GPs in dispensing practices are more likely to prescribe higher cost drugs, according to research carried out by the University of Oxford, Imperial College London, the Institute for Global Health, and the London School of Hygiene and Tropical Medicine.
The research, published in the BMJ Open, assessed prescribing data for four commonly prescribed classes of drug where there is no evidence of superiority for high-cost options - statins, proton pump inhibitors (PPIs), angiotensin receptor blockers (ARBs) and ACE inhibitors (ACEis). Prescribing was measured for the whole of England, eliminating selection bias.
The authors found that dispensing practices were more likely to prescribe high-cost drugs across all classes. The adjusted odds ratio (OR) for statins was 1.51 (95% CI 1.49-1.53; P<.0001 and was for ppis ci p while aceis arbs the or respectively.>
The mean cost per dose in pence was higher in dispensing practices - 7.44 vs 6.27 for statins, 5.57 vs 5.46 for PPis, 4.30 vs 4.24 for ACEis, and 11.09 vs 8.19 for ARBs.
For all drug classes, the more dispensing patients a practice had, the more likely it was to issue a prescription for a high-cost option.
This is the largest study ever conducted on dispensing practices and, according to the authors, is the first contemporary research suggesting some UK doctors respond to a financial conflict of interest in treatment decisions.
“The reimbursement system for dispensing practices may generate unintended consequences,” the authors say. They further call for robust routine audit of practices prescribing higher volumes of unnecessarily expensive drugs which may help reduce costs.