Items which should not routinely be prescribed in primary care - lutein and antioxidants

Below are the database queries which are used to create this measure. These are run against a copy of the BSA prescribing data which we store in Google BigQuery. We're working on making our BigQuery tables publicly available at which point it will be possible to run and modify these queries yourself. But even where code and database queries are not directly useable by others we believe it is always preferable to make them public.

Description Cost of lutein and antioxidant per 1000 patients
Why it matters

NHS England guidance states:

The supplements lutein and antioxidants (e.g. vitamin A, C, E and zinc) are sometimes recommended for age-related macular degeneration (AMD). A variety of supplements are available to purchase in health food stores and other outlets where they are promoted to assist with ‘eye health’.

Two Cochrane reviews have been conducted on this topic:

  1. Antioxidant vitamin and mineral supplements for preventing age-related macular degeneration. The authors conclude: 'There is accumulating evidence that taking vitamin E or beta-carotene supplements will not prevent or delay the onset of AMD. There is no evidence with respect to other antioxidant supplements, such as vitamin C, lutein and zeaxanthin, or any of the commonly marketed multivitamin combinations'.
  2. Antioxidant vitamin and mineral supplements for slowing the progression of age-related macular degeneration. The authors conclude: 'People with AMD may experience delay in progression of the disease with antioxidant vitamin and mineral supplementation. This finding is drawn from one large trial conducted in a relatively well-nourished American population. The generalisability of these findings to other populations is not known'.

PrescQIPP CIC has issued a bulletin that did not find evidence to support prescribing of lutein and antioxidants routinely on the NHS.

NICE guidance on AMD includes a recommendation for research on the effectiveness and cost-effectiveness of lutein and antioxidants, which is currently a gap in the research.

For guidance on when prescribing may be appropriate in some exceptional circumstances, please see the full NHS England guidance document.
Tags Cost Saving, Efficacy, Eye, NHS England - items which should not routinely be prescribed in primary care
Implies cost savings Yes
Authored by richard.croker
Checked by christopher.wood
Last reviewed 2024-03-05
Next review due 2025-03-05
History View change history on GitHub →

Numerator SQL

SELECT
     CAST(month AS DATE) AS month,
     practice AS practice_id,
     SUM(actual_cost) AS numerator
 FROM hscic.normalised_prescribing
 WHERE bnf_code IN ("091000000BBTPBU", "091000000BBUSBT", "091000000BBVFBT", "091000000BBVGBT", "091000000BBVQBT", "091000000BBVSBT", "091000000BBVTBT", "091000000BBVXBT", "091000000BBWHA0", "091000000BBWNBT", "091000000BBWPBT", "091000000BBWQBT", "091000000BBWWBT", "091000000BBWYBT", "091000000BBXRBT", "091200000BEJYFS", "091200000BEXXFR", "091200000BFSIA0", "091200000BFWUFT", "091200000BFWVFT", "091200000BFXRFT", "190500000BBDPA0", "190500000BBDYA0")
 GROUP BY month, practice_id

Denominator SQL

SELECT
     CAST(month AS DATE) AS month,
     practice AS practice_id,
     SUM(total_list_size / 1000.0) AS denominator
 FROM hscic.practice_statistics
 GROUP BY month, practice_id
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