Palliative care services in Australia

In 2021–22, 453,300 people received 1.3 million palliative care-related prescriptions. This section provides information related to these prescriptions and the characteristics of the people who received them over the period 2017–18 to 2021–22. Further information about how palliative care prescriptions are identified through the Pharmaceutical Benefits Scheme (PBS) and the Repatriation Pharmaceutical Benefits Scheme (RPBS) are described below and in the Data sources section.

The information in this section was last updated in May 2023.

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Who were dispensed these prescriptions?

In 2021–22, 453,300 people were dispensed with at least one palliative care-related prescription nationally, equating to 1.8% of the Australian population (or 1,800 per 100,000 population). Among people dispensed with palliative care-related prescriptions (Figure PBS.1):

• More were females (54%) – 245,300 compared with 207,900 for males, equating to 1,900 per 100,000 females and 1,600 per 100,000 males.
• 1 in 2 (53%) were aged 65 and over – increasing from 5.7% to 20% between the ages 25 and 74, and then declining to 14% for those aged 85 and over. However, taking into account the size of the population in each age group, those aged 85 and over had the highest prescription rate (11,700 per 100,000), 2–3 times as high as those in 65–74 and 75–84 age groups.
• Those living in Inner regional and Outer regional areas were more likely to be dispensed with palliative care-related prescriptions (2,300 per 100,000 in each) than those in other areas (1,600 per 100,000 in Major cities and 1,400 per 100,000 in Remote and very remote areas combined). Note that medicines distributed through Remote Area Aboriginal Health Services are not included in these data. This could contribute to the low rate observed in remote areas.
• The rate varied across the states and territories, ranging from 1,100 per 100,000 in Northern Territory to 2,300 per 100,000 in Tasmania.

Figure PBS.1: People who received prescriptions from Palliative Care Schedule, 2021–22

How many prescriptions were dispensed?

In 2021–22, 1.3 million palliative care-related prescriptions were dispensed, at an average of 2.8 prescriptions per person. Among these palliative care-related prescriptions (Figure PBS.2):

• On average, more prescriptions were dispensed to females than males – 2.9 prescriptions per females and 2.7 per males, consistent with the higher number of females receiving these prescriptions.
• Number of prescriptions per person increased steadily from age 15 (1.6 prescriptions per person) to age 84 (3.2 prescriptions per person) and then dropped slightly to 3.1 prescriptions per person for those aged 85 and over. Those aged 15 and under had an average of 2.1 prescriptions per person.
• 8 in 10 (79%) prescriptions were for pain relief – this equated to 1.0 million prescriptions or 3,900 per 100,000 population. The next most common prescription type was for gastrointestinal symptoms (123,000 prescriptions; 480 per 100,000), followed by prescription for neurological symptoms (102,000 prescriptions; 400 per 100,000). For further details on these prescriptions, see Table 1 in the Data sources.
• Tasmania had the highest rate of prescriptions dispensed, 1.5 times the national average rate – 7,300 and 4,900 per 100,000 population, respectively. Prescriptions for pain relief accounted for the highest rate of palliative care-related prescriptions in all states and territories, ranging from 2,400 per 100,000 population in Northern Territory to 6,200 per 100,000 in Tasmania.

Figure PBS.2: Prescriptions from Palliative Care Schedule, 2021–22

Pain relief medications

Pain management is an integral component of quality palliative care, and pain-relieving medications are often used in conjunction with other strategies. Pain can be due to a life-limiting illness, its treatment, debility or comorbid illnesses (see Therapeutic Guidelines: Palliative Care for further information).

In 2021–22, the most common type of pain relief medication was opioids (37%), followed by other analgesics and antipyretics (33%) and non-steroidal anti-inflammatory and antirheumatic products (30%). In previous years, non-steroidal anti-inflammatory and antirheumatic accounted for the majority of pain relief medications (60%, compared with 13% for opioids in 2020–21). This more equal share of pain relief sub-group medications in 2021–22, was due to the large annual decline in non-steroidal anti-inflammatory and antirheumatic prescriptions (52% decline from 621,500 to 300,700 between 2020–21 and 2021–22), and the steep annual increase in opioids (almost tripled from 131,500 to 372,000; Table PBS.10).

This increase in opioids was driven by increases in morphine (accounted for 22% of this increase) and new listings for oxycodone (for the management of severe disabling pain) from July 2021 (accounted for 45% of this increase). Most of the decline in non-steroidal anti-inflammatory and antirheumatic prescriptions was due to diclofenac being de-listed from the Palliative Care Schedule from June 2021, as this prescription can be obtained from the General Schedule with the same or similar restriction/clinical criteria and number of quantities/repeats (DoH 2021a; DoH 2021b; DoH 2021c; NPS Medicinewise 2021).

Among all pain relief prescriptions, almost 1 in 2 (48%) anti-inflammatory and antirheumatic and other analgesics and antipyretics palliative care-related prescriptions were repeat scripts, compared with about 1 in 10 (11%) opioids prescriptions (Table PBS.5).

There were variations across the states and territories in the prescription rates for pain relief medications. Consistent with the patterns observed above for pain relief medications overall, Tasmania had the highest rates for non-steroidal anti-inflammatory and antirheumatic prescriptions and opioids, while New South Wales had the highest rate for other analgesics and antipyretics. Northern Territory had the lowest rate for opioids and other analgesics and antipyretics and South Australia for non-steroidal anti-inflammatory and antirheumatic prescriptions (Figure PBS.3).

Figure PBS.3: Prescriptions for pain relief from Palliative Care Schedule, by medication group (ATC level 3) and state and territory, 2021–22

Who prescribed these medications?

In 2021–22 (Figure PBS.4):

• General practitioners (GPs) prescribed the majority (89%) of palliative care-related prescriptions, while palliative medicine specialists prescribed 1.4% of medications. The remainder (10%) were prescribed by other clinicians (including medical specialists from other disciplines and nurse practitioners).
• 8 in 10 prescriptions (82%) by GPs were for pain relief – palliative medicine specialists and other clinicians also predominately prescribed for pain relief, but to a lesser extent (69% and 60%, respectively).  
• Palliative medicine specialists were more likely than GPs and other clinicians to prescribe medications for gastrointestinal symptoms (14% vs 9.6% and 11%), for respiratory symptoms (2.9% vs 1.3% and 1.5%), and for psychological symptoms (5.2% vs 1.2% and 2.4%). Other clinicians were 3–4 times as likely to prescribe medications for neurological symptoms than GPs and palliative medicine specialists (25% compared with 6.2% and 8.4%, respectively).
• There were some variations across the states and territories in prescriptions from GPs, ranging from 85% in Western Australia to 92% in Tasmania. This lower proportion in Western Australia was due to prescriptions from other clinicians accounting for a higher proportion (12%), which was also the case for Victoria (13%) and Australian Capital Territory (12%).

Figure PBS.4: Prescriptions from Palliative Care Schedule, by prescriber type, 2021–22

How have these prescriptions changed over time?

In the 5 years to 2021–22, the number of people dispensed with palliative care-related medications had declined by 18% (from 551,200 to 453,300 people between 2017–18 and 2021–22, see Figure PBS.5). Since 2018–19 the rate of decline had increased each year from a decline of 3.7% in the 12 months to 2019–20 to a decline of 12% in the 12 months to 2021–22. However, for most of this period, the number of palliative care-related prescriptions dispensed had remained relatively stable (1.21–1.26 million prescriptions in 2018–19, 2019–20 and 2021–22), except in 2020–21 where prescriptions dispensed declined by 4.2% from 2019–20, but still 2.9% higher than in 2017–18. This decline in the number of prescriptions in 2020–21 may reflect changes in consumer behaviour coinciding with the introduction and then easing of restrictions during the COVID-19 pandemic, resulting in high demand for medicines in the early months of the pandemic resulting in short-term shortages in medicines (see 2022 edition of this report for further details on the impacts of COVID pandemic).

The number of prescriptions per person had increased, from 2.1 in 2017–18 to 2.8 in 2021–22, reflecting declines in the number of people dispensed with palliative care-related prescriptions and prescriptions increasing over this period.

The declines in the number of people dispensed with palliative care-related medications was driven by declines in the number of people receiving pain relief medications that accounted for 79% of all prescriptions – the number of people receiving pain relief medications fell by 29% in the 5 years to 2021–22 (and 21% in the 12 months to 2021–22). Meanwhile, the number of people receiving prescriptions for all other symptoms increased over this period – 2-fold increase for gastrointestinal prescriptions, 3-fold increase for psychological symptoms and 7-fold increase for neurological symptoms.

Consistent with these patterns, palliative care prescribing by most clinicians had increased between 2017–18 and 2021–22, except for GPs. For palliative medicine specialists, prescriptions dispensed increased steeply from 2019–20 – 30% increase in the 12 months to 2020–21 and almost 3-fold increase in the 12 months to 2021–22, reflecting that palliative medicine specialists were more likely to prescribe prescriptions for gastrointestinal, psychological, and neurological symptoms. For other clinicians, number of prescriptions dispensed was relatively stable in the 4 years to 2020–21 but rose steeply by 41% in the 12 months to 2021–22. In contrast, the number of prescriptions from GPs had been falling in 2020–21, reflecting declines in the number of people prescribed with pain relief medications that accounted for the majority of prescriptions by GPs (Figure PBS.5).

As shown in Figure PBS.5 and Table PBS.10, prescriptions increased for most types of palliative care-related medications between 2017–18 and 2021–22:

• 9-fold increase in prescriptions for neurological symptoms (from 11,000 in 2017–18 to 16,400 in 2020–21, and then increased to 102,000 in 2021–22), due to expanded indications and reduced authority requirements for Clonazepam under the neurological symptoms antiepileptics medications in 2021–22.

• 2-fold increase for gastrointestinal symptoms (from 64,300 to 123,000), largely driven by the increase of Metoclopramide due to the new form (tablet) with reduced authority requirements.
• 2-fold increase for psychological symptoms (8,600 to 17,400), mainly driven by the new listing drugs of Haloperidol introduced in 2020–21.
• More modest increases for respiratory symptoms (from 11,700 to 16,500 between 2019–20 and 2021–22).

However, prescriptions for pain relief had been declining since 2018–19 (from 1.11 million to 996,200 in 2021–22), driven by steep falls in prescriptions of non-steroidal anti-inflammatory and antirheumatic (from 802,800 in 2018–19 to 300,700 in 2021–22). In the 12 months to 2021–22, there had been considerable changes to pain relief medications. While the number of pain relief medications had declined by 4.2% overall since 2020–21, non-steroidal anti-inflammatory and antirheumatic prescriptions had fallen by 52% (from 621,500 to 300,700 due to Diclofenac being de-listed) and opioids had almost tripled (from 131,500 to 372,000 due to the addition of Oxycodone products). For further details on recent changes to the Palliative Care Schedule see Australian Department of Health and Aged Care, The Pharmaceutical Benefits Scheme website.

Figure PBS.5: Trends in prescriptions from Palliative Care Schedule and people receiving them, 2017–18 to 2021–22

How much was spent on these medications?

During 2021–22:

• $34.4 million was paid nationally in benefits for medications included on the Palliative Care Schedule, this was an increase of 69% (in current prices) from $20.4 million in 2017–18 or a 54% increase after adjusting for inflation (in real terms; Table PBS.12). The annual increase in this expenditure was steeper in 2021–22, than in previous years (43% increase compared with annual increases of 1.7% in 2019–20 and 6.4% in 2020–21 after adjusting for inflation; Table PBS.12).
• Nationally, the cost per person dispensed with at least one palliative care-related prescription was $76 – this ranged from $48 per patient in Northern Territory to $100 per patient in Tasmania (Table PBS.11), consistent with the prescription rate in each state and territory, where Tasmania had the highest and Northern Territory the lowest (Table PBS.1).
• Pain relief prescriptions made up 87% of this expenditure ($30 million), followed by prescriptions for gastrointestinal symptoms (8.1% or $2.8 million), and prescriptions for neurological symptoms (2.8% or $962,500; Table PBS.12). The proportion of benefits paid for pain relief medications ranged from 84% in South Australia and Western Australia to 94% in Australian Capital Territory (Table PBS.11).