The Effect of the COVID-19 Pandemic on Medicines Utilisation in England

Background: The Covid-19 pandemic has had major indirect impacts on health systems, potentially disrupting or delaying diagnosis and treatment of other health conditions.

Objectives: We aimed to estimate the effect of the pandemic on medicines utilisation in England, using a nationwide medicines dispensations database.

Methods: Medicines utilisation was identified using the English Prescribing Dataset, a national database of all prescriptions issued by General Practitioners in England and dispensed within Great Britain (except Northern Ireland), between January 2014 and November 2021. Medicines were analysed at the chemical substance level using the number of items dispensed as the measure of utilisation. Mid-year population estimates for each Clinical Commissioning Group (CCG) were used to calculate incidence rates of the number of individual items dispensed. Seasonal trend decomposition was applied, using the "ggseas" package in R, to account for variability due to seasonality and trend, and to estimate changes in utilisation occurring during the Covid-19 pandemic.

Results: Between January 2014 and November 2021, a total of 8,170,028,668 dispensations were recorded. The overall rate of dispensation remained stable during the time period with rates approximately 50 unique items per 1,000 person days. The effect of the Covid-19 pandemic on overall medicines utilisation was small, with a reduction of 0.7 unique items per 1,000 person days, however by November 2021 rates had recovered to pre-pandemic values. There were larger changes in the utilisation of specific medications. Seasonal trend decomposition showed a 25% and 75% decrease in oral and injectable glucocorticoids respectively with rates of both yet to recover by November 2021. There was a 14% reduction in all antibiotic dispensations associated with the March 2020 lockdown followed by a further 11% reduction in October 2020, however different effects were seen in different common antibiotics. Between March 2020 and June 2020 Amoxicillin dispensations were reduced by 45%, before being further reduced by an additional 11% by December 2020 whilst Flucloxacillin prescriptions which have had a decreasing trend since 2014 did not appear to be substantially affected.

Conclusions: In aggregate, the pandemic had a small effect on the medicine utilisation in England. However certain acute treatments were highly affected potentially leading to unmet health need and future complications of the associated conditions.