The impact of the 'Better Care Better Value' prescribing policy on the utilisation of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers for treating hypertension in the UK primary care setting: longitudinal quasi-experimental design

• Published in: BMC health services research Vol. 15; no. 1; p. 367
• Main Authors: Baker, Amanj, Chen, Li-Chia, Elliott, Rachel A, Godman, Brian
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 10.09.2015; BioMed Central
• Subjects: Adult; Aged; Aged, 80 and over; Ambulatory care; Angiotensin Receptor Antagonists - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Antihypertensives; Clinical medicine; Cost analysis; Cost control; Cost Savings - economics; Cross-Sectional Studies; Drug Costs; Efficiency; Enzymes; Female; Generic drugs; Humans; Hypertension; Hypertension - drug therapy; Impact analysis; Longitudinal Studies; Male; Medicin och hälsovetenskap; Middle Aged; Pharmaceuticals; Practice research; Prescription Drugs - economics; Primary care; Primary Health Care - economics; Reimbursement; Research Design; Society; State Medicine - economics; Trends; United Kingdom; Young Adult; United Kingdom; Sweden
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-015-1013-y

In April/2009, the UK National Health Service initiated four Better Care Better Value (BCBV) prescribing indicators, one of which encouraged the prescribing of cheaper angiotensin-converting enzyme inhibitors (ACEIs) instead of expensive angiotensin receptor blockers (ARBs), with 80 % ACEIs/20 % ARBs as a proposed, and achievable target. The policy was intended to save costs without affecting patient outcomes. However, little is known about the actual impact of the BCBV indicator on ACEIs/ARBs utilisation and cost-savings. Therefore, this study aimed to evaluate the impact of BCBV policy on ACEIs/ARBs utilisation and cost-savings, including exploration of regional variations of the policy's impact. This cross-sectional study used data from the UK Clinical Practice Research Datalink. Segmented time-series analysis was applied to monthly ACEIs prescription proportion, adjusted number of ACEIs/ARBs prescriptions and costs. Overall, the proportion of ACEIs prescription decreased during the study period from 71.2% in April/2006 to 70.7% in March/2012, with a small but a statistically significant pre-policy reduction in its monthly trend of 0.02% (p < 0.001). Instantly after its initiation, the policy was associated with a sudden reduction in the proportion of ACEIs prescription; however, it resulted in a statistically significant increase in the post-policy monthly trend of ACEIs prescription proportion of 0.013% (p < 0.001), resulting in an overall post-policy slope of -0.007%. Despite this post-policy induced increment, the policy failed to achieve the 80% target, which resulted in missing a potential cost-saving opportunity. The pre-policy trend of the adjusted number of ACEIs/ARBs prescriptions was increasing; however, their trends declined after the policy implementation. The policy affected neither total ACEIs/ARBs cost nor individual ACEIs or ARBs costs. ACEIs/ARBs utilisation was not affected by the BCBV policy. The small increase in post-policy ACEIs prescription proportion was not associated with any savings. This study represents a case study of a failed or ineffective policy and thus provides key learning lessons for other healthcare authorities. Given the existing opportunity of potential cost-savings from achieving the 80 % target, specific measures would be needed to enhance the policy implementation and uptake; however, this must be balanced against other cost-saving policies in other high-priority areas.