ORIGINAL REPORT Prescription of teriparatide in the UK — a nationwide register study from 2004 to 2008 Abhishek Abhishek 1,2 *, Ira Pande 1 and Richard B Hubbard 3 1 Department of Rheumatology, Nottingham University Hospital, Nottingham, Nottinghamshire, UK 2 Academic Rheumatology, Clinical Sciences Building, City Hospital Nottingham, Nottingham, Nottinghamshire, UK 3 Department of Epidemiology, Clinical Sciences Building, University of Nottingham, Nottingham, Nottinghamshire, UK ABSTRACT Introduction The objectives were to ascertain the incidence of teriparatide prescription in the UK stratified by region and sex, examine the association between National Institute for Health and Clinical Excellence (NICE) and European Medicines Agency approval and geographic variation in teriparatide prescription, and compare the regional rates of teriparatide and oral bisphosphonate use. Methods Healthcare at Home provided anonymized information on age, sex, year, and treating hospital for all UK residents commenced on teriparatide between 1 January 2004 and 31 December 2008. The crude and age‐ and sex‐adjusted rates of teriparatide prescription were calculated for each region. Rates of teriparatide prescription for each region, in the year before and in the year after approval by NICE and European Medicines Agency, were compared in a multiplicative model (likelihood‐ratio test) for women and men, respectively. The number of patients on oral bisphosphonates in each region was estimated from quantity of oral bisphosphonates dispensed in 2007. Results Compared with that in England, the incidence of teriparatide prescription was 54% and 50% higher in Wales and in Scotland, respectively. The Northeast and East of England had lowest rate of teriparatide use. There was significant geographic variation in increase in teriparatide prescription in women after favorable NICE recommendation (p = 0.0001). In contrast, prescription rates in men increased uniformly across the UK (p = 0.15). Geographic variation in oral bisphosphonate prescription did not mirror that of teriparatide. Conclusion We report wide geographic variation in teriparatide prescription rates within the UK. In a country with government‐funded health care, reasons for this inequality need to be identified. Copyright © 2011 John Wiley & Sons, Ltd. key words —osteoporosis; post‐code prescribing; teriparatide; geographic variation Received 10 June 2010; Revised 10 February 2011; Accepted 23 March 2011 INTRODUCTION Teriparatide (Forsteo ® , Eli Lilly & Co., Indianapolis, Indiana, USA) is an expensive drug licensed for treatment of severe established osteoporosis. 1–3 It is the only anabolic drug available for patients who may have failed to respond to several anti‐osteoporotic agents. 3 Therefore, it is of immense importance to patient care that there are no undue regional differences in its availability. This is particularly important in the UK where there is universal access to government‐ funded healthcare system, the National Health Service (NHS). The NHS provides free health care for everyone in the UK. Recommendations from National Institute for Health and Clinical Excellence (NICE) also ensure that there is equal access to medical treatment and care from the NHS. 4 Although NICE does not license new drugs for human use, it provides recommendations on the use of new and existing medicines and treatments within the NHS. 4 It develops evidence‐based clinical guidelines on the appropriate treatment and care of people with specific diseases. 4 NICE guidelines apply to England, Wales, and Northern Ireland but not to Scotland except for multiple technology appraisals, such as the one for teriparatide. 3 However, in reality, access to health care is influenced by decisions of local health authorities as to whether they can fund a specific drug for a particular condition in their respective areas, resulting in “post‐code prescribing.” 5–9 Post‐ code prescribing occurs when a patient’s access to * Correspondence to: A. Abhishek, Academic Rheumatology, Clinical Sciences Building, City Hospital Nottingham, Nottingham, Nottinghamshire, UK. E‐mail: docabhishek.@gmail.com Copyright © 2011 John Wiley & Sons, Ltd. pharmacoepidemiology and drug safety 2011; 20: 1327–1333 Published online 1 July 2011 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/pds.2154