BMC Medicine 201816:119, 2 August 2018
- Analysis of the impact of potential policy changes on different stakeholders (patient groups and CCGs), by exploring changes in expenditure on gluten free (GF) products across all CCGs in England between 2012 and 2017; understanding the groups of patients likely to be affected most by reduced prescribing of GF products; and cost-savings made by CCGs which have switched to a ‘complete ban’ with CCGs that have continued to provide GF prescriptions.
- See : Gluten-free foods on NHS prescription - DHSC consultation closes 1 October 2018
Abstract
Background: Coeliac disease affects approximately 1% of the population and is increasingly diagnosed in the United Kingdom. A nationwide consultation in England has recommend that state-funded provisions for gluten-free (GF) food should be restricted to bread and mixes but not banned, yet financial strain has prompted regions of England to begin partially or fully ceasing access to these provisions. The impact of these policy changes on different stakeholders remains unclear.
Methods: Prescription data were collected for general practice services across England (n = 7176) to explore changes in National Health Service (NHS) expenditure on GF foods over time (2012–2017). The effects of sex, age, deprivation and rurality on GF product expenditure were estimated using a multi-level gamma regression model. Spending rate within NHS regions that had introduced a ‘complete ban’ or a ‘complete ban with age-related exceptions’ was compared to spending in the same time periods amongst NHS regions which continued to fund prescriptions for GF products.
Results: Annual expenditure on GF products in 2012 (before bans were introduced in any area) was £25.1 million. Higher levels of GF product expenditure were found in general practices in areas with lower levels of deprivation, higher levels of rurality and higher proportions of patients aged under 18 and over 75. Expenditure on GF food within localities that introduced a ‘complete ban’ or a ‘complete ban with age-related exceptions’ were reduced by approximately 80% within the 3 months following policy changes. If all regions had introduced a ‘complete ban’ policy in 2014, the NHS in England would have made an annual cost-saving of £21.1 million (equivalent to 0.24% of the total primary care medicines expenditure), assuming no negative sequelae.
Conclusions: The introduction of more restrictive GF prescribing policies has been associated with ‘quick wins’ for NHS regions under extreme financial pressure. However, these initial savings will be largely negated if GF product policies revert to recently published national recommendations. Better evidence of the long-term impact of restricting GF prescribing on patient health, expenses and use of NHS services is needed to inform policy.
Results: Annual expenditure on GF products in 2012 (before bans were introduced in any area) was £25.1 million. Higher levels of GF product expenditure were found in general practices in areas with lower levels of deprivation, higher levels of rurality and higher proportions of patients aged under 18 and over 75. Expenditure on GF food within localities that introduced a ‘complete ban’ or a ‘complete ban with age-related exceptions’ were reduced by approximately 80% within the 3 months following policy changes. If all regions had introduced a ‘complete ban’ policy in 2014, the NHS in England would have made an annual cost-saving of £21.1 million (equivalent to 0.24% of the total primary care medicines expenditure), assuming no negative sequelae.
Conclusions: The introduction of more restrictive GF prescribing policies has been associated with ‘quick wins’ for NHS regions under extreme financial pressure. However, these initial savings will be largely negated if GF product policies revert to recently published national recommendations. Better evidence of the long-term impact of restricting GF prescribing on patient health, expenses and use of NHS services is needed to inform policy.
