TY - JOUR
T1 - 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
T2 - Longitudinal quasi-experimental design
AU - Baker, Amanj
AU - Chen, Li Chia
AU - Elliott, Rachel A.
AU - Godman, Brian
N1 - Funding Information:
The lead author (Amanj Baker) was funded by the Higher Committee for Education Development in Iraq for a PhD studentship. Li-Chia Chen was granted the Early Career Research and Knowledge Transfer Award from the University of Nottingham from 2010 to 2012 that supported accessing the CPRD dataset in this study. The funding bodies had no role in the design, collection, analysis, and interpretation of data; in writing the manuscript and in the decision to submit the manuscript for publication.
Publisher Copyright:
© 2015 Baker et al.
PY - 2015/9/10
Y1 - 2015/9/10
N2 - Background: 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. Methods: 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. Results: 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. Conclusions: 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.
AB - Background: 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. Methods: 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. Results: 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. Conclusions: 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.
UR - http://www.scopus.com/inward/record.url?scp=84941565284&partnerID=8YFLogxK
U2 - 10.1186/s12913-015-1013-y
DO - 10.1186/s12913-015-1013-y
M3 - Article
C2 - 26359265
AN - SCOPUS:84941565284
VL - 15
JO - BMC Health Services Research
JF - BMC Health Services Research
SN - 1472-6963
IS - 1
M1 - 367
ER -