Trends in the prescribing of topical nasal agents Using an NHS England data base

Our aim is to present data depicting geographical prescribing trends and expenditure related to topical nasal agent prescriptions across clinical commissioning groups (CCG's) in England. We assess if prescribing trends can act as a surrogate marker for allergic rhinitis (AR) and rhinosinusitis disease burden (RS).

NHS England primary care prescriptions dispensed for topical drugs used in nasal allergy (BNF chapter 12.2.1) were accessed using OpenPrescribing beta software. Graphical data over a 5-year period was generated to highlight nationwide trends in prescribing and expenditure. Out of 211 CCG districts, the highest and lowest 40 prescribing rate CCG's were subdivided according to rural/urban output and geographical location to highlight specific regional trends. Two sampled, paired and unpaired t tests of unequal variance were performed to determine the significance of observed trends.

The 5-year trend in prescription rate (mean yearly expenditure £40 725 258) for drugs used in nasal allergy marginally increased. Peak prescription was during months of high environmental pollen. Regardless of pollen season (June 2016 vs November 2015), CCG's of urban districts had significantly lower rates of prescribing (P ≤ .001). Amongst the 40 lowest and 40 highest prescribing rate CCG's, prescription rates fell significantly between months of high and low environmental pollen (P ≤ .0001). Regardless of pollen season, rural eastern and eastern coastal districts of England had persistently high rates of prescription.

This study shows marked geographical variation in prescribing for topical nasal agents in England. There is propensity for eastern districts to have higher rates of prescribing in England. Adopting prescribing trends as a surrogate marker for disease burden could allow allergy and endoscopic sinus surgery services to be concentrated to specific regions. This would provide more effective, economical treatment for both AR and RS.