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pres-costs-hosp-comm-v1.Rmd
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---
title: "Prescribing Costs in Hospitals and the Community"
pagetitle: Prescribing Costs in Hospitals and the Community
always_allow_html: TRUE
output:
html_document:
anchor_sections: no
css: www/style.css
toc: yes
toc_depth: 2
toc_float:
collapsed: no
pdf_document:
toc: yes
toc_depth: '2'
word_document:
toc: yes
toc_depth: '2'
---
<script>
<!-- $(document).ready(function() { -->
<!-- $('#TOC').prepend('<div><img src=`r knitr::image_uri("www/national-statistics-logo.svg")` alt=\"National Statistics logo\" style=\"position: relative; width: 50%; margin: 10% auto 10% auto; display: block;\"></div>'); -->
<!-- }); -->
$(document).ready(function() {
$('#header').prepend('<img src=`r knitr::image_uri("www/bsa_logo.svg")` alt=\"NHSBSA logo\" style=\"position:relative; float: right; top: 0; right: 0; padding: 10px; width: 25%;\">');
});
</script>
<style type="text/css">
* {
font-family: Arial;
}
body, td {
font-size: 16px;
font-family: sans-serif;
}
h2 {
color: #005EB8;
}
</style>
<html lang="en">
```{r setup, echo=FALSE, warning=FALSE, message=FALSE}
# set code chunk options to disable echo by default
knitr::opts_chunk$set(echo = FALSE)
```
<main>
# England April 2017 to March 2022 {.toc-ignore}
Published 10 November 2022
## Key findings
The total cost to NHS commissioners (known as actual cost in primary care data) in England, for the issue of medicines, appliances, and medical devices in 2021/22 is estimated to be £17.2 billion. This includes a deduction of £619 million for central rebates. The total cost without central rebates was £17.8 billion, an increase of 8.32% from £16.4 billion in 2020/21.
In 2021/22, the cost to NHS commissioners in England for medicines:
* prescribed in primary care and dispensed in the community was £8.90 billion, 50.0% of total expenditure
* issued in hospitals was £8.77 billion, 49.3% of total expenditure
* prescribed in hospitals and dispensed in the community was £85.1 million
* prescribed by dentists and dispensed in the community was £29.3 million
In 2021/22, the BNF Chapter 8 – Malignant Disease and Immunosuppression had the highest spend across all settings of £3.11 billion when using Net Ingredient Cost (NIC) for items dispensed in the community, 16.9% of the total spend. Of this spend, £2.95 billion was for medicines issued and dispensed in hospitals.
The average costs per capita when using NIC for items dispensed in the community for medicines, appliances, and medical devices prescribed in England in 2021/22 across all settings was £324. This is an increase from £301 in 2020/21.
---
## 1. Introduction
### 1.1 Scope
These statistics cover NHS prescriptions and medicines issued in England. This includes:
* prescriptions issued by GP practices and community prescribers in England that have been dispensed in the community in the UK (excluding Northern Ireland)
* prescriptions issued by hospitals in England that have been dispensed in the community in the UK (excluding Northern Ireland)
* prescriptions issued by dental practitioners that have been dispensed in the community in the UK (excluding Northern Ireland)
* medicines issued in hospitals in England that have been dispensed via the hospital pharmacy, homecare companies and outsourced outpatient pharmacy partnerships
But excludes:
* prescriptions issued through Justice and Armed Services health services in England commissioned by NHS England & Improvement (NHSEI) but not dispensed in the community -- this covers pharmacy, appliances, Dispensing Doctors (DD) and Personally Administered Items (PADM)
* any medicines issued in hospitals in England but not managed via the hospital pharmacy service
* dressings and devices issued in secondary care as supply of these is usually made via the NHS Supply Chain
This publication aims to explore the costs of medicines prescribed within both primary and secondary care in England. These statistics detail:
* cost breakdowns by financial year and month within each setting
* cost breakdowns by BNF Chapter and BNF Section level by financial year and setting
* financial year cost breakdowns in each setting by Integrated Care Board (ICB)
* a view of the data down to financial year, BNF Chapter, BNF Section and ICB combined
### 1.2 Data sources
Data for this publication is collated from 2 sources. Rx-Info collect data from hospital pharmacy systems including the actual costs paid with discounts. This data is accessed and extracted using the Define system operated by Rx-Info. Data is available from April 2017 onwards.
Data for prescription items dispensed in the community are taken from the NHSBSA Enterprise Data Warehouse and contain 2 different cost measures, Net Ingredient Cost (NIC) and Actual Cost, full definitions for these measures can be found in section 1.3 -- Definitions. Actual Cost has been included in these statistics alongside NIC at a national level to give a more accurate measure of the total cost to NHS commissioners for the prescribing of medicines, appliances, and medical devices.
For breakdowns below national totals, such as ICB or BNF section, NIC has been used for prescription items dispensed in the community due to limitations of Actual Cost and how it is calculated.
Data for Central Rebates is provided by the Commercial Medicines Unit, a part of NHSEI. It is not possible to include the central rebates in the figures broken down by ICB or BNF category owing to commercial confidentiality. The central rebate figure includes rebates from arrangements NHSEI have agreed with pharmaceutical companies following successful negotiations to commission a variety of treatments both in the cancer drugs fund (CDF) and in routine commissioning. This includes treatments for both rare diseases and more common conditions.
### 1.3 Definitions
Throughout this publication when 'costs' are referred to within hospitals they are the actual costs paid (including applicable VAT) for medicines, appliances, and medical devices which have been issued in NHS hospitals in England by the hospital pharmacy, following any discount.
For prescription items dispensed in the community, Actual Cost is the cost recharged to NHS commissioners for the provision of drugs, appliances, and medical devices by dispensing contractors. It is calculated as the basic price of a product (Net Ingredient Cost) less the national average discount percentage (NADP) plus payments for consumables, out of pocket expenses (OOPE), and payments for containers:
**Actual Cost = NIC * (1 – NADP) + payments for consumables + OOPE + payment for containers**
The NADP is calculated using the discount rates applied to individual dispensing contractors according to the Drug Tariff for England and Wales for Pharmacy and Appliance contractors and the General Medical Services Statement of Financial Entitlement Annex G Part 1 for Dispensing Doctors and Personal Administration accounts.
Actual cost is not reflective of the payment made to a dispensing contractor for the cost of the individual drugs dispensed and excludes other fees paid that a prescription item may attract.
Net Ingredient Cost (NIC) for prescription items dispensed in the community is the basic price given either in the Drug Tariff or is determined from prices published by manufacturers, wholesalers, or suppliers. Basic price is set out in Parts VIII and IX of the Drug Tariff. For any drugs not in Part VIII, the price is usually taken from the manufacturer, wholesaler or supplier of the product. This basic price also includes retained margin, where applicable. This retained medicine margin contributes to the provision of pharmaceutical services alongside the other agreed fees and allowances.
These statistics use the therapeutic classifications defined in the BNF to group medicines together based on their primary therapeutic indication. The NHSBSA uses and maintains the classification system of the BNF implemented prior to the release of edition 70, including the six pseudo BNF chapters (18 to 23) created by NHS Prescription Services used to classify products that fall outside of chapters 1 to 15.
ICBs are statutory organisations responsible for bringing the NHS together locally to improve population health and establish shared strategic priorities within the NHS. They took over the functions of Sustainability and Transformation Partnerships (STPs) in July 2022.
Prescribing volumes are not included in this publication. Unlike in the primary care dataset, where item level data is available, in secondary care, data is collated as quantities issued. The concept of a prescription item does not exist for secondary care medicines data.
---
## 2. Results and commentary
The charts in this report are interactive and allow you to isolate the topics that you are interested in by selecting or deselecting a series from the legend of the chart. For example, if you only want to view a single series on a chart, you can click the series names you are not interested in within the legend of the chart. This will remove the item from the charts. If you wish to subsequently include them, just click their legend entry again.
### 2.1 Costs by setting
#### Figure 1: Total costs to NHS commissioners by setting between 2017/2018 and 2021/2022
##### These figures use actual costs for both items dispensed in the community and those issued in hospitals.
```{r fy_actual_costs, out.width = "100%"}
chart_data <- table_1 |>
pivot_longer(
cols = contains("GBP"),
names_to = "Area",
values_to = "Cost"
) |>
mutate(
sf =
prettyNum(
signif(
Cost,
3
),
big.mark = ","
)
)
figure_1 <- highchart() |>
hc_add_series(
name = "Primary care in the community",
type = "column",
data = chart_data |> filter(Area == "Primary care prescribing dispensed in the community (GBP)"),
color = "#009639",
hcaes(
x = `Financial Year`,
y = Cost,
sf = sf
)
) |>
hc_add_series(
name = "Issued in hospitals",
type = "column",
data = chart_data |> filter(Area == "Hospital prescribing issued within hospitals (GBP)"),
color = "#005EB8",
hcaes(
x = `Financial Year`,
y = Cost,
sf = sf
)
) |>
hc_add_series(
name = "Hospital in the community",
type = "column",
data = chart_data |> filter(Area == "Hospital prescribing dispensed in the community (GBP)"),
color = "#7C2855",
hcaes(
x = `Financial Year`,
y = Cost,
sf = sf
)
) |>
hc_add_series(
name = "Dental in the community",
type = "column",
data = chart_data |> filter(Area == "Dental prescribing dispensed in the community (GBP)"),
color = "#768692",
hcaes(
x = `Financial Year`,
y = Cost,
sf = sf
)
) |>
hc_xAxis(
type = "category",
title =list(
text = "Financial year"
)
) |>
hc_yAxis(
title =list(
text = "Costs (GBP)"
)
) |>
hc_plotOptions(
column = list(
stacking = "normal"
)
) |>
highcharter::hc_credits(enabled = TRUE) |>
hc_tooltip(
shared = T,
pointFormat = '<span style="color:{point.color}">\u25CF</span> {series.name}: <b>\u00A3{point.sf}</b><br/>' )
figure_1
```
Source: [Summary Tables - Prescribing Costs in Hospitals and the Community - Table One](https://nhsbsa-opendata.s3.eu-west-2.amazonaws.com/pchc/pchc-2022-summary-tables-v001.xlsx)
The actual cost of items prescribed in primary care in England in 2021/22 was £8.90 billion, 50.0% of total expenditure. In 2017/18 the actual cost of items prescribed in primary care in England was £8.26 billion, 54.9% of total expenditure.
The cost of medicines issued in hospitals in England in 2021/22 was £8.77 billion, 49.3% of total expenditure. In 2017/18 the cost of medicines issued in hospitals in England was £6.63 billion, 44.1% of total expenditure.
#### Figure 2: Total costs by setting between 2017/2018 and 2021/2022
##### These figures use Net Ingredient Costs (NIC) for items dispensed in the community and actual costs for those issued in hospitals.
```{r fy_nic, out.width = "100%"}
chart_data <- table_2 |>
pivot_longer(
cols = contains("GBP"),
names_to = "Area",
values_to = "Cost"
) |>
mutate(
sf =
prettyNum(
signif(
Cost,
3
),
big.mark = ","
)
)
figure_2 <- highchart() |>
hc_add_series(
name = "Primary care in the community",
type = "column",
data = chart_data |> filter(Area == "Primary care prescribing dispensed in the community (GBP)"),
color = "#009639",
hcaes(
x = `Financial Year`,
y = Cost,
sf = sf
)
) |>
hc_add_series(
name = "Issued in hospitals",
type = "column",
data = chart_data |> filter(Area == "Hospital prescribing issued within hospitals (GBP)"),
color = "#005EB8",
hcaes(
x = `Financial Year`,
y = Cost,
sf = sf
)
) |>
hc_add_series(
name = "Hospital in the community",
type = "column",
data = chart_data |> filter(Area == "Hospital prescribing dispensed in the community (GBP)"),
color = "#7C2855",
hcaes(
x = `Financial Year`,
y = Cost,
sf = sf
)
) |>
hc_add_series(
name = "Dental in the community",
type = "column",
data = chart_data |> filter(Area == "Dental prescribing dispensed in the community (GBP)"),
color = "#768692",
hcaes(
x = `Financial Year`,
y = Cost,
sf = sf
)
) |>
hc_xAxis(
type = "category",
title =list(
text = "Financial year"
)
) |>
hc_yAxis(
title =list(
text = "Costs (GBP)"
)
) |>
hc_plotOptions(
column = list(
stacking = "normal"
)
) |>
highcharter::hc_credits(enabled = TRUE) |>
hc_tooltip(
shared = T,
pointFormat = '<span style="color:{point.color}">\u25CF</span> {series.name}: <b>\u00A3{point.sf}</b><br/>' )
figure_2
```
Source: [Summary Tables - Prescribing Costs in Hospitals and the Community - Table Two](https://nhsbsa-opendata.s3.eu-west-2.amazonaws.com/pchc/pchc-2022-summary-tables-v001.xlsx)
The NIC of items prescribed in primary care in England in 2021/22 was £9.49 billion, 51.6% of total expenditure. In 2017/18 the NIC of items prescribed in primary care in England was £8.88 billion, 56.6% of total expenditure.
The cost of medicines issued in hospitals in England in 2021/22 was £8.77 billion, 47.7% of total expenditure. In 2017/18 the cost of medicines issued in hospitals in England was £6.63 billion, 42.3% of total expenditure.
#### Figure 3: Percentage change in costs from previous financial year by setting between between 2017/2018 and 2021/2022
##### These figures use Net Ingredient Costs (NIC) for items dispensed in the community and actual costs for those issued in hospitals.
```{r fy_changes, out.width = "100%"}
chart_data <- table_3 |>
pivot_longer(
cols = contains("%"),
names_to = "Area",
values_to = "Cost"
) |>
mutate(
sf =
prettyNum(
round(signif(
Cost,
3
),2),
big.mark = ","
)
)
figure_3 <- highchart() |>
hc_add_series(
name = "Primary care in the community",
type = "line",
data = chart_data |> filter(Area == "Primary care prescribing dispensed in the community (%)"),
color = "#009639",
hcaes(
x = `Financial Year`,
y = Cost,
sf = sf
)
) |>
hc_add_series(
name = "Issued in hospitals",
type = "line",
data = chart_data |> filter(Area == "Hospital prescribing issued within hospitals (%)"),
color = "#005EB8",
hcaes(
x = `Financial Year`,
y = Cost,
sf = sf
)
) |>
hc_add_series(
name = "Hospital in the community",
type = "line",
data = chart_data |> filter(Area == "Hospital prescribing dispensed in the community (%)"),
color = "#7C2855",
hcaes(
x = `Financial Year`,
y = Cost,
sf = sf
)
) |>
hc_add_series(
name = "Dental in the community",
type = "line",
data = chart_data |> filter(Area == "Dental prescribing dispensed in the community (%)"),
color = "#768692",
hcaes(
x = `Financial Year`,
y = Cost,
sf = sf
)
) |>
hc_xAxis(
type = "category",
title =list(
text = "Financial year"
)
) |>
hc_yAxis(
title =list(
text = "Change in costs (%)"
)
) |>
hc_plotOptions(
column = list(
stacking = "normal"
)
) |>
hc_tooltip(
shared = T,
pointFormat = '<span style="color:{point.color}">\u25CF</span> {series.name}: <b>{point.sf}%</b><br/>'
) |>
highcharter::hc_credits(enabled = TRUE)
figure_3
```
Source: [Summary Tables - Prescribing Costs in Hospitals and the Community - Table Three](https://nhsbsa-opendata.s3.eu-west-2.amazonaws.com/pchc/pchc-2022-summary-tables-v001.xlsx)
The cost of items within primary care in the community in England in 2021/22 was £9.49 billion. This was a 0.74% increase of £70.0 million from £9.42 billion in 2020/21 and a 6.93% increase of £616 million from £8.88 billion in 2017/18.
The cost of items dispensed in hospitals in England in 2021/22 was £8.77 billion. This was a 16.8% increase of £1.26 billion from £7.51 billion in 2020/21 and a 32.2% increase of £2.13 billion from £6.63 billion in 2017/18.
In 2021/22 the total costs paid for drugs, dressing, appliances, and medical devices was £18.4 billion. This was an increase of 7.86% from the £17.0 billion paid in 2020/21 and an increase of 17.3% from the £15.7 billion paid in 2017/18.
#### Figure 4: Total costs by setting between April 2017 and March 2022
##### These figures use Net Ingredient Costs (NIC) for items dispensed in the community and actual costs for those issued in hospitals.
```{r monthly_summary, out.width = "100%"}
chart_data <- table_4 |>
pivot_longer(
cols = contains("GBP"),
names_to = "Area",
values_to = "Cost"
) |>
mutate(
sf =
prettyNum(
round(signif(
Cost,
3
),2),
big.mark = ","
),
`Year Month` = as.Date(
paste(`Year Month`,"01",sep=""),
format = "%Y%m%d"
)
)
figure_4 <- highchart() |>
hc_add_series(
name = "Primary care in the community",
type = "line",
data = chart_data |> filter(Area == "Primary care prescribing dispensed in the community (GBP)"),
color = "#009639",
hcaes(
x = `Year Month`,
y = Cost,
sf = sf
)
) |>
hc_add_series(
name = "Issued in hospitals",
type = "line",
data = chart_data |> filter(Area == "Hospital prescribing issued within hospitals (GBP)"),
color = "#005EB8",
hcaes(
x = `Year Month`,
y = Cost,
sf = sf
)
) |>
hc_add_series(
name = "Hospital in the community",
type = "line",
data = chart_data |> filter(Area == "Hospital prescribing dispensed in the community (GBP)"),
color = "#7C2855",
hcaes(
x = `Year Month`,
y = Cost,
sf = sf
)
) |>
hc_add_series(
name = "Dental in the community",
type = "line",
data = chart_data |> filter(Area == "Dental prescribing dispensed in the community (GBP)"),
color = "#768692",
hcaes(
x = `Year Month`,
y = Cost,
sf = sf
)
) |>
hc_xAxis(
type = "datetime",
title =list(
text = "Month"
)
) |>
hc_yAxis(
title =list(
text = "Costs (GBP)"
)
) |>
hc_plotOptions(
line = list(
marker = list(
enabled = FALSE
)
)
) |>
hc_tooltip(
shared = T,
pointFormat = '<span style="color:{point.color}">\u25CF</span> {series.name}: <b>\u00A3{point.sf}</b><br/>'
) |>
highcharter::hc_credits(enabled = TRUE)
figure_4
```
Source: [Summary Tables - Prescribing Costs in Hospitals and the Community - Table Four](https://nhsbsa-opendata.s3.eu-west-2.amazonaws.com/pchc/pchc-2021-summary-tables-v001.xlsx)
In March 2022, the total costs paid for medicines, appliances, and medical devices which have been issued in NHS hospitals in England was £814 million. This in an increase of 11.8% on the £728 million paid in March 2021 and an increase of 40.8% on the £578 million paid in March 2018.
### 2.2 Costs by BNF Chapter
#### Figure 5: Total costs by BNF Chapter in the 2021/2022 financial year
##### These figures use Net Ingredient Costs (NIC) for items dispensed in the community and actual costs for those issued in hospitals.
```{r bnf_summary, out.width = "100%"}
chart_data <- table_5 |>
pivot_longer(
cols = contains("GBP"),
names_to = "Area",
values_to = "Cost"
) |>
mutate(
sf =
prettyNum(
round(signif(
Cost,
3
),2),
big.mark = ","
)
) |>
filter(
`Financial Year` == max(`Financial Year`)
)
figure_5 <- highchart() |>
hc_add_series(
name = "Primary care in the community",
type = "column",
data = chart_data |> filter(Area == "Primary care prescribing dispensed in the community (GBP)"),
color = "#009639",
hcaes(
x = `BNF Chapter Code`,
y = Cost,
sf = sf,
desc = `BNF Chapter Name`
)
) |>
hc_add_series(
name = "Issued in hospitals",
type = "column",
data = chart_data |> filter(Area == "Hospital prescribing issued within hospitals (GBP)"),
color = "#005EB8",
hcaes(
x = `BNF Chapter Code`,
y = Cost,
sf = sf,
desc = `BNF Chapter Name`
)
) |>
hc_add_series(
name = "Hospital in the community",
type = "column",
data = chart_data |> filter(Area == "Hospital prescribing dispensed in the community (GBP)"),
color = "#7C2855",
hcaes(
x = `BNF Chapter Code`,
y = Cost,
sf = sf,
desc = `BNF Chapter Name`
)
) |>
hc_add_series(
name = "Dental in the community",
type = "column",
data = chart_data |> filter(Area == "Dental prescribing dispensed in the community (GBP)"),
color = "#768692",
hcaes(
x = `BNF Chapter Code`,
y = Cost,
sf = sf,
desc = `BNF Chapter Name`
)
) |>
hc_yAxis(
title =list(
text = "Costs (GBP)"
)
) |>
hc_xAxis(
type = "category",
title =list(
text = "BNF Chapter"
)
) |>
hc_plotOptions(
column = list(
stacking = "normal"
)
) |>
hc_tooltip(
shared = T,
headerFormat = '{point.key}: {point.point.desc}<br>',
pointFormat = '<span style="color:{point.color}">\u25CF</span> {series.name}: <b>\u00A3{point.sf}</b><br/>'
) |>
highcharter::hc_credits(enabled = TRUE)
figure_5
```
Source: [Summary Tables - Prescribing Costs in Hospitals and the Community - Table Five](https://nhsbsa-opendata.s3.eu-west-2.amazonaws.com/pchc/pchc-2022-summary-tables-v001.xlsx)
In 2021/22 the largest single spend for a BNF Chapter in any setting was for medicines in chapter 8 - Malignant Disease and Immunosuppression issued in hospitals at £2.95 billion. This represents 33.6% of the total spend within hospitals. This is also the BNF Chapter with the highest costs across all combined settings in 2020/21 at £3.11 billion, 16.9% of the total spend of £18.4 billion.
Within primary care in the community in 2021/22 chapter 2 - Cardiovascular System accounted for the largest spend at £1.61 billion. This was 17.0% of the total costs in primary care prescribing dispensed in the community.
Within hospitals in 2021/22 there was a spend of £382 million which is not accounted for under any of the BNF Chapters. These are drugs manufactured as specials, dressings, appliances, and medical devices which are not authored on the Dictionary of Medicines and Devices (dm+d).
#### Figure 6: Top 10 BNF Sections by spend across all settings in the 2021/2022 financial year
##### These figures use Net Ingredient Costs (NIC) for items dispensed in the community and actual costs for those issued in hospitals.
```{r bnf_section_summary, out.width = "100%"}
chart_data_top_n <- table_6 |>
pivot_longer(
cols = contains("GBP"),
names_to = "Area",
values_to = "Cost"
) |>
mutate(
sf =
prettyNum(
round(signif(
Cost,
3
),2),
big.mark = ","
)
) |>
filter(
`Financial Year` == max(`Financial Year`)
) |>
filter(
Area == "Total (GBP)"
) |>
top_n(
10,
Cost
) |>
arrange(
desc(Cost)
)
chart_data <- table_6 |>
pivot_longer(
cols = contains("GBP"),
names_to = "Area",
values_to = "Cost"
) |>
mutate(
sf =
prettyNum(
round(signif(
Cost,
3
),2),
big.mark = ","
)
) |>
filter(
`Financial Year` == max(`Financial Year`),
`BNF Section Code` %in% chart_data_top_n$`BNF Section Code`
) |>
arrange(match(`BNF Section Code`, c(chart_data_top_n$`BNF Section Code`)))
figure_6 <- highchart() |>
hc_add_series(
name = "Primary care in the community",
type = "column",
data = chart_data |> filter(Area == "Primary care prescribing dispensed in the community (GBP)"),
color = "#009639",
hcaes(
x = `BNF Section Code`,
y = Cost,
sf = sf,
desc = `BNF Section Name`
)
) |>
hc_add_series(
name = "Issued in hospitals",
type = "column",
data = chart_data |> filter(Area == "Hospital prescribing issued within hospitals (GBP)"),
color = "#005EB8",
hcaes(
x = `BNF Section Code`,
y = Cost,
sf = sf,
desc = `BNF Section Name`
)
) |>
hc_add_series(
name = "Hospital in the community",
type = "column",
data = chart_data |> filter(Area == "Hospital prescribing dispensed in the community (GBP)"),
color = "#7C2855",
hcaes(
x = `BNF Section Code`,
y = Cost,
sf = sf,
desc = `BNF Section Name`
)
) |>
hc_add_series(
name = "Dental in the community",
type = "column",
data = chart_data |> filter(Area == "Dental prescribing dispensed in the community (GBP)"),
color = "#768692",
hcaes(
x = `BNF Section Code`,
y = Cost,
sf = sf,
desc = `BNF Section Name`
)
) |>
hc_xAxis(
type = "category",
title =list(
text = "BNF Section"
)
) |>
hc_yAxis(
title =list(
text = "Costs (GBP)"
)
) |>
hc_plotOptions(
column = list(
stacking = "normal"
)
) |>
hc_tooltip(
shared = T,
headerFormat = '{point.key}: {point.point.desc}<br>',
pointFormat = '<span style="color:{point.color}">\u25CF</span> {series.name}: <b>\u00A3{point.sf}</b><br/>'
) |>
highcharter::hc_credits(enabled = TRUE)
figure_6
```
Source: [Summary Tables - Prescribing Costs in Hospitals and the Community - Table Six](https://nhsbsa-opendata.s3.eu-west-2.amazonaws.com/pchc/pchc-2022-summary-tables-v001.xlsx)
In 2021/22 the largest single spend for a BNF Section in any setting was for medicines in section 0801 - Cytotoxic Drugs issued in hospitals at £1.98 billion. This represents 22.6% of the total spend within hospitals.
Within primary care in the community in 2021/22 section 0601 - Drugs Used in Diabetes accounted for the largest spend at £1.25 billion. This was 13.2% of the total costs in primary care prescribing dispensed in the community.
### 2.3 Costs by ICB
#### Figure 7: Total costs by ICB in the 2021/2022 financial year
##### These figures use Net Ingredient Costs (NIC) for items dispensed in the community and actual costs for those issued in hospitals.
```{r stp_summary, out.width = "100%"}
chart_data_order <- table_7 |>
pivot_longer(
cols = contains("GBP"),
names_to = "Area",
values_to = "Cost"
) |>
filter(
`Financial Year` == max(`Financial Year`)
) |>
filter(
Area == "Total (GBP)"
) |>
arrange(
desc(Cost)
)
chart_data <- table_7 |>
pivot_longer(
cols = contains("GBP"),
names_to = "Area",
values_to = "Cost"
) |>
mutate(
sf =
prettyNum(
round(signif(
Cost,
3
),2),
big.mark = ","
)
) |>
filter(
`Financial Year` == max(`Financial Year`)
) |>
arrange(match(ICB, c(chart_data_order$ICB)))
figure_7 <- highchart() |>
hc_add_series(
name = "Primary care in the community",
type = "column",
data = chart_data |> filter(Area == "Primary care prescribing dispensed in the community (GBP)"),
color = "#009639",
hcaes(
x = `ICB Code`,
y = Cost,
sf = sf,
icb = `ICB`
)
) |>
hc_add_series(
name = "Issued in hospitals",
type = "column",
data = chart_data |> filter(Area == "Hospital prescribing issued within hospitals (GBP)"),
color = "#005EB8",
hcaes(
x = `ICB Code`,
y = Cost,
sf = sf,
icb = `ICB`
)
) |>
hc_add_series(
name = "Hospital in the community",
type = "column",
data = chart_data |> filter(Area == "Hospital prescribing dispensed in the community (GBP)"),
color = "#7C2855",
hcaes(
x = `ICB Code`,
y = Cost,
sf = sf,
icb = `ICB`
)
) |>
hc_xAxis(
type = "category",
title =list(
text = "ICB"
)
) |>
hc_yAxis(
title =list(
text = "Costs (GBP)"
)
) |>
hc_plotOptions(
column = list(
stacking = "normal"
)
) |>
hc_tooltip(
shared = T,
headerFormat = '{point.key}: {point.point.icb}<br>',
pointFormat = '<span style="color:{point.color}">\u25CF</span> {series.name}: <b>\u00A3{point.sf}</b><br/>'
) |>
highcharter::hc_credits(enabled = TRUE)
figure_7
```
Source: [Summary Tables - Prescribing Costs in Hospitals and the Community - Table Seven](https://nhsbsa-opendata.s3.eu-west-2.amazonaws.com/pchc/pchc-2022-summary-tables-v001.xlsx)
NHS Greater Manchester was the ICB with the highest costs across all settings of £1.11 billion in 2021/22.
Data under the 'Undefined' ICB relate to costs in both the primary and secondary care datasets which we have been unable to map to an ICB.
Data around dental in the community has not been included in figure 5 as dental data is captured under a national code and not available at ICB level.
ICB costs in secondary care are based on the ICB in which the hospital is located. Not all spend is specifically for that ICB (for example, patients may be referred to a hospital outside of their usual ICB of residence).
#### Figure 8: Average costs per capita by ICB in the 2021/2022 financial year
##### These figures use Net Ingredient Costs (NIC) for items dispensed in the community and actual costs for those issued in hospitals.
```{r stp_per_capita, out.width = "100%"}
chart_data <- table_7 |>
pivot_longer(
cols = contains("GBP"),
names_to = "Area",
values_to = "Cost"
) |>
mutate(
sf =
prettyNum(
round(signif(
Cost,
3
),2),
big.mark = ","
)
) |>
filter(
`Financial Year` == max(`Financial Year`),
Area == "Average Cost Per Capita (GBP)"
) |>
filter(`ICB Code` != "-") |>
arrange(desc(Cost)) |>
mutate(total_cost = Cost * Population)
ave_per_capita <- sum(chart_data$total_cost, na.rm = T)/sum(chart_data$Population, na.rm = T)
chart_data <- chart_data |>
mutate(ave = ave_per_capita,
sf_ave = prettyNum(as.numeric(signif(ave,3)), big.mark = ","))
figure_8 <- highchart() |>
hc_add_series(
name = "ICB",
type = "column",
data = chart_data,
color = "#005EB8",
hcaes(
x = `ICB Code`,
y = `Cost`,
sf = sf,
icb = ICB
)
) |>
hc_add_series(
name = "National average",
type = "line",
data = chart_data,
color = "black",
hcaes(
x = `ICB Code`,
y = ave,
sf = sf_ave
)
) |>
hc_xAxis(
type = "category",
title = list(
text = "ICB"
)
) |>
hc_yAxis(
title =list(
text = "Costs (GBP)"
)
) |>
hc_plotOptions(
column = list(
stacking = "normal"
),
line = list(
marker = list(
enabled = FALSE
)
)
) |>
hc_tooltip(
shared = T,
headerFormat = '{point.key}: {point.point.icb}<br>',
pointFormat = '<span style="color:{point.color}">\u25CF</span> {series.name}: <b>\u00A3{point.sf}</b><br/>'
) |>
highcharter::hc_credits(enabled = TRUE)
figure_8
```