UK interventions to control medicines wastage: a critical review

The objective is to evaluate the scope of medicines wastage in the UK, assigning a value to the costs at both a national and individual patient level to assess the cost-effectiveness of the pharmacy interventions that have been introduced to curb wastage.

Publicly available information was assessed in a desk-based systematic review using online search engines and publication databases. Data on community prescribing trends and costs in England from 1997 to 2008 from the Department of Health, and published reports from Primary Care Trusts (PCTs) comprise the core information that has been analysed.

The commonly used upper wastage estimate of 10% is likely to be overstated, because it pre-dates major measures to curb wastage and over-prescribing. In pilot programmes, medicines use reviews have achieved cost savings of up to 20%. Awareness campaigns aimed at patients appear to be effective. Twenty-eight-day repeat prescribing has resulted in year-on-year reductions on the quantity of medication issued per prescription item to reach an average prescription length of 40 days in 2008. The increasing availability of generic medications has seen significant reductions in net ingredient costs. Nearly two-thirds of prescriptions are now issued as generics, with an average net ingredient cost of 3.83 sterling pounds. Pharmacy charges to dispense a prescription item in 2008 averaged 1.81 sterling pounds, so that pharmacy charges make up around one-third of the cost of most prescription items dispensed. If all 842.5 million prescription items issued by the NHS in England in 2008 had been 28-day repeat-dispensing items, this would have added a projected 700 million sterling pounds to the actual pharmacy costs of around 1.5 billion sterling pounds.

Unnecessary spending on pharmacy charges has the potential to outstrip the estimated cost of medicines wastage in the UK. The cost-effectiveness of restricted prescription lengths for the cheaper, mostly generic medications merits an urgent re-examination.