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44 End of life anticipatory medication: understanding the financial costs of medicines
  1. L Morgan1,
  2. S Barclay2 and
  3. B Bowers3
  1. 1Medical Student, University of Cambridge
  2. 2Associate Professor in General Practice and Palliative Care, Department of Public Health and Primary Care, University of Cambridge
  3. 3PhD Candidate and Queen’s Nurse, Department of Public Health and Primary Care, University of Cambridge


Introduction The prescribing of injectable end-of-life anticipatory medications ahead of possible need is recommended and established practice. Published studies calculating the costs of anticipatory medication have done so from partial prescribing and administration data, limiting the accuracy of findings to date.

Aims To identify the prescription, usage and wastage costs of anticipatory medications dispensed to patients living at home and in residential care.

Method Retrospective observational study using GP and community nursing records. Data was collected from 11 GP practices, from two CCGs, using the records of the last 30 most recent deaths per practice. Patients were aged 18+ and died from any cause except trauma, sudden death or suicide, between 2017 and 2019.

Anticipatory medications were prescribed to 167/329 patients, of which 164 were included in the analysis as they had complete records. Two researchers reviewed prescriptions to ensure they were anticipatory. Medicines were costed using BNF 2021 drug tariff prices. Costs and wastage were analysed both at patient-level and drug-level using univariate analysis.

Results Median anticipatory prescription cost was £43.17 (IQR: £38.98-£60.47, range £8.76 to £229.82). Median administration prescription cost was £2.16 (IQR: £0.00-£12.09, range £0.00 to £83.14). Median wastage was £41.47 (IQR: £29.15-£54.33, range £0.00 to £195.36). There were no notable differences between cause of death, age, GP practice or CCG and prescription, usage or wastage costs. There were wide variations in the wastage costs of individual drugs; Haloperidol and Cyclizine, two commonly prescribed anti-emetic drugs, contributed 49% of the total wastage costs.

Conclusion The prescription and wastage costs of anticipatory medications are higher than previously estimated but remain modest when compared with the costs of potentially avoided inpatient admissions. Usage of prescriptions is lower than previously expected.

Impact There may be scope to reduce the quantity of drug ampules that are routinely prescribed without adversely affecting care.

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