Patient-level analysis of the cost and variation in melatonin prescribing patterns in those under 18 in the North East of England.

Background: Melatonin is widely used to promote sleep in both normally developing children and adolescents and those with neurodevelopmental disorders. It has an evidence base as both hypnotic and chronobiotic although the optimum dose and timing remain unclear. There are now a wide variety of different preparations of melatonin both immediate and prolonged release. We reviewed annual national and regional prescribing data and undertook a detailed review of one year of melatonin prescriptions issued to those under 18 within one of the UK's dedicated paediatric hospitals, this included a cost analysis. This was to understand whether prescribing was appropriate, whether behavioural therapies had been recommended first and whether there had been consideration of other causes of poor sleep, such as sleep apnoea.

Methods: Between November 2020 and October 2021, 220 patients under 18 had one or more melatonin prescriptions issued to treat poor sleep. The audit assessed whether prescriptions were issued in accordance with local Melatonin Shared Care Guidance standards that emphasise: an initial behavioural approach, fixed timing, use of licensed preparations and review of benefit. This included a detailed review of electronic patient care records. A cost analysis of the different preparations was also made.Results adherence to the audit were not met for any of the audit standards, only 9% had a prior behavioural intervention, and only 15% had another sleep disorder considered. Community prescribers were more likely to give advice on timing and review any subsequent benefit. The total costs of prescriptions were £13 299 of which £8736 was issued as off licence, liquid suspension.

Conclusion: The audit highlighted a lack of knowledge about appropriate melatonin prescribing and led to a trust-wide sleep education programme. It additionally highlighted the cost and potential risk of inappropriate prescribing and a clear need for better access to effective behavioural interventions.