Items which should not routinely be prescribed in primary care - paracetamol and tramadol combination

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 paracetamol and tramadol combination per 1000 patients
Why it matters

NHS England guidance states:

Although the combination product has reduced in price since this guidance was first published in 2017, there is no further evidence that indicates significant advantages over individual products.

A PrescQIPP CIC bulletin did not identify any significant advantages over individual products; however, it recognised that some people may prefer to take one product instead of two. While the strengths of tramadol (37.5mg) and paracetamol (325mg) in the combination product are lower than those in commonly available individual preparations of tramadol (50mg) and paracetamol (500mg), the PrescQIPP CIC review found no evidence that the combination product is more effective or safer than the individual preparations.

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, 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 ("040702040AAAUAU", "040702040AABABA", "040702040AABCBC", "040702040BFAAAU", "040702040BFABBA", "040702040BYAAAU")
 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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