In addition to ensuring that the choice of medicines is evidence-based and clinically appropriate to meet the needs of the patient, the principles of medicines optimisation require that cost-effective medicines are used where possible81.
Principle 2: Evidence based choice of medicines
- Ensure that the most appropriate choice of clinically and cost effective medicines (informed by the best available evidence base) are made that can best meet the needs of the patient.
Unsurprisingly, given the wide variety of unlicensed formulations of melatonin available in the UK, there is a significant variation in drug cost42. However, despite this disparity, the more expensive, unlicensed formulations of melatonin continue to be prescribed widely.
Figure 4. Melatonin formulations – variation in cost (Source: e.PACT.net data – NHS Business Services Authority. January 2015)
Figure 5. Most expensive solid dose formulations of melatonin – 2013-14 (Source: e.PACT.net data – NHS Business Services Authority. January 2015)
In 2013, the London Procurement Partnership advised that “all other formulations of melatonin are significantly more expensive than Circadin” and whilst “approximately 40% of all melatonin dispensed is Circadin®, [this only] accounts for around 20% of the cost of all melatonin formulations.”
Whilst there will be instances whereby alternative formulations will be considered the most appropriate for specific patients (eg. liquid formulations for patients with swallowing difficulties) it is clear that many prescribers are not currently adhering to best practice by using the licensed, most cost-effective formulation of melatonin wherever possible.