Impact of issuing longer- versus shorter-duration prescriptions: a systematic review

Abstract

There is insufficient evidence relating to the overall impact of differing prescription lengths on clinical and health service outcomes, although studies do suggest medication adherence may improve with longer prescriptions. UK recommendations to provide shorter prescriptions are not substantiated by the current evidence base.

Long-Term Costs and Health Consequences of Issuing Shorter Duration Prescriptions for Patients with Chronic Health Conditions in the English NHS

“…We first identified and then adapted existing decision analytic models used to assess the clinical and cost-effectiveness of relevant pharmaceutical products by the National Institute for Health and Care Excellence (NICE). We then identified data on (1) the relationship between prescription length and adherence in patients with chronic health conditions (from the systematic review [13]), (2) the relative treatment effects of the drugs vs placebo (where existing analyses did not compare versus placebo) (from relevant NICE guidance), (3) transactions costs (dispensing fees and prescriber time) and (4) cost of drug wastage (from an analysis of UK primary care data [14]).…”

“…A general overview is shown in Figure 1; the long term cost and QALYs associated with a particular treatment were assumed to represent perfect adherence and those of placebo to represent zero adherence. Given that the systematic review [13] showed 3month repeat prescriptions were associated with higher adherence than 28-day prescriptions, in the absence of evidence to the contrary, we assumed the 3-month repeat prescriptions would yield the expected cost and QALYs associated with perfect adherence (i.e. p=1 in Figure 1), and 28-day be equal to those multiplied by the relative risk of adherence.…”

“…Plausible values for the relative risk for each of the three groups of commonly prescribed medications were extracted from studies identified in the systematic review that had examined medications which could be reasonably categorised into those three groups. [13] Where there was more than one estimate, or a range of estimates, these were subsequently used in sensitivity analyses.…”

“…A recent systematic review identified consistent (but poor quality) evidence that longer prescription duration was associated with increased adherence but increased wastage. [13] An analysis of UK primary care data confirmed the positive relationship between prescription duration and wastage. [14] However, this also showed that reductions in transaction costs associated with longer prescriptions more than compensated for the costs of increased wastage (at least in the case studies examined).…”

“…[14] However, this also showed that reductions in transaction costs associated with longer prescriptions more than compensated for the costs of increased wastage (at least in the case studies examined). The review [13] noted (1) a shortage of studies examining the long term relationship between prescription duration and health outcomes (mean follow-up of previous studies was 20.3 months), (2) that existing studies were entirely US based and so of questionable relevance to the UK setting, (3) only one examined any impact on health outcomes, [15] and (4), none reported outcomes in terms of QALYs gained.…”