical Society said it supported its finding that significantly greater returns could be generated by better medicines use, as opposed to waste reduction per se.
“The report identifies a problem around medicines not being taken as prescribed. This will adversely affect health outcomes,” said Howard Duff, English pharmacy board director at the RPS.
He added: “the report clearly identifies the potential for pharmacy led interventions to help improve patient outcomes. Reviewing medicine use and providing advice for people with long term conditions helps patients understand their therapy better.”