General practitioner prescribing habits in asthma/COPD

Abstract

A study has been carried out in nine UK general practices to consider the prescribing costs in Asthma/COPD patients. Using the practices' computerised prescribing records, a search was carried out to identify all patients over 40 years of age, who had been prescribed a Beta-agonist during the previous six month period and who had a positive smoking history. The medical notes for these patients were reviewed and only those satisfying the following criteria were included in the study: consistently low lung function, sputum production and a history of chest infections. The age, sex, current diagnosis and prescribing history over the six months were manually recorded for the study group. 434 patients were identified, 224 female and 210 male, with an average age of 65 years. The diagnosis as recorded by the GP on the computer records was asthma in 52% and COPD (including emphysema and chronic bronchitis) in 45%; 3% of cases had no or other diagnoses. Each prescription written for these patients during the six month period was costed. The total cost of treatment for all patients was £51,920. For bronchodilators, £16,730 was spent on Beta-agonists, £4295 on anticholinergics (23% of patients) and £1887 on combination preparations containing a beta-agonist and an anticholinergic (12% of patients). 351 patients (81%) were receiving steroid therapy at a cost of £29,008; an average cost of £82.65/patient. Assuming that the criteria for entry into this study actually identified patients with COPD and that only 10-15% of such patients may benefit from steroid therapy, it can be estimated that the treatment costs of steroids could potentially be reduced to £5380, a saving of £23,628. This study demonstrates the economic implications of prescribing for asthma/COPD patients. Some of these resources may be better utilised by improving the accuracy of diagnosis and the appropriateness of treatment.