Items which should not routinely be prescribed in primary care - trimipramine

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 trimipramine per 1000 patients
Why it matters

NHS England guidance states:

The tricyclic antidepressant (TCA) trimipramine is significantly more expensive than other antidepressants.

NICE guidance on depression in adults recommends selective serotonin reuptake inhibitor (SSRI) antidepressants first line if indicated as they have a more favourable risk-to-benefit ratio compared to TCAs. However, if a TCA is required, more cost-effective TCAs than trimipramine are available.

Due to the significant cost associated with trimipramine and the availability of alternative treatments, the joint clinical working group considered trimipramine 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, Mental Health, NICE
Implies cost savings Yes
Authored by richard.croker
Checked by andrew.brown
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 ("0403010Y0AAAAAA", "0403010Y0AAABAB", "0403010Y0AAACAC", "0403010Y0AAAGAG", "0403010Y0AAAHAH", "0403010Y0AAAKAK", "0403010Y0BBAAAA", "0403010Y0BBACAC")
 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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