Abstract
We read with interest the paper 1 and subsequent letter 2 from Walker et al. concerning the use of medicines identified as being of low priority for funding by NHS England. In Wales, a letter to healthcare professionals from the Chief Medical Officer and Chief Pharmaceutical Officer in June 2017 highlighted the need to urgently review co-proxamol prescribing. The All Wales Medicines Strategy Group subsequently endorsed advice relating to two groups of medicines: the first in October 2017 and the second in December 2018. The first group of medicines included co-proxamol, doxazosin modified-release tablets, lidocaine patches, liothyronine and tadalafil once-daily preparations. Dispensing data for the 12-month period following the All Wales Medicines Strategy Group endorsement are now available.
During the 12-month period from October 2017 to September 2018, 78,674 WP10 items (prescriptions issued by general practices in Wales) were dispensed for this group of medicines. This represented a reduction of 2415 items (3.0%) compared to the equivalent period of the previous year. The decrease was driven by reductions in doxazosin modified-release, lidocaine patch and co-proxamol dispensing (−1556, −1032 and −1015 items, respectively) and was somewhat offset by an increase in tadalafil dispensing (+1330 items). Autoregressive integrated moving average analysis revealed a statistically significant change in dispensing trend in the 12 months before and after the All Wales Medicines Strategy Group endorsement (Figure 1). The trend changed from an increase of 32 items per month before endorsement to a decrease of 32 items per month after endorsement (p = 0.017). This significant difference in trend was in contrast to that observed by Walker et al.
2
in England (albeit based on a slightly different group of medicines).
Trends in total number of items dispensed (pre and post October 2017), for medicines included in advice endorsed by All Wales Medicines Strategy Group in October 2017.
Evidence to support disinvestment from Health Technology Appraisal agencies is somewhat limited. 3 However, the apparent willingness of health professionals to engage with the All Wales Medicines Strategy Group and Welsh Government advice in Wales provides encouragement in relation to future work.