Items which should not routinely be prescribed in primary care - omega-3 fatty acid compounds (excluding icosapent ethyl [Vazkepa®])

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 omega-3 fatty acid compounds per 1000 patients
Why it matters

NHS England guidance states:

Omega-3 fatty acid compounds are essential fatty acids that can be obtained from the diet. They are licensed for adjunct to diet and statin in Type IIb or III hypertriglyceridaemia; adjunct to diet in Type IV hypertriglyceridaemia; adjunct in secondary prevention in those who have had a myocardial infarction in the preceding 3 months.

The summary of national guidance for lipid management outlines the clinical pathway for primary and secondary prevention of cardiovascular disease (CVD). It states that omega-3 fatty acids should not be offered alone or in combination with a statin for the prevention of CVD. This pathway should be followed for lipid management.

NICE recommends that only one omega-3 fatty acid compound is recommended in specific clinical circumstances - icosapent ethyl [Vazkepa®], and that all other omega-3 fatty acid compounds are not suitable for prescribing:

  • Do not offer or advise people to use omega-3 fatty acid capsules or omega-3 fatty acid supplemented foods to prevent another myocardial infarction. If people choose to take omega-3 fatty acid capsules or eat omega-3 fatty acid supplemented foods, be aware that there is no evidence of harm.
  • Do not offer omega-3 fatty acid compounds for the prevention of cardiovascular disease to any of the following: people who are being treated for primary prevention, people who are being treated for secondary prevention, people with chronic kidney disease, people with type 1 diabetes, people with type 2 diabetes.
  • Do not offer the combination of a bile acid sequestrant (anion exchange resin), fibrate, nicotinic acid or omega-3 fatty acid compound with a statin for the primary or secondary prevention of CVD.
  • Do not offer omega-3 fatty acids to adults with non-alcoholic fatty liver disease because there is not enough evidence to recommend their use.
  • Initiation of omega-3-acid ethyl esters supplements is not routinely recommended for patients who have had a myocardial infarction (MI) more than 3 months earlier.
  • Do not use omega-3 fatty acids to manage sleep problems in children and young people with autism.
  • People with familial hypercholesterolemia (FH) should not routinely be recommended to take omega-3 fatty acid supplements.
  • Do not offer omega-3 or omega-6 fatty acid compounds to treat multiple sclerosis (MS). Explain that there is no evidence that they affect relapse frequency or progression of MS.

The joint clinical working group agreed with NICE recommendations and considered omega-3 fatty acid compounds suitable for inclusion in this guidance.

NHS England recommend that GPs:

  • Do not initiate.
  • Deprescribe in patients currently prescribed this medicine.
Tags Cardiovascular system, Cost Saving, Efficacy, NHS England - items which should not routinely be prescribed in primary care, NICE
Implies cost savings Yes
Authored by richard.croker
Checked by christopher.wood
Last reviewed 2023-09-18
Next review due 2025-09-18
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 ("0212000ABAAAAAA", "0212000ABBBAAAA", "0212000ABBCAAAA", "0212000ABBDAAAA", "0212000ABBEAAAA", "0212000ABBGAAAA", "0212000ABBHAAAA", "0212000ABBIAAAA", "0212000ABBJAAAA", "0212000ABBKAAAA", "0212000ABBLAAAA", "0212000V0BBABAB")
 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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