3.6 Expenditure on Prescribing
3.6.1 Could the Department provide information
on total NHS expenditure on pharmaceuticals for the past four
years, including a breakdown by sector and by generic/branded
drugs? Could the Department please state what data are available
on pharmaceuticals in the non primary care sector, and how they
are monitoring drug spending and cost pressures in the acute hospital
and community sectors? [4.10a]
1. Total NHS net expenditure on medicines
and listed appliances in England in 2001-02 was £7,356 million.
£5,703 million of this total relates to prescriptions dispensed
in the community and £1,653 million relates to medicines
supplied in a secondary care setting (please note that these are
provisional figures and are to be finalised).
2. In cash terms, total NHS net expenditure
on medicines and listed appliances relating to prescriptions dispensed
in the community in England in 2001-02 was £5,554 million.
Cash figures for HCHS 2001-02 expenditure are not available.
3. Historical NHS Drug Bill expenditure
figures, broken down by sector, for the financial years 1998-99
to 2001-02 is provided in table below:
Year
(Cash)
| Total NHS net expenditure relating to prescriptions dispensed in the community (£m)
| Total NHS net expenditure relating to medicines supplied in a secondary care setting (£m)
| Total NHS net expenditure on medicines and listed appliances
(£m)
|
| 1998-99 | 4,339 | 1,211
| 5,550 |
| 1999-2000 | 4,833 | 1,369
| 6,202 |
| 2000-01 | 5,161 | N/A
| N/A |
| 2001-02 | 5,554 | N/A
| N/A |
| Year (Resource) | Total NHS net expenditure relating to prescriptions dispensed in the community (£m)
| Total NHS net expenditure relating to medicines supplied in a secondary care setting (£m)
| Total NHS net expenditure on medicines and listed appliances
(£m)
|
| 2000-01 | 5,158 | 1,530
| 6,688 |
| 2001-02 | 5,703 | 1,653
| 7,356 |
4. For prescriptions dispensed in the community in England,
a breakdown between branded medicines, generic medicines, dressings
and listed appliances for the financial years 1992-93 to 2001-02
is provided in Table 3.6.1. The table shows both the cost (expressed
in terms of net ingredient cost) and the volume (number of prescription
items) for each category. In 2001-02, branded drugs dispensed
represent about 78 per cent of the total net ingredient cost (inc.
the cost of dressings and appliances). In 2001-02, the share of
prescription items written generically was 72 per cent, and the
share of prescription items dispensed generically was 51 per cent.
Table 3.6.1
NUMBER AND NET INGREDIENT COST OF GENERIC AND PROPRIETAR
PRESCRIPTION ITEMS DISPENSED IN THE COMMUNITY
1992-93 TO 2001-02
England
| Drugs dispensed generically
| Drugs dispensed as proprietary |
Dressings and Appliance |
| NIC | Prescription items
| NIC | Prescription items |
NIC | Prescription items |
| Financial Year | (£m) |
(m) | (£m) | (m)
| (£m) | (m) |
| 1992-93 | 305 | 149
| 2,449 | 267 | 173
| 13 |
| 1993-94 | 351 | 169
| 2,680 | 264 | 190
| 14 |
| 1994-95 | 402 | 186
| 2,881 | 262 | 205
| 14 |
| 1995-96 | 457 | 201
| 3,066 | 259 | 216
| 15 |
| 1996-97 | 516 | 214
| 3,328 | 258 | 228
| 15 |
| 1997-98 | 651 | 230
| 3,574 | 260 | 240
| 15 |
| 1998-99 | 703 | 240
| 3,845 | 261 | 251
| 15 |
| 1999-2000 | 1,049 | 254
| 4,116 | 265 | 270
| 15 |
| 2000-01 | 1,077 | 284
| 4,283 | 261 | 291
| 16 |
| 2001-02 | 1,079 | 300
| 4,886 | 275 | 316
| 17 |
Notes:
1. Source: PCA, PPA, England. Figures are for prescription
items dispensed by chemists and appliance contractors and dispensing
doctors including items personally administered in England, for
financial years April to March. Note that in addition to prescriptions
written by GPs in England, this includes those written by nurses,
dentists, hospital doctors, (and, up to March 1994, armed services
doctors and dentists) provided they were dispensed in the community.
Also included are prescriptions written in Wales, Scotland, Northern
Ireland and the Isle of Man but dispensed in England. The data
do not cover drugs dispensed in hospital or private prescriptions.
2. The net ingredient cost (NIC) is the basic cost of
a drug. This cost does not take account of discounts, dispensing
costs, fees or prescription charge income. All figures are expressed
at outturn prices.
3. Generic dispensing covers drugs that are prescribed
and available generically and the dispenser is reimbursed at the
Drug Tariff or generic price. It is possible in some circumstances
for a branded drug or parallel import to be dispensed against
the prescription.
5. The Department collects data on secondary care prescribing
through NHS Trust and Health Authority financial returns. On an
annual basis, these high level aggregate returns enable it to
monitor the pressure faced by local NHS organisations and the
aggregate cost to the NHS as a whole. More detailed information
is available to Trusts at a local level from hospital pharmacy
IT systems. This is primarily used to monitor local spending on
pharmaceuticals together with adherence to local policies aimed
at ensuring the cost effective use of medicines.
6. "Pharmacy in the Future", the modernisation
programme for pharmacy services in England made a commitment to
implement a self-assessment tool for medicines management in NHS
hospitals. The tool was developed by the Office of the Chief Pharmacist,
at the Department of Health, with the support of the Regional
Directors of Performance Management and Public Health and Regional
Pharmaceutical Advisers. It was introduced to NHS Trust hospitals
in England through a roll-out programme managed by the Regional
Office (RO) network.
7. The self-assessment tool recognised that achieving
clinical and cost-effective medicines use is an organisation-wide
issue on which managers, prescribers and pharmacists need to work
together. The self-assessment tool provided an opportunity for
hospitals to examine their arrangements ahead of the Audit Commission's
review of medicines management in Spring 2001.
8. Regional Offices organised meetings with Trusts in
Autumn 2001 to ensure action plans were in place to improve performance.
9. The Audit Commission published their report "A
Spoonful of Sugar" in December 2001. The report complements
the Department's medicines management performance framework.
10. Work is in hand to develop the next stage of the
framework. The next wave will focus on implementation of action
plans and the greater use of automation and IT. The central aim
is to ensure that clinicians, pharmacists and financial planners
work more closely together across local health economies.
3.6 Expenditure on Prescribing
3.6.2 Could the Department provide information on (i)
total Family Health Services expenditure on prescribing for each
year from 1992-93 to 2001-02, (ii) the average expenditure per
capita, (iii) the total number of items prescribed and average
number per capita, and (iv) the average cost per prescription?
Any commentary, which the Department would wish to append would
be welcome, including an assessment of progress in meeting its
stated target of restraining the growth in the drugs bill to sustainable
and affordable limits. In particular, could the Department provide
an update on the measures being taken to control NHS expenditure
on generic drugs in primary care following the price increases
in 1999-2000? [4.10b-c]
1. The information requested is shown in Table 3.6.2
Table 3.6.2
NUMBER AND NET INGREDIENT COST OF PRESCRIPTION ITEMS DISPENSED
IN THE COMMUNITY
1992-93 TO 2001-02
England
Financial year | NIC
| NIC/Head | Prescription
items
| Items/Head | NIC/Item
|
| (£m) | (£)
| (m) | | (£)
|
| 1992-93 | 2,926 | 60
| 430 | 8.9 | 6.81
|
| 1993-94 | 3,222 | 66
| 447 | 9.2 | 7.20
|
| 1994-95 | 3,489 | 72
| 463 | 9.5 | 7.54
|
| 1995-96 | 3,739 | 76
| 474 | 9.7 | 7.88
|
| 1996-97 | 4,072 | 83
| 487 | 9.9 | 8.37
|
| 1997-98 | 4,465 | 91
| 505 | 10.2 | 8.85
|
| 1998-99 | 4,799 | 97
| 516 | 10.4 | 9.30
|
| 1999-2000 | 5,435 | 109
| 534 | 10.7 | 10.18
|
| 2000-01 | 5,651 | 113
| 561 | 11.2 | 10.07
|
| 2001-02 | 6,281 | 125
| 592 | 11.8 | 10.61
|
Notes:
1. Source: PCA, PPA, England. Figures are for prescription
items dispensed by chemists and appliance contractors and dispensing
doctors including items personally administered in England, for
financial years April to March. Note that that in addition to
prescriptions written by GPs in England, this includes those written
by nurses, dentists, hospital doctors, (and, up to March 1994,
armed services doctors and dentists) provided they were dispensed
in the community. Also included are prescriptions written in Wales,
Scotland, Northern Ireland and the Isle of Man but dispensed in
England. The data do not cover drugs dispensed in hospital or
private prescriptions.
2. The net ingredient cost (NIC) is the basic cost of
a drug. This cost does not take account of discounts, dispensing
costs, fees or prescription charge income. All figures are expressed
at outturn prices.
3. Population figures are based on ONS 1998 based mid-year
population projections of the resident England population (all
ages).
Progress in Restraining the Drugs Bill
2. Since 1999-2000 funding for hospital and community
health services, prescribing and discretionary general medical
services have been brought together into a single funding stream
at Health Authority and Primary Care Group level. Unified allocations
enable Health Authorities and Primary Care Groups to deploy resources
flexibly to best meet the health needs of their population. In
2001-02 it is for Health Authorities in partnership with Primary
Care Groups and other local stakeholders to determine how best
to use their funds to meet national and local priorities for improving
health, tackling health inequalities and modernising services.
However, with the introduction of Shifting the Balance of Power,
from 2002-03 onwards it will be for Primary Care Trusts to deploy
resources and work in collaboration with other local stakeholders
to determine how best to use their funds to meet national and
local priorities for improving health, tackling health inequalities
and modernising services.
3. Average growth in the FHS cash drugs bill over the
last five years has been 8 per cent per annum. Considerable effort
was put into ensuring clinical and cost effective prescribing
through for example, prescribing incentive schemes and the provision
of quality advice and support to prescribers. New and innovative
medicines often offer the most cost-effective form of treatment
so the Government does not necessarily view growth at this level
(or any other level) as a bad thing. In resource terms, 2001-02
growth in prescribing expenditure over the preceding year was
around 10.7 per cent and largely reflects the implementation of
Government priorities set out in National Service Frameworks.
4. A new Pharmaceutical Price Regulation Scheme (PPRS)
was agreed in 1999 with the Association of British Pharmaceutical
Industry (ABPI). The scheme, which will run for five years, began
in October 1999, with all suppliers being required to reduce the
prices of all products covered by the scheme by 4.5 per cent.
The price reduction is achieving savings to the NHS drugs bill
in excess of £230 million a year. See question 3.6.3 for
more detail.
5. Progress has been made on other key initiatives. Around
23,000 nurses with a district nurse or health visitor qualification
have been trained to prescribe from a limited formulary of drugs
and appliances (the Nurse Prescribers' Formulary for District
Nurses and Health Visitors). This enables them to manage a range
of specified medical conditions—minor ailments, minor injuries,
health promotion and palliative care. Following training, independent
nurse prescribers under the extended scheme will be able to prescribe
all General Sales List and Pharmacy medicines currently prescribable
by GPs at NHS expense, together with an agreed list of Prescription
Only Medicines (the Nurse Prescribers' Extended Formulary). The
first nurses began training to prescribe from the Extended Formulary
in January 2002, and by 30 June 2002 over 500 nurses had either
completed or were undergoing the training course. In addition
the Department of Health and Medicines Control Agency have completed
a joint public consultation on the introduction of supplementary
prescribing by nurses and pharmacists following initial diagnosis
by a doctor. The aim is to have a training programme for nurse
supplementary prescribers in place by the end of 2002, and for
pharmacists during 2003. The contribution of general practitioners
to quality prescribing is being recognised through additional
remuneration as part of the Sustained Quality Prescribing Scheme
announced in April (HSC 1999-107). Every practitioner in a practice
which qualifies for the payment, in accordance with a number of
benchmarks, among which is the requirement to use a formulary
or an increase in generic prescribing, will receive an additional
annual payment.
6. Measures continue to improve rational prescribing
by GPs and towards eliminating unwarranted variations in prescribing.
The National Institute for Clinical Excellence (NICE) continues
to promote the clinical and cost effectiveness of medicines through
its technology appraisals, clinical guidelines and audit tools.
7. The National Prescribing Centre (NPC) and the Prescribing
Support Unit (PSU) have continued to provide support to medical
and pharmaceutical advisors via bulletins and through the provision
of analytical services.
8. The PRODIGY programme of work continues to be developed
and make progress to improve rational prescribing.
9. A survey carried out in June 2001 estimated that 80
per cent of practices have clinical systems installed that could
support PRODIGY. Of these GPs who could use PRODIGY, 14 per cent
did so in order to support the care process, involve patients
in the decision-making, up-date their own knowledge—all
providing practical support for clinical governance. The education
and communication programme continues to support GPs in their
uptake and use of PRODIGY, demonstrating an increase in both awareness
and use in twelve months.
10. The clinical content in PRODIGY continues to be updated
to ensure clinicians have up-to-date evidence-based information
on their desktops. Between July 2001 and July 2002 revisions to
101 guidance topics were completed, and the number of topics was
expanded to 141 in total. The system continues to integrate primary
care guidance developed by the National Institute for Clinical
Excellence (NICE), and guidelines published by the Public Health
Laboratory Service (PHLS) on potential bio-terrorist attacks.
Three new topics are also being developed to support independent
nurse prescribing.
11. PRODIGY continues to develop, not only to encompass
more conditions, but also to offer more comprehensive, patient
specific support for clinical decision-making, and the application
of national protocols for the treatment of all major conditions.
A research phase, testing a revised prototype, which helps clinicians
manage patients with chronic diseases (such as heart disease),
has recently been completed in partnership with GPs, practices
and the suppliers of clinical computer systems.
12. The contribution of general practitioners to quality
prescribing is being recognised through payment of the Sustained
Quality Allowance. This allowance is paid when all of seven benchmarks
are achieved, including increase in generic prescribing or the
use of a formulary. All Primary Care Trusts employ teams of prescribing
advisers, mainly pharmacists, having a common aim to encourage
and secure rational and cost-effective prescribing.
13. Present and possible future measures to secure value
for money and security of supply of generic medicines for the
NHS are covered below.
Measures being taken to control NHS expenditure on generic
drugs in primary care following the price increases in 1999-2000
14. The maximum price scheme introduced in August 2000
was rolled forward unchanged on 18 October 2001. It is saving
the NHS some £330 million a year compared to the expenditure
that would have been incurred if prices had remained at March
2000 levels.
15. The Department published a Discussion Paper "Options
for the Future Supply and Reimbursement of Generic Medicines for
the NHS" in July 2001 which set out options for the longer
term, which if implemented could replace the maximum price scheme.
Since then the Department has discussed these and other options
with representative bodies of the generics manufacturers, wholesalers
and community pharmacies. The objective is to find a longer term
solution that meets the Government's objective and is acceptable
to the generics' supply chain. The Department has concluded that
it should consider longer term solutions for generics reimbursement
in the context of issues that could affect community pharmacy
more generally such as the outcome of the OFT review of control
of entry. As a result decisions on longer term reimbursement arrangements
for generics are unlikely to be taken until later in the year.
3.6 Expenditure on Prescribing
3.6.3 Could the Department give an update on progress
in getting the pharmaceutical industry to reduce drug costs by
4.5 per cent (as agreed in the PPRS)? Could the Department comment
on issues such as volume, price and substitution? Has monitoring
information improved since last year, and has this helped cost
control? [4.10d]
1. The Department has continued to monitor the delivery
of the 4.5 per cent price cut which companies were required to
make from 1st October 1999. As reported last year the PPRS agreement
allows companies to achieve the reduction by an across-the-board
reduction or by modulation (variable reductions to the prices
of different products provided that the overall effect is a price
reduction of 4.5 per cent). Companies that opt for the latter
route submit annually independently audited output data. The Department
has analysed the returns submitted by companies up to 31 December
2001 to ensure that the overall 4.5 per cent price reduction is
being delivered.
2. The price reduction is achieving savings in excess
of £230 million a year.
3. Following turbulence in the generics market in 1999-2000
the Department of Health put in place a statutory maximum price
scheme covering the main generics in August 2000, which was rolled
forward unchanged on 18 October 2001. This brought stability to
the market and meant in 2001-02 the growth in price (cost per
item) had returned to a similar level as the average growth in
price in the 3 years previous to 1999-00 (see Table 3.6.2). Question
3.6.2 also gives further information about recent developments
in relation to the supply and reimbursement of generics.
4. The problems in the generic market in 1999-00 did
also lead to prescription processing problems at the Prescription
Pricing Authority (PPA) and therefore to delays in the availability
of up-to-date prescribing information. The PPA introduced a recovery
strategy to reduce the delays and by November 2001 were back to
a normal processing timetable. This meant that up to date prescribing
information was available to the Department of Health and NHS
and that prescribing expenditure could be monitored and forecasted
more effectively.
5. The volume of prescription items (for both generic
and branded prescription items) increased in 2001-02 by 5.4 per
cent. The average growth over the previous three years was 3.6
per cent (see Table 3.6.2).
3.6 Expenditure on Prescribing
3.6.4 Could the Department provide estimates of the likely
costs of NICE recommendations for the current financial year?
1. The information requested is shown in Table 3.6.4
As at 16 August 2002
Table 3.6.4
ESTIMATED COSTS OF NICE GUIDANCE
Title of guidance | Date of issue
| Estimated
full-year
costs
(England, £m)
| Comment |
| Completed appraisals | |
| |
1
|
Wisdom teeth |
March 2000 |
-4.7 |
|
| 2 |
Hip replacement |
April 2000 |
-7.6 |
|
| 3 |
Taxanes for ovarian cancer |
May 2000 |
6.6 |
|
| 4 |
Coronary artery stents |
May 2000 |
n/a |
|
| 5 |
Liquid based cytology |
June 2000 |
n/a |
|
| 6 |
Taxanes for breast cancer |
June 2000 |
15.1 |
|
| 7 |
Proton Pump Inhibitors |
July 2000 |
-42.5 |
|
8 |
Hearing aids |
July 2000 |
n/a |
|
| 9 |
Rosiglitazone for Type II Diabetes
|
August 2000 |
0.0 |
Original estimate was 14.5, but this
was in effect superseded by the later estimate for the two
glitazones together in the pioglitazone appraisal. |
| 10 |
Inhaler systems for under 5s |
August 2000 |
n/a |
|
| 11 |
Implantable cardioverter defibrillators
|
September 2000 |
26.0 |
This assumes an offset of £15-20m
to gross costs of £45m |
| 12 |
Glycoprotein IIB/IIIA inhibitors
|
September 2000 |
28.6 |
|
| 13 |
Ritalin for ADHD |
October 2000 |
19.8 |
NICE made separate estimates of the
year 1 drug and associated running costs, and of the cost
of initial assessment of potentially eligible patients. |
| 14 |
Ribivirin and interferon alpha for
Hepatitis C |
October 2000 |
17.3 |
£55m spread over three years
to clear the prevalent cases, then reducing to £5m pa.
|
| 15 |
Zanamivir for influenza |
November 2000 |
6.6 |
|
| 16 |
Autologous cartilage transplantation
in knee joints |
December 2000 |
n/a |
|
| 17 |
Laparoscopic surgery for colorectal
cancer |
January 2001 |
n/a |
|
| 18 |
Laparoscopic surgery for inguinal
hernia |
December 2000 |
n/a |
|
19 |
Donepezil, rivastigmine and glantamine
for Alzheimer's |
January 2001 |
39.7 |
This is the long-run annual cost—NICE
expected a slow build-up over several years |
| 20 |
Riluzole for motor neurone disease
|
January 2001 |
4.7 |
|
21 |
Pioglitazone for Type II diabetes
|
March 2001 |
-11.3 |
See comment on rosiglitazone above.
|
| 22 |
Orlistat for obesity |
March 2001 |
9.0 |
£6m for drug costs and £3-4m
for overheads |
| 23 |
Temozolomide for brain cancer |
April 2001 |
0.9 |
|
| 24 |
Difficult to heal surgical wounds
|
April 2001 |
n/a |
|
25 |
Gemcitabine for pancreatic cancer
|
May 2001 |
1.8 |
|
| 26 |
4 drugs for non-small cell lung cancer
|
June 2001 |
9.0 |
These are the short-run costs—NICE
comment that take-up may increase in the longer term. |
| 27 |
Cox II for osteoarthritis and rheumatoid
arthritis |
July 2001 |
23.6 |
|
28 |
Topotecan for advanced ovarian cancer
|
August 2001 |
6.6 |
|
29 |
Fludarabine for B-cell chronic lymphocytic
leukaemia |
September 2001 |
0.0 |
Estimated to be broadly cost neutral—no
detailed costings given. |
| 30 |
Taxanes for breast cancer - review
|
September 2001 |
0.0 |
Earlier guidance unchanged |
| 31 |
Sibutramine for obesity in adults
|
October 2001 |
18.1 |
Year 3 figure |
| 32 |
Beta interferon & glatiramer
for MS |
January 2002 |
n/a |
|
| 33 |
3 drugs for advanced colorectal cancer
|
March 2002 |
38.7 |
Upper bound (no lower bound given).
|
| 34 |
Trastuzumab for advanced breast cancer
|
March 2002 |
16.0 |
|
| 35 |
Etanercept for juvenile arthritis
|
March 2002 |
2.8 |
|
36 |
Etanercept and infliximab for rheumatoid
arthritis |
March 2002 |
59.0 |
|
| 37 |
Rituximab—non-Hodkin's lymphoma
|
March 2002 |
|
NICE do not attempt a quantative
estimate, but information in the guidance suggests a figure
of around £1m. |
| 38 |
Inhaler Systems for children 5-15
years |
March 2002 |
0.9 |
|
| 39 |
Nicotine replacement therapy &
Zyban |
March 2002 |
38.7 |
|
| 40 |
Infliximab for Crohn's disease |
May 2002 |
1.6 |
NICE estimated £2.5m for the
first year costs. They expected lower costs in subsequent
years but did not quantify. |
| 41 |
Routine anti-D prophylaxis |
May 2002 |
3.8 |
|
| 42 |
Human growth hormone in children
|
May 2002 |
44.3 |
Upper bound (no lower bound given).
|
| 43 |
Atypical antipsychotics |
June 2002 |
104.8 |
|
| 44 |
Metal on metal hip resurfacing |
June 2002 |
1.9 |
NICE say cost is more likely to be
at lower end of range. |
| 45 |
Caelyx for advanced ovarian cancer
|
July 2002 |
2.9 |
|
| 46 |
Surgery for the morbidly obese |
July 2002 |
12.7 |
This is long-run cost—NICE suggest
£1.7m in year 1. |
|
|
|
|
|
| Total costs for all guidance to date
| | 495.7
|
|
2. The estimated full-year costs of all NICE appraisal
guidance issued so far, relatively to previous levels of NHS spending
where appropriate, amount to some £495.7 million for England
(see Table 3.6.4). In some cases the financial impact on the NHS
may build up gradually over a number of years, for instance where
infrastructural changes are needed to put the recommendations
into full effect. In addition, there will be some costs arising
out of appraisals due to be completed during the current year.
Notes:
1. All estimates are based on figures published in NICE's
appraisal guidance.
2. Where the NICE estimate is given as a range, a central
value (usually the mid-point of the range) is taken.
3. NICE estimates are usually given on an England and
Wales basis. For this table, they have been pro-rated to an England
basis using appropriate population factors (Source: ONS and NICE
guidance)
4. Where appropriate, estimates represent the additional
impact of NICE's recommendations relative to the immediately previous
level of NHS spending on treatments for the condition in question.
3.6 EXPENDITURE ON
PRESCRIBING
3.6.5 Could the Department provide figures for the
amount of money spent on statins per year over each of the last
four years, if possible broken down by Trust and Health Authority.
1. The information requested is shown in Table 3.6.5
Table 3.6.5
BNF SECTION 2.12 TOTAL ACTUAL COST AND NUMBER OF ITEMS
| 1998/99 | 1999/00
| 2000/01 | 2001/02
|
| |
| | |
| Total
Actual
Cost
(£000s)
| Number
of items
(000s)
| Total
Actual
Cost
(£000s)
| Number
of items
(000s)
| Total
Actual
Cost
(£000s)
|
Number
of items
(000s)
| Total
Actual
Cost
(£000s)
| Number
of items
(000s)
|
| ENGLAND | 187,347.1
| 6,420.5 | 242,178.2
| 8,434.8 | 316,902.0
| 11,067.2 | 420,021.9
| 14,353.0 |
| HEALTH AUTHORITY | |
| | |
| | | |
| AVON | 3,378.1 | 102.0
| 4,194.1 | 129.9 | 5,419.4
| 168.0 | 7,232.2 | 218.4
|
| BARKING & HAVERING | 1,479.6
| 50.7 | 2,012.5 | 68.4
| 2,632.0 | 87.7 | 3,447.9
| 112.0 |
| BARNET,ENFIELD & HARINGEY | 3,006.1
| 98.1 | 3,906.9 | 127.1
| 4,950.1 | 161.9 | 6,502.0
| 206.3 |
| BARNSLEY | 1,033.1 | 45.4
| 1,315.0 | 57.9 | 1,656.2
| 70.9 | 2,383.9 | 93.5
|
| BEDFORDSHIRE | 1,515.1 | 53.5
| 1,891.3 | 68.8 | 2,488.0
| 90.4 | 3,301.5 | 117.3
|
| BERKSHIRE | 2,395.8 | 76.0
| 2,973.2 | 97.9 | 3,709.5
| 124.8 | 4,891.9 | 166.5
|
| BEXLEY,BROMLEY & GREENWICH | 2,962.8
| 86.8 | 3,604.0 | 104.9
| 4,499.6 | 129.4 | 5,705.2
| 158.7 |
| BIRMINGHAM | 2,948.1 | 104.8
| 3,910.6 | 140.6 | 4,994.2
| 180.8 | 6,520.8 | 230.6
|
| BRADFORD | 1,762.8 | 63.8
| 2,174.6 | 78.8 | 2,828.3
| 100.9 | 4,075.7 | 138.8
|
| BRENT & HARROW | 1,518.2
| 45.0 | 2,171.6 | 62.1
| 3,201.6 | 86.7 | 4,204.1
| 109.4 |
| BUCKINGHAMSHIRE | 2,120.0 |
62.8 | 2,572.9 | 77.2
| 3,273.0 | 97.5 | 4,285.9
| 124.7 |
| BURY & ROCHDALE | 1,819.1
| 64.4 | 2,248.6 | 81.3
| 2,775.4 | 100.6 | 3,542.3
| 125.6 |
| CALDERDALE, KIRKLEES | 2,862.4
| 86.2 | 3,533.8 | 108.1
| 4,469.0 | 137.3 | 5,791.4
| 178.0 |
| CAMBRIDGESHIRE | 2,490.6 |
97.7 | 3,317.3 | 131.3
| 4,239.0 | 168.3 | 5,351.8
| 210.9 |
| CAMDEN & ISLINGTON | 1,301.8
| 34.2 | 1,671.9 | 43.0
| 2,079.1 | 51.5 | 2,593.5
| 63.2 |
| CORNWALL & SCILLY | 2,349.6
| 85.3 | 2,826.9 | 106.9
| 3,560.3 | 143.2 | 4,686.8
| 186.2 |
| COUNTY DURHAM & DARLINGTON | 2,552.5
| 91.0 | 3,456.5 | 123.1
| 4,558.8 | 162.6 | 6,077.9
| 210.1 |
| COVENTRY | 765.7 | 29.3
| 1,197.3 | 45.0 | 1,769.1
| 67.0 | 2,581.2 | 96.8
|
| CROYDON | 966.4 | 29.3
| 1,177.4 | 36.2 | 1,661.8
| 49.9 | 2,287.2 | 68.1
|
| DONCASTER | 1,216.8 | 56.9
| 1,698.3 | 81.9 | 2,265.0
| 108.4 | 3,027.6 | 141.9
|
| DORSET | 3,279.5 | 114.7
| 3,895.6 | 141.0 | 4,700.0
| 174.7 | 5,894.3 | 218.6
|
| DUDLEY | 1,169.5 | 36.2
| 1,489.0 | 46.8 | 1,909.8
| 60.0 | 2,500.4 | 76.5
|
| EALG, HSMITH, HNSLOW | 2,721.3
| 70.1 | 3,450.6 | 89.4
| 4,405.1 | 115.5 | 5,510.3
| 142.1 |
| EAST KENT | 3,435.4 | 114.9
| 4,544.1 | 156.2 | 5,948.6
| 198.9 | 7,590.8 | 244.0
|
| EAST LANCASHIRE | 2,403.2 |
91.6 | 3,128.8 | 120.6
| 3,986.9 | 155.6 | 5,373.4
| 204.9 |
| EAST LONDON & CITY | 1,799.8
| 52.1 | 2,555.6 | 73.5
| 3,541.5 | 101.8 | 4,596.3
| 130.9 |
| EAST RIDING AND HULL | 1,848.4
| 73.4 | 2,624.8 | 106.8
| 3,632.1 | 151.3 | 4,811.9
| 198.3 |
| EAST SURREY | 1,452.9 | 41.2
| 1,848.2 | 52.2 | 2,415.4
| 67.4 | 3,218.2 | 88.3
|
| EAST SUSS,B/TON.HOVE | 3,090.2
| 100.1 | 4,023.9 | 130.4
| 5,263.2 | 171.7 | 7,119.2
| 221.6 |
| G/HEAD & SOUTH TYNE | 1,417.5
| 52.2 | 1,858.7 | 69.2
| 2,479.0 | 90.2 | 3,507.3
| 122.8 |
| GLOUCESTERSHIRE | 2,246.7 |
70.7 | 2,624.0 | 88.8
| 3,292.4 | 114.7 | 4,419.0
| 150.7 |
| HEREFORDSHIRE | 631.3 | 24.3
| 801.7 | 29.4 | 1,046.5
| 36.5 | 1,341.8 | 44.2
|
| HERTFORDSHIRE | 3,758.6 |
112.4 | 4,676.7 | 143.1
| 5,870.4 | 183.1 | 7,621.6
| 240.4 |
| HILLINGDON | 854.5 | 30.2
| 1,057.1 | 38.4 | 1,413.1
| 50.8 | 1,952.8 | 67.9
|
| IOW,PORTSMOUTH & SE HAMPS | 2,270.2
| 70.7 | 2,917.4 | 93.5
| 3,990.5 | 128.7 | 5,665.1
| 175.2 |
| KENS, CHELSEA, WESTM | 1,082.4
| 27.0 | 1,466.4 | 37.2
| 1,973.6 | 50.6 | 2,535.5
| 64.4 |
| KINGSTON & RICHMOND | 1,145.1
| 32.8 | 1,528.0 | 45.5
| 1,988.8 | 62.0 | 2,455.6
| 75.7 |
| LBETH, S/WARK, LSHAM | 2,220.1
| 60.2 | 2,832.1 | 77.5
| 3,576.4 | 98.6 | 4,638.7
| 129.7 |
| LEEDS | 3,766.2 | 130.9
| 4,507.9 | 158.9 | 5,497.7
| 195.0 | 6,945.5 | 243.8
|
| LEICESTERSHIRE | 2,704.3 |
92.2 | 3,428.6 | 120.4
| 4,541.4 | 160.4 | 5,751.6
| 202.1 |
| LINCOLNSHIRE | 2,140.3 | 88.6
| 2,984.0 | 127.4 | 4,226.4
| 190.2 | 6,071.5 | 268.9
|
| LIVERPOOL | 1,977.7 | 73.0
| 2,640.2 | 95.8 | 3,594.0
| 130.5 | 4,883.4 | 171.2
|
| MANCHESTER | 2,015.1 | 73.2
| 2,626.8 | 97.5 | 3,413.1
| 125.7 | 4,418.0 | 160.5
|
| MERTON, SUTTON, WAND | 2,220.2
| 63.2 | 2,823.3 | 80.9
| 3,617.4 | 104.8 | 4,690.7
| 133.6 |
| MORECAMBE BAY | 1,556.0 |
55.6 | 1,961.4 | 71.8
| 2,508.4 | 94.6 | 3,243.0
| 123.0 |
| NEWCASTLE & NTH TYNE | 1,773.8
| 71.4 | 2,349.4 | 96.6
| 3,230.0 | 129.4 | 4,692.3
| 176.4 |
| NORFOLK | 2,849.3 | 101.5
| 3,908.2 | 143.9 | 5,225.7
| 199.6 | 6,764.1 | 253.1
|
| NORTH & EAST DEVON | 1,544.0
| 56.2 | 2,055.5 | 75.5
| 2,705.2 | 98.2 | 3,869.8
| 132.2 |
| NORTH & MID HANTS | 1,776.0
| 53.6 | 2,243.0 | 69.9
| 2,749.3 | 87.6 | 3,565.3
| 109.9 |
| NORTH CHESHIRE | 1,810.8 |
61.4 | 2,221.7 | 77.8
| 2,865.4 | 102.0 | 3,880.9
| 134.8 |
| NORTH CUMBRIA | 1,316.1 |
43.7 | 1,774.2 | 60.0
| 2,428.0 | 81.7 | 3,592.5
| 110.5 |
| NORTH DERBYSHIRE | 1,349.1 |
48.3 | 1,828.9 | 67.6
| 2,490.5 | 92.7 | 3,274.2
| 121.9 |
| NORTH ESSEX | 2,793.0 | 105.3
| 3,798.8 | 145.3 | 5,000.5
| 196.2 | 6,640.6 | 255.4
|
| NORTH NOTTINGHAMSHIRE | 1,476.4
| 62.8 | 1,895.0 | 81.3
| 2,532.7 | 109.3 | 3,352.8
| 140.8 |
| NORTH STAFFORDSHIRE | 1,384.0
| 52.6 | 1,943.3 | 74.2
| 2,805.4 | 106.5 | 3,874.5
| 144.4 |
| NORTH YORKSHIRE | 2,637.3 |
92.8 | 3,388.9 | 122.8
| 4,366.6 | 158.6 | 5,598.6
| 200.7 |
| NORTHAMPTONSHIRE | 1,890.0 |
75.7 | 2,237.3 | 92.2
| 2,856.6 | 122.5 | 3,912.5
| 162.8 |
| NORTHUMBERLAND | 1,265.1 |
45.4 | 1,662.2 | 60.2
| 2,161.6 | 78.0 | 2,992.6
| 105.4 |
| NOTTINGHAM | 1,869.1 | 66.8
| 2,754.7 | 98.6 | 3,966.5
| 140.8 | 5,398.2 | 185.9
|
| NTH WEST LANCASHIRE | 2,187.0
| 86.2 | 2,918.8 | 114.3
| 3,942.3 | 151.0 | 5,187.0
| 197.2 |
| OXFORDSHIRE | 2,057.4 | 60.5
| 2,606.1 | 79.9 | 3,169.2
| 99.2 | 4,072.1 | 123.3
|
| REDBRIDGE & WALTHAM | 1,458.5
| 46.5 | 2,038.6 | 62.6
| 2,657.3 | 78.0 | 3,360.8
| 95.1 |
| ROTHERHAM | 973.0 | 37.4
| 1,330.7 | 53.2 | 1,712.1
| 69.1 | 2,287.0 | 90.5
|
| S/HAMPTON & SW HAMPS | 1,887.2
| 63.7 | 2,442.7 | 84.4
| 3,266.6 | 114.3 | 4,340.9
| 148.8 |
| SALFORD & TRAFFORD | 2,255.4
| 85.1 | 2,906.9 | 109.1
| 3,846.5 | 144.6 | 5,137.1
| 190.6 |
| SANDWELL | 1,074.3 | 37.4
| 1,446.1 | 51.7 | 1,867.5
| 67.9 | 2,552.9 | 90.8
|
| SEFTON | 1,262.6 | 41.8
| 1,625.9 | 55.4 | 2,127.4
| 74.3 | 2,899.6 | 98.8
|
| SHEFFIELD | 1,963.5 | 78.0
| 2,667.9 | 108.7 | 3,579.6
| 146.9 | 4,562.0 | 183.9
|
| SHROPSHIRE | 1,505.2 | 47.8
| 1,989.9 | 64.5 | 2,664.8
| 85.2 | 3,541.6 | 111.9
|
| SOLIHULL | 717.4 | 27.2
| 960.3 | 37.4 | 1,244.9
| 48.9 | 1,560.8 | 60.9
|
| SOMERSET | 1,999.2 | 68.3
| 2,551.4 | 90.0 | 3,175.1
| 114.5 | 4,012.0 | 144.4
|
| SOUTH & WEST DEVON | 2,478.6
| 80.7 | 3,115.2 | 102.8
| 4,124.5 | 136.6 | 5,451.4
| 175.6 |
| SOUTH CHESHIRE | 3,126.3 |
97.4 | 3,952.5 | 126.7
| 5,133.9 | 163.3 | 6,775.6
| 210.2 |
| SOUTH ESSEX | 2,649.2 | 82.4
| 3,560.9 | 110.9 | 4,846.4
| 148.7 | 6,569.8 | 194.2
|
| SOUTH HUMBER | 1,223.6 | 54.0
| 1,703.2 | 74.5 | 2,421.9
| 101.2 | 3,234.8 | 131.0
|
| SOUTH LANCASHIRE | 1,274.7 |
52.1 | 1,622.5 | 66.7
| 2,159.4 | 87.0 | 2,871.2
| 113.5 |
| SOUTH STAFFORDSHIRE | 1,949.1
| 70.7 | 2,603.9 | 96.5
| 3,321.1 | 124.7 | 4,234.0
| 160.4 |
| SOUTHERN DERBYSHIRE | 1,935.9
| 60.6 | 2,589.1 | 81.5
| 3,517.8 | 108.2 | 4,653.9
| 140.5 |
| ST.HELENS & KNOWSLEY | 1,845.3
| 75.4 | 2,327.8 | 95.5
| 2,988.4 | 122.1 | 4,199.6
| 166.7 |
| STOCKPORT | 1,750.0 | 67.4
| 2,046.0 | 79.1 | 2,544.0
| 98.9 | 3,146.7 | 124.1
|
| SUFFOLK | 2,494.6 | 83.1
| 3,292.5 | 114.8 | 4,344.7
| 151.6 | 5,770.3 | 198.6
|
| SUNDERLAND | 921.8 | 34.6
| 1,258.5 | 47.9 | 1,848.5
| 66.6 | 2,749.0 | 91.9
|
| TEES | 2,118.3 | 69.0
| 2,795.4 | 91.5 | 3,704.2
| 120.2 | 5,067.8 | 158.0
|
| WAKEFIELD | 1,302.7 | 49.3
| 1,887.3 | 69.9 | 2,566.4
| 92.7 | 3,325.9 | 115.4
|
| WALSALL | 961.2 | 33.1
| 1,172.0 | 40.5 | 1,529.3
| 52.6 | 2,186.5 | 74.2
|
| WARWICKSHIRE | 1,658.2 | 60.4
| 2,127.6 | 78.5 | 2,843.3
| 106.9 | 3,806.4 | 140.0
|
| WEST KENT | 3,873.5 | 143.5
| 5,017.4 | 184.6 | 6,642.6
| 239.6 | 8,766.6 | 305.3
|
| WEST PENNINE | 1,834.9 | 72.5
| 2,262.9 | 91.5 | 2,888.6
| 115.7 | 3,883.4 | 152.3
|
| WEST SURREY | 2,368.7 | 65.2
| 2,962.8 | 82.6 | 3,945.5
| 108.4 | 5,071.5 | 135.7
|
| WEST SUSSEX | 3,323.5 | 104.0
| 4,324.9 | 135.3 | 5,634.3
| 173.9 | 7,515.5 | 223.6
|
| WIGAN & BOLTON | 2,624.5
| 102.0 | 3,348.0 | 131.4
| 4,366.5 | 167.4 | 5,635.0
| 208.7 |
| WILTSHIRE | 2,257.0 | 73.0
| 2,777.1 | 93.4 | 3,537.5
| 120.9 | 4,653.2 | 158.9
|
| WIRRAL | 2,342.8 | 82.2
| 2,765.1 | 99.4 | 3,467.8
| 127.3 | 4,584.7 | 166.1
|
| WOLVERHAMPTON | 652.6 | 21.2
| 860.1 | 28.2 | 1,152.6
| 39.5 | 1,666.9 | 56.0
|
| WORCESTERSHIRE | 1,654.3 |
54.3 | 2,109.1 | 71.2
| 2,874.5 | 94.8 | 4,032.2
| 125.7 |
Notes:
1. Source: EPACT, PPA, England. Figures are for prescription
items prescribed by GPs in England. The data do not cover drugs
dispensed in hospital or private prescriptions.
2. The total actual cost takes account of the net ingredient
cost (NIC) of a drug, discount allowances, container costs and
VAT.
3. BNF sections are based on the British National Formulary
(September 2001). Dressings and appliances and those items in
the PPA pseudo classification are excluded.
2. Note, the figures contained in the table are for BNF
section 2.12 and not just for statins. However, statins form about
93 per cent by cost of the section.
3. The expenditure on lipid regulating drugs continues
to grow at around 33 per cent a year and reflects effective implementation
of the standards in the National Service Framework for Coronary
Heart Disease.
|
