The Information Centre for Health and Social Care, part of the Government Statistical Service, has recently released its most detailed analysis yet of hospital prescribing data.

A special health authority, the Information Centre exists to provide facts-and-figures to help the NHS and social services run effectively. It collects data from across the sector, analyses it, and converts it into useful information.

Hospital Prescribing, 2006: England was published on 30 October.

Despite its title, the report presents information on the use of medicines in both hospitals and in the community. Data includes both the general and specific; the latter examining selected areas of prescribing, not least drugs positively appraised by the NICE.

This is the third year that such an analysis has been published by the Information Centre This latest IC publication presents summary figures taken from the Hospital Pharmacy Audit Index (HPAI), a data source collected by IMS Health.

Surprisingly there is no NHS collation of information on medicines used and issued in NHS hospitals similar to that in primary care. IMS Health collects and collates data on a commercial basis.

The IC’s statistics are derived from both the IMS Health Hospital Pharmacy Audit Index database and the database of Prescription Pricing Division of the NHS Business Services Authority.

Though for most of the country around 20% of prescribing is in primary care there are some regional variations. The SHA with the greatest proportion of drugs supplied in hospitals is London with 38.2%. By contrast the area with the lowest proportion of drugs supplied through hospitals is South East Coast SHA where the comparable figure is 17.1%.

The differences in the proportions between localities are mainly driven by two factors. Firstly the presence of tertiary hospitals in an SHA: tertiary referral hospitals provide specialist services and consequently tend use more expensive medicines than general hospitals. Secondly local arrangements for service provision vary: in some areas some drugs are commonly provided through hospitals whilst in others they are provided through primary care.

Despite costs bouncing back in 2006, graphical data clearly shows the sharp dip in 2005 due to the price changes which resulted from the new Pharmaceutical Prices Regulation Scheme as well as the reduction in the prices of many generics.

There have been many changes in prices for drugs available generically under the scheme introduced by the Department of Health: in January 2005 for example a pack of 4 Alendronic acid 70mg tablets cost £22.80 - two years later the price had dropped to £7.22.

In hospitals in 2006, trastuzumab (Herceptin, cancer), at £54.7 million, was the most costly for the NHS. Etanercept (Enbrel, arthritis), infliximab (Remicade, arthritis), imatinib (Gleevec, leukaemia) were the next highest, respectively costing £50.7, £50.4 and £47.5 million.

At £102.4 million, olanzapine (Zyprexa, schizophrenia) was the drug with the greatest recorded use in primary care: in total it cost the NHS over £124.2 million.

Key Findings 2006

1) Total cost of prescribing £10.3 billion.

2) The cost of prescribing in primary care rose by 3.2%

3) Cost of drugs used in hospitals rose by 7.7%.

4) The cost of medicines prescribed in hospital but dispensed in the community rose by 6.4%.

5) Drugs dispensed in hospital made up 23.8% of the total cost of medicines.

6) The estimated cost of medicines per person in England for 2006 was £210.92.

A substantial number of the drugs positively appraised by NICE are only used in hospitals. Steve Ainsworth