The impact of lidocaine plaster prescribing reduction strategies: a comparison of two national health services in Europe

Introduction In 2017, two distinct interventions were implemented in Ireland and England to reduce prescribing of lidocaine medicated plasters. In Ireland, restrictions on reimbursement were introduced. In England, updated guidance on items not to routinely prescribe in primary care, including lidocaine plasters, was published. This study aims to compare how the interventions impacted prescribing of lidocaine plasters in these countries. Methods We conducted an interrupted time series study using general practice data. For Ireland, monthly dispensing data (2015-2019) from the means-tested General Medical Services scheme was used. For England, data covered all patients. Outcomes were the rate of dispensings, quantity and costs of lidocaine plasters, and we modelled level and trend changes from the first full month of the policy/guidance change. Findings Ireland had higher rates of lidocaine dispensings compared to England throughout the study period; this was 15.22/1,000 population immediately pre-intervention, and there was equivalent to a 97.2% immediate reduction following the intervention. In England, the immediate pre-intervention dispensing rate was 0.36/1,000, with an immediate reduction of 0.0251/1,000 (a 5.8% decrease), followed by a small but significant decrease in the monthly trend relative to the pre-intervention trend of 0.0057 per month. Interpretation Among two different interventions aiming to decrease low-value lidocaine plaster prescribing, there was a substantially larger impact in Ireland of reimbursement restriction compared to issuing guidance in England. However, this is in the context of much higher baseline rates of use in Ireland compared to England. Funding This study was funded by the Health Research Board (SDAP-2019-023). ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study is funded by the Health Research Board in Ireland (HRB) through the Secondary Data Analysis Projects scheme (CDRx project, PI FM, grant number SDAP-2019-023). The funder had no role in in study design; in the collection, analysis, and interpretation of data; in the writing of this paper; or in the decision to submit this paper for publication. EW is funded by a HRB Emerging Clinician Scientist Award (grant number: ECSA/2020/002). MEW is funded by a HRB Applying Research into Policy and Practice Award (ARPP/2020/004). OpenPrescribing.net is currently funded by NHS England Primary Care and Medicines Analytics Unit. All other Bennett funding information is available at ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was approved by the RCSI University of Medicine and Health Sciences Human Research Ethics Committee (REC202201015). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Code and data for the analysis of NHS data is available from . Code for the analysis of GMS data is available from . GMS data in aggregated form can be requested from the HSE PCRS at .