A model-based cost-effectiveness analysis of prescribing by dietitians and therapeutic radiographers in England

Non-medical prescribing (NMP) was introduced into the UK healthcare system and other countries to improve patient care and facilitate better access to medicine. However, very few studies have evaluated the cost-effectiveness of the prescribing authorities granted to certain healthcare professional groups. This study aims to evaluate the cost-effectiveness of prescribing by dietitians and therapeutic radiographers in England. A model-based cost-effectiveness analysis was conducted to evaluate the services provided by dietitian and therapeutic radiographer prescribers compared to services delivered by dietitian and therapeutic radiographer non-prescribers in terms of direct and indirect costs and effectiveness outcomes, e.g. quality-adjusted life year (QALY) and patient satisfaction, from the National Health Service (NHS) perspective. Unit costs were obtained from the NHS National Reference Costs 2021-22. Sensitivity analyses were performed to assess the robustness of the model parameters. The mean costs associated with NMP were higher for prescribers than non-prescribers due to training costs and consultation time to manage prescriptions. However, these costs were compensated by higher referrals by non-prescribers to other specialists for prescribing. NMP in either profession was perceived as positive by patients. Differences in QALY were not statistically significant among patients managed by prescribers and non-prescribers for either profession. Results were sensitive to the model assumptions and parameters. Our estimates suggest NMP might save £64,269 over five years per dietitian prescriber and £16,570 per therapeutic radiographer prescriber. Despite uncertainties around the cost-effectiveness of NMP, it may save money with minimal or no changes in quality-of-life outcomes for patients being managed by either profession.