Variation in the cost of newly-qualified doctors’ prescriptions: a review of data from a hospital electronic prescribing system

Purpose of the study To investigate the variation in the net ingredient cost (NIC) of the medications most commonly prescribed by Foundation Year 1 (F1) doctors in a teaching hospital and to compare the effects of working in different specialties and rotations on this cost.

Design of the study Retrospective review of prescription data from 5 August 2010 to 3 August 2011 extracted from an electronic prescribing system.

Results The F1 doctors generated 81?316 prescriptions with an estimated total cost of £579?398. The mean NIC per doctor was £7334 (SE=£430). Prescribing costs varied significantly across clinical departments and between drug classes considered in the analysis. Specifically, prescribing in the infection and respiratory drug categories and within the trauma and orthopaedics department was associated with higher prescribing costs. Significant variability was also attributable to the prescribing doctor (p<0.001) with average prescription costs ranging from 72.2% lower to 193.8% higher than the median doctor.

Conclusions There is considerable variation in the total costs of medications prescribed by F1 doctors, even after considering a range of prescription factors. This variation may suggest that some doctors are prescribing uneconomically relative to the rest of the cohort. Knowledge of which clinical areas and drug classes have higher NICs may allow an alternative focus for medicine management teams and postgraduate education.