Title : Optimising hepatitis B antiviral prescribing in a rural NHS population: A quality improvement study demonstrating £50k annual trust savings
Abstract:
Background: Optimising models of care for hepatitis B treatment delivery is an important component of global hepatitis elimination strategies. However, centralised dispensing may increase travel and financial burden for patients, particularly in rural populations.
Methods: A retrospective quality improvement audit was conducted of 95 patients receiving entecavir or tenofovir between 2020–2024 at a rural UK district general hospital. Prescribing route and patient travel distance were analysed. Trust medication costs were calculated using local pharmacy procurement prices and community prescribing tariffs. Patient burden was modelled using travel costs (£0.374/mile), average travel speed (35 mph), parking costs (£2.50/hour assuming 2.5 hours per visit), and time costs (£15.50/hour). Environmental impact was estimated using UK government greenhouse gas conversion factors.
Results: Hospital dispensing produced substantial trust-level cost savings. If all patients received antiviral therapy through hospital pharmacy, the projected annual saving was £49,583.82. However, patients receiving hospital-dispensed medication incurred an estimated £118.74 per patient annually in travel, parking, and time costs. A targeted optimisation strategy identified 24 patients living within 15 miles currently receiving community prescriptions. Transitioning these patients to hospital dispensing could generate approximately £10,700 annual savings while minimising additional patient burden.
Conclusion: Implementation of a targeted prescribing pathway demonstrates that substantial system-level savings can be achieved while maintaining equitable patient access, supporting scalable models of care for hepatitis B elimination.
