• Lloyd Morgan, Stephen Barclay, Kristian Pollock, Efthalia Massou, and Ben Bowers.
• Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, England, UK.
• Palliat Med. 2023 Dec 1; 37 (10): 155415611554-1561.

BackgroundThe prescribing of injectable end-of-life anticipatory medications ahead of possible need is recommended best practice. The financial costs of these medications have been little studied.AimTo identify the costs of anticipatory medications prescribed, used and not used for patients approaching the end-of-life at home and in residential care.DesignRetrospective observational study using general practitioner and community nursing clinical records.Setting/ParticipantsData were collected from eleven general practitioner practices using the records of the 30 most recent deaths per practice. Patients were aged 18+ and died between 2017 and 2019 from any cause except trauma, sudden death or suicide.ResultsAnticipatory medications were prescribed to 167/329 patients, of which 164 were included in the analysis. Costs (GBP) were analysed both at patient-level and drug-level. Median anticipatory prescription cost was £43.17 (IQR: £38.98-£60.47, range £8.76-£229.82). Median administered (used) drug cost was £2.16 (IQR: £0.00-£12.09, range £0.00-£83.14). Median unused (wasted) drug cost was £41.47 (IQR: £29.15-£54.33, range £0.00-£195.36). Prescription, administered and unused costs were significantly higher for the 59 patients prescribed an anticipatory syringe driver. There were wide variations in the unused costs of individual drugs; Haloperidol and Cyclizine contributed 49% of total unused costs.ConclusionThe costs of prescribed and unused anticipatory medications were higher than previously reported but remain modest. Usage of prescriptions was lower than previously documented. There may be scope to reduce the quantity of vials that are routinely prescribed without adversely affecting care; further research is needed to investigate this possibility.

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