Items which should not routinely be prescribed in primary care - oxycodone and naloxone combination product

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 oxycodone and naloxone combination per 1000 patients
Why it matters

NHS England guidance states:

Oxycodone and naloxone combination product is used to treat severe pain and can also be used second line in restless legs syndrome. The opioid antagonist naloxone is added to counteract opioid-induced constipation by blocking the action of oxycodone at opioid receptors in the gut.

PrescQIPP CIC has issued a bulletin, which does not identify a benefit of oxycodone and naloxone in a single product over other analgesia (with laxatives if necessary).

Due to the significant cost of the oxycodone and naloxone combination product and the unclear role of the combination product in therapy compared with individual products, the joint clinical working group considered oxycodone and naloxone suitable for inclusion in this guidance.

For guidance on when prescribing may be appropriate in some exceptional circumstances, please see the full NHS England guidance document.
Tags Cost Saving, NHS England - items which should not routinely be prescribed in primary care, Opioids, Pain
Implies cost savings Yes
Authored by richard.croker
Checked by christopher.wood
Last reviewed 2024-03-05
Next review due 2026-03-05
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 ("0407020AFAAAAAA", "0407020AFAAABAB", "0407020AFAAACAC", "0407020AFAAADAD", "0407020AFBBAAAA", "0407020AFBBABAB", "0407020AFBBACAC", "0407020AFBBADAD", "0407020AFBCAAAA", "0407020AFBCABAB", "0407020AFBCACAD", "0407020AFBCADAC", "0407020AFBDAAAC", "0407020AFBDABAA", "0407020AFBDACAB", "0407020AFBDADAD")
 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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