Regional variation and trends in prostaglandin analogue prescribing for glaucoma in England 2019–2024

BACKGROUND: Prescribing for glaucoma drops constitutes a large proportion of the NHS medicines budget for ophthalmology. NICE guidelines direct clinicians towards the prescription of a generic prostaglandin analogue (PGA) as a first-line topical hypotensive for lowering intraocular pressure. Between 2009 and 2018 the cost-effectivity of PGA prescribing at a national level in England was questionable. This study aimed to examine the variation and trends of PGA prescription at a regional level from 2019 to 2024. METHODS: Using an online open-access source, monthly data relating to General Practitioner prescription of latanoprost, bimatoprost, travoprost and tafluprost were collected. Data gathered related to PGA prescription activity from each of the individual Clinical Commissioning Groups (CCGs) in England. Descriptive statistics and choropleth maps were produced to display outcomes. RESULTS: Total PGA prescribing cost over 5 years was £166 M for 21.9 M prescriptions. A broad trend towards generic prescribing was identified. Branded and preservative free prescribing, in preference to a generic equivalent, resulted in an additional cost of approximately £54 M. Latanoprost was most readily prescribed in the South West and South East regions. Bimatoprost and travoprost were prescribed more in the North East and the East of England respectively. CONCLUSIONS: Regional variation in PGA prescribing exists in England. Further investigation is required to determine the primary cause for the reported differences. Reducing variations so that prescribing clinicians are directed towards the most cost-effective PGA choice has the potential for considerable cost savings to NHS budgets.