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Impact of the COVID-19 pandemic on prescription refills for immune-mediated inflammatory disorders: a time series analysis (Jan 2019 to Jan 2021) using the English Prescribing Dataset

Impact of the COVID-19 pandemic on prescription refills for immune-mediated inflammatory disorders: a time series analysis (Jan 2019 to Jan 2021) using the English Prescribing Dataset
Impact of the COVID-19 pandemic on prescription refills for immune-mediated inflammatory disorders: a time series analysis (Jan 2019 to Jan 2021) using the English Prescribing Dataset
Objective To investigate monthly prescription refills for common immunosuppressive/immunomodulatory therapy (sulfasalazine, hydroxychloroquine, azathioprine, methotrexate, leflunomide) prescriptions in England during the complete first wave of the COVID-19 pandemic. Secondary analysis examined unit cost analysis and regional use.

Design and setting A national cohort of community-based, primary care patients who anonymously contribute data to the English Prescribing Dataset, dispensed in the community in England, were included. Descriptive statistics and interrupted time series analysis over 25 months (14 months before, 11 months after first lockdown) were evaluated (January 2019 to January 2021, with March 2020 as the cut-off point).

Outcome measures Prescription reimbursement variance in period before the pandemic as compared with after the first lockdown.

Results Fluctuation in monthly medicines use is noted in March 2020: a jump is observed for hydroxychloroquine (Mann-Whitney, SE 14.652, standardised test statistic 1.911, p value=0.059) over the study period. After the first lockdown, medicines use fluctuated, with wide confidence intervals. Unit-cost prices changed substantially: sulfasalazine 33% increase, hydroxychloroquine 98% increase, azathioprine 41% increase, methotrexate 41% increase, leflunomide 20% decrease. London showed the least quantity variance, suggesting more homogeneous prescribing and patient access compared with Midlands and East of England, suggesting that some patients may have received medication over/under requirement, representing potential resource misallocation and a proxy for adherence rates. Changepoint detection revealed four out of the five medicines’ use patterns changed with a strong signal only for sulfasalazine in March/April 2020.

Conclusions Findings potentially present lower rates of adherence because of the pandemic, suggesting barriers to care access. Unit price increases are likely to have severe budget impacts in the UK and potentially globally. Timely prescription refills for patients taking immunosuppressive/immunomodulatory therapies are recommended. Healthcare professionals should identify patients on these medicines and assess their prescription-day coverage, with planned actions to flag and follow-up adherence concerns in patients.
2044-6055
Barrett, Ravina
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Barrett, Robert
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Lin, Sharon Xiaowen
413ac51f-0097-4056-8572-0f3a09b8e33c
Culliford, David
25511573-74d3-422a-b0ee-dfe60f80df87
Fraser, Simon
135884b6-8737-4e8a-a98c-5d803ac7a2dc
Edwards, Christopher
dcb27fec-75ea-4575-a844-3588bcf14106
Barrett, Ravina
a9162374-e419-450c-81c7-0c17de3bd087
Barrett, Robert
3b3a434f-318d-4d1b-b9b6-10dd8005396c
Lin, Sharon Xiaowen
413ac51f-0097-4056-8572-0f3a09b8e33c
Culliford, David
25511573-74d3-422a-b0ee-dfe60f80df87
Fraser, Simon
135884b6-8737-4e8a-a98c-5d803ac7a2dc
Edwards, Christopher
dcb27fec-75ea-4575-a844-3588bcf14106

Barrett, Ravina, Barrett, Robert, Lin, Sharon Xiaowen, Culliford, David, Fraser, Simon and Edwards, Christopher (2022) Impact of the COVID-19 pandemic on prescription refills for immune-mediated inflammatory disorders: a time series analysis (Jan 2019 to Jan 2021) using the English Prescribing Dataset. BMJ Open.

Record type: Article

Abstract

Objective To investigate monthly prescription refills for common immunosuppressive/immunomodulatory therapy (sulfasalazine, hydroxychloroquine, azathioprine, methotrexate, leflunomide) prescriptions in England during the complete first wave of the COVID-19 pandemic. Secondary analysis examined unit cost analysis and regional use.

Design and setting A national cohort of community-based, primary care patients who anonymously contribute data to the English Prescribing Dataset, dispensed in the community in England, were included. Descriptive statistics and interrupted time series analysis over 25 months (14 months before, 11 months after first lockdown) were evaluated (January 2019 to January 2021, with March 2020 as the cut-off point).

Outcome measures Prescription reimbursement variance in period before the pandemic as compared with after the first lockdown.

Results Fluctuation in monthly medicines use is noted in March 2020: a jump is observed for hydroxychloroquine (Mann-Whitney, SE 14.652, standardised test statistic 1.911, p value=0.059) over the study period. After the first lockdown, medicines use fluctuated, with wide confidence intervals. Unit-cost prices changed substantially: sulfasalazine 33% increase, hydroxychloroquine 98% increase, azathioprine 41% increase, methotrexate 41% increase, leflunomide 20% decrease. London showed the least quantity variance, suggesting more homogeneous prescribing and patient access compared with Midlands and East of England, suggesting that some patients may have received medication over/under requirement, representing potential resource misallocation and a proxy for adherence rates. Changepoint detection revealed four out of the five medicines’ use patterns changed with a strong signal only for sulfasalazine in March/April 2020.

Conclusions Findings potentially present lower rates of adherence because of the pandemic, suggesting barriers to care access. Unit price increases are likely to have severe budget impacts in the UK and potentially globally. Timely prescription refills for patients taking immunosuppressive/immunomodulatory therapies are recommended. Healthcare professionals should identify patients on these medicines and assess their prescription-day coverage, with planned actions to flag and follow-up adherence concerns in patients.

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Accepted/In Press date: 13 December 2022
Published date: 23 December 2022

Identifiers

Local EPrints ID: 473800
URI: http://eprints.soton.ac.uk/id/eprint/473800
ISSN: 2044-6055
PURE UUID: 57610e4f-3954-4898-be3e-2bf6d3ec25f0
ORCID for David Culliford: ORCID iD orcid.org/0000-0003-1663-0253
ORCID for Simon Fraser: ORCID iD orcid.org/0000-0002-4172-4406

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Date deposited: 31 Jan 2023 17:52
Last modified: 01 Feb 2023 02:40

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Contributors

Author: Ravina Barrett
Author: Robert Barrett
Author: Sharon Xiaowen Lin
Author: David Culliford ORCID iD
Author: Simon Fraser ORCID iD

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