The logistics of drug monitoring

Although opinions differ to some extent there is increasing belief in the value of monitoring plasma levels for effective therapy with neuropsychiatric drugs, especially with anticonvulsants. Monitoring should not be on a comprehensive and routine basis, but should be selective and discriminating. In these circumstances the expenditure incurred on the laboratory operations involved might work out for Britain at about pounds 5 million per year. This figure should be compared to a total annual expenditure from the prescribing of neuropsychiatric medication amounting to an estimated pounds 40 million per year. The benefits thus achieved in patient care, together with the possible economies in prescribing, could well merit this monitoring exercise. In terms of personnel and administration, the laboratory facilities could be organized on a regional, or on a district general hospital, basis.