Prescription of teriparatide in the UK - a nationwide register study from 2004 to 2008

Introduction: The objectives were to ascertain the incidence of teriparatide prescription in the UK stratified by region and sex, examine the association between National Institute for Health and Clinical Excellence (NICE) and European Medicines Agency approval and geographic variation in teriparatide prescription, and compare the regional rates of teriparatide and oral bisphosphonate use. Methods: Healthcare at Home provided anonymized information on age, sex, year, and treating hospital for all UK residents commenced on teriparatide between 1 January 2004 and 31 December 2008. The crude and age- and sex-adjusted rates of teriparatide prescription were calculated for each region. Rates of teriparatide prescription for each region, in the year before and in the year after approval by NICE and European Medicines Agency, were compared in a multiplicative model (likelihood-ratio test) for women and men, respectively. The number of patients on oral bisphosphonates in each region was estimated from quantity of oral bisphosphonates dispensed in 2007. Results: Compared with that in England, the incidence of teriparatide prescription was 54% and 50% higher in Wales and in Scotland, respectively. The Northeast and East of England had lowest rate of teriparatide use. There was significant geographic variation in increase in teriparatide prescription in women after favorable NICE recommendation (p=0.0001). In contrast, prescription rates in men increased uniformly across the UK (p=0.15). Geographic variation in oral bisphosphonate prescription did not mirror that of teriparatide. Conclusion: We report wide geographic variation in teriparatide prescription rates within the UK. In a country with government-funded health care, reasons for this inequality need to be identified.