The cost of the antidepressant, sertraline, to the NHS in England increased by more than 500% between 2019 and 2020/2021, despite the number of items dispensed only rising by 12% in that time, figures released by the NHS Business Services Authority (NHSBSA) have shown.
The annual Prescription Cost Analysis (PCA), published on 10 June 2021, includes information about the costs and volumes of prescriptions that have been dispensed in England over the past year.
Drugs containing the active ingredient, sertraline hydrochloride, increased in cost from £1.56 per item in 2019 to £8.89 per item in 2020/2021; an increase of 470%. As a result, the total cost to the NHS was almost £168m in 2020/2021, compared with just over £26m in 2019, an increase of 538%. This was despite the number of items prescribed increasing by just 12%, from 16.8 million to 18.9 million.
Sertraline (100mg tablets) was the presentation with the largest absolute increase in cost between 2019/2020 and 2020/2021, with an increase of £78.9m, from £21.0m to £99.9m, the PCA showed.
The 2020/2021 PCA also detailed that the cost of prescription items dispensed in the community in England had risen to £9.61bn — a 3.49% increase of £324m from £9.28bn in 2019/2020.
The NHSBSA said this was the second consecutive year that the cost of items dispensed in England had increased, following three consecutive years of decreases between 2015/2016 and 2018/2019.
The Pharmaceutical Journal reported in April 2020 that manufacturers had reported “industry-wide” supply challenges, exacerbated by export bans and border closures implemented as a result of the COVID-19 pandemic.
At the time, Accord Healthcare said its sertraline products had been out of stock for approximately four weeks, owing to a shortage of the API.
Overall, a study published in March 2021 found that the total number of antidepressant prescriptions dispensed in 2020 increased by 4 million compared to 2019 — costing the NHS England an extra £139m.
Steve Bazire, honorary professor at the School of Pharmacy at the University of East Anglia, said there had been “erratic” shortages of sertraline since the beginning of 2020, with the 100mg tablets in particularly short supply.
“My last trust has been able to source sertraline but from different suppliers each time and at varying costs; they currently pay around £5 for 28x100mg, but that does change from week to week according to who has what available,” he said.
Bazire said it appeared that the huge price increases were only being experienced in the UK.
“The US/world branded sertraline product, Zoloft, is still expensive but generics elsewhere seem cheap enough,” he said.
A price concession — which is set when pharmacists may face difficulties in getting medicines at their usual prices owing to supply or other issues — was granted for sertraline 100mg and 50mg by the Department of Health and Social Care for the period April 2020 to October 2020.
The NHSBSA moved to reporting by financial year in 2020/2021, rather than by calendar year as it had done previously, to align the PCA with other publications that it produces, and also with other PCA publications across the UK.
This article was corrected on 15 June 2021 to clarify that the calendar year of 2019 is being compared with the financial year of 2020/2021 for some data.