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. 2018 May;118(9):1268-1275.
doi: 10.1038/s41416-018-0065-2. Epub 2018 Apr 23.

Impact of NICE guidance on tamoxifen prescribing in England 2011-2017: an interrupted time series analysis

Helen J Curtis  1 , Alex J Walker  1 , Ben Goldacre  2
Affiliations

Impact of NICE guidance on tamoxifen prescribing in England 2011-2017: an interrupted time series analysis

Helen J Curtis et al. Br J Cancer. 2018 May.

Abstract

Background: Tamoxifen was recommended by NICE in 2013 for chemoprevention of breast cancer, but a recent survey suggested only a quarter of GPs are aware of this. We set out to measure the uptake of tamoxifen, and the alternative raloxifene, in national prescribing data sets.

Methods: Tamoxifen and raloxifene data were extracted from England's monthly prescribing data sets, October 2010-October 2017. We used interrupted time series analysis to reveal national and local responses to guidelines. We investigated variation between practices by calculating percentiles for prescribing rates and ratios of change.

Results: We found an increase in monthly tamoxifen prescribing following release of the guidelines, with an increase in gradient (p = 0.001) but no step change (p = 0.342). Alongside a small change in raloxifene prescribing we estimate 8450 women took up chemoprevention between 2013 and 2016. We did not find evidence that this was limited to a small group of practices.

Conclusions: Our results suggest that the uptake of new guidance on chemoprevention has been slow and has potentially left women exposed to avoidable risk. Improving dissemination of guidance to healthcare professionals and routinely monitoring implementation could help reduce this risk.

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Conflict of interest statement

B.G has received funding from the Health Foundation, the National Institute for Health Research School of Primary Care Research, the NIHR Biomedical Research Centre Oxford, the West of England Academic Health Sciences Network and NHS England for work on UK prescribing data. H.C. and A.W. are employed on these grants. B.G. has additionally received funding from the Laura and John Arnold Foundation, the Wellcome Trust, and the World Health Organisation to work on better use of data in medicine; and receives personal income from speaking and writing for lay audiences on the misuse of science.

Figures

Fig. 1
Fig. 1
Interrupted time series analysis for total tamoxifen ADQs prescribed per 1000 population (females 35–74) per month in all practices in England
Fig. 2
Fig. 2
Median, deciles and extreme percentiles (0–9 and 91–100) tamoxifen ADQs prescribed per 1000 population (females 35–74) per practice across England, averaged across rolling 6-month periods
Fig. 3
Fig. 3
Median, deciles and extreme percentiles (0–9 and 91–100) representing fold-change in tamoxifen ADQs prescribed per 1000 population per practice across England, for rolling 6-month periods, calculated as a ratio to the baseline period. A logarithmic scale is used and zero values are excluded
Fig. 4
Fig. 4
Interrupted time series analysis for total tamoxifen ADQs prescribed per 1000 population (female 35–74) per month in GM practices (filled) compared to others (control, outlines)
Fig. 5
Fig. 5
Interrupted time series analysis for total raloxifene ADQs prescribed per 1000 population (female 45 + ) per month in GM practices (‘1’, filled) compared to others (‘controls’, outlines)
See this image and copyright information in PMC

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References

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