NPS MedicineWise delivers nationwide educational programs to improve quality use of medicines and medical tests in Australia. Targeted horizon scanning approaches are required to detect and address emerging challenges in the healthcare landscape such as overutilization and unexpectedly high expenditure on medicines and medical tests. Publicly available utilization and expenditure data from the Australian Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS) may provide insights into identifying potential areas for intervention.

Five financial years (2013-18) of publicly available PBS/MBS data was extracted from Australian Government websites and clustered according to medicine class, disease groups or anatomical therapeutic chemical classification (ATC). Usage and expenditure trends were explored with signals of potential inappropriate use identified as unusual spikes or changes.

PBS data showed two fixed dose combination inhalers for respiratory conditions, three direct oral anticoagulants, four analgesics (including opioids) and two blood glucose lowering agents had high volume and expenditure growths in the 2016-17 financial year. Cholesterol-reducing medicines and anti-hypertensives also commonly had high utilisation growth. The highest growth classified by ATC level two codes were for urologicals. These signals were collated into themes of stroke prevention, cardiovascular, respiratory, pain management and type two diabetes. MBS data on pathology tests showed viral and bacterial testing had the highest growth, followed by vitamin B12 testing and vitamin D testing. Magnetic resonance imaging had the highest growth in expenditure and volume of services of the various imaging modalities and X-ray of the lower leg had the highest volume of services.

Several medicines and medical tests were detected as possible targets for interventions based on high volume or expenditure growth. Themes identified from the data can then be further investigated and contextualized to inform topic areas for primary care education to support quality use of medicines and medical tests.