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Spending on anti-depressants soars as the pandemic’s effect on NHS prescribing patterns is revealed

  • Wilmington Healthcare’s State of the Nation prescribing report shows that spending on sertraline, commonly used to treat depression and anxiety, increased by 305.5% between 2019/20 and 2020/21 while overall spend on mental health drugs rose 66.1%. The spending value of GP-prescribed laxatives, heart burn medication and statins also increased as the pandemic took its toll on people’s physical and mental health.

  • The report, based on analysis of NHS primary and secondary care data, also shows significant falls in spending on drugs for certain eye conditions, which is likely to be the result of interruptions in hospital-based ophthalmology services during the pandemic, as well as sharp rises in spending on innovative treatments for haemophilia, cystic fibrosis and other rare diseases.

The emotional strain of the pandemic – combined with difficulties in maintaining access to face-to-face counselling and other forms of non-medical support during lockdown – is likely to have contributed to a massive rise in NHS spending on anti-depressants, a new report from Wilmington Healthcare suggests.

Its State of the Nation report draws on comprehensive review of primary and secondary data from 2019 to 2021 to reveal the full impact of the pandemic on activity and prescribing habits across health services during an unprecedented period.

In primary care, the prescribing data shows:

  • Annual spend on the anti-depressant drug sertraline in primary care rose by more than 300 per cent in 2020/21 compared to the previous year, while overall spending on anti-depressants in primary care increased by two-thirds to £371 million, as GPs dealt with increasing numbers of patients experiencing depression and anxiety during the pandemic.
  • Statins such as atorvastatin (up 24.8 per cent), and the heartburn and indigestion drug omeprazole (up 49.6 per cent) also saw significant gains over this period. Overall spending on statins and other lipid-regulating drugs (up 17 per cent) and laxatives (up 14.9 per cent) in primary care also rose significantly, reflecting the impact of the pandemic on people’s diet and lifestyle.
  • The largest area of expenditure in primary care remained diabetes drugs, which accounted for £1.2 billion of prescribing costs in 2020/21, rising by just over 3 per cent year-on-year. This was followed by anti-coagulant medication (£740 million), where there were notable increases in spending on drugs such as apixaban (up 16 per cent), rivaroxaban (up 5.1 per cent) and edoxaban (up 73.3 per cent).

In secondary care, the prescribing data shows:

  • Spend on ophthalmic preparations fell by 14.6 per cent as reductions in routine eye appointments in hospitals during the pandemic affected patient access to high-value treatments for wet AMD. Antibacterial drugs spending also fell sharply (down 8.9 per cent) as prescribing rates for antibiotics continue to drop – a trend potentially exacerbated by the reduction of inpatient admissions (which led to fewer, non-COVID-related hospital-acquired infections).
  • Several innovative therapies meanwhile recorded over three-fold increases in the amount spent on them, as the NHS invested heavily in new treatments for rare diseases. These include the cystic fibrosis treatment ivacaftor (up 225.5 per cent), emicizumab for haemophilia patients (up 247.3 per cent) and asfotase alfa for the genetic disorder hypophosphatasia (up 201.3 per cent)
  • Areas associated with oncology and immunology provided the largest source of prescribing expenditure in secondary care, with cytotoxic drug costs increasing by 9.0% to £1.8 billion in 2020/21. Mucolytics saw the sharpest percentage increase in costs (up 242.7 per cent to £388 million), partly as a result of increased prescribing of the cystic fibrosis drug ivacaftor, as mentioned above.

The report also reveals stark and largely unexplained regional disparities in per patient healthcare costs:

  • Integrated Care Systems (ICSs) in the south and south-east spent up to 23% more on secondary care costs per patient than in other parts of the country in 2020/21, despite these areas often having lower hospital admissions rates. Cost per patient were highest in Surrey Heartlands Health and Care Partnership (£3,200), where there were comparatively low hospital admissions, but lowest in areas such as Coventry and Warwickshire ICS (£2,605), Our Dorset (£2,610) and Greater Manchester Health & Social Care Partnership (£2,640), where hospital admissions were comparatively high.
  • Regional variation is also seen in per capita spend on prescribing, where the highest spending systems have more than double the rate of expenditure on patient drugs than the lowest. Highest per capita spend on prescribing is in North London Partners in Health & Care ICS (£469.90), Birmingham and Solihull ICS (£413.30) and Cambridge and Peterborough ICS (GBP £405.50), while the lowest per capita prescribing spend is seen in Hertfordshire and West Essex ICS (£215.70), Bedfordshire, Luton and Milton Keynes ICS (GBP 218.20) and Frimley Health and Care (£228.90).

Finally, Wilmington’s analysis of Hospital Episode Statistics data shows the impact of COVID on patient volumes and the spend on different therapy areas within the NHS:

  • Inpatient spells collapsed from 17.3 million in 2019/20 to 12.8 million in 2020/21, as the NHS took dramatic steps to minimise patient footfall. Outpatient care saw a similarly stark redrawing of activity, with a 39 per cent drop in in-person appointments and over a five-fold increase in telemedicine appointments.
  • With the exception of infectious disease – which saw an increase during this period largely as a result of COVID-19 admissions – all therapy areas saw annual declines in admissions in 2020/21. Overall, the NHS spent between 12 and 51 per cent less across all therapy areas in 2020/21 compared to the previous year.

Oli Hudson, policy and communications director at Wilmington Healthcare, said:

“Prescribing data reveals the many challenges faced by health professionals during the pandemic. Our report finds that COVID exposed and aggravated a whole range of lifestyle-related conditions in primary care – from high blood cholesterol to digestive complaints – as well as contributing to a dramatic rise in anti-depressant prescribing.

“It also created major problems in prescribing across secondary care, where we saw sharp falls in the amount spent on advanced treatments for Wet AMD as a result of hospital outpatient services being restricted. More positive was the significant increase in spending on novel drugs for cystic fibrosis and other rare diseases, which offered some hope for patients amidst the many hard realities of the pandemic.”

Saffon Cordery, interim chief executive of NHS Providers, said:

“COVID-19 laid bare the extent of health inequalities in this country, and unwarranted variations in prescribing is an important part of that story. This report shows there is more work to do to ensure fair and equitable access to medicines across the NHS.

“Any attempt to improve health outcomes needs to start with a healthy respect for the evidence. By bringing together a series of different data sources into a single place, this report provides a valuable overview of where the NHS, and the wider health and care system, needs to focus.”

Wilmington Healthcare provides data, insight and intelligence for pharma and medtech companies, healthcare charities and other NHS suppliers. Its State of the Nation report draws on a wide range of data sources, including the English Hospital Episodes Statistics (HES) collected by NHS Digital*, RTT waiting times data published by NHS England, and prescribing data provided by the NHS Business Services Authority. The full report can be downloaded here: https://wilmingtonhealthcare.com/state-of-the-nation/

*Secondary care data is taken from the English Hospital Episode Statistics (HES) database produced by NHS Digital. Copyright © 2022, NHS Digital. Re-used with the permission of NHS Digital. All rights reserved.

13th June 2022

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