A “top down” analysis was used to identify the therapeutic areas making major contributions to the greater than £22m increase in general practitioner prescription costs in the former South Western regional health authority (RHA) between the years ending August, 1992, and August, 1993. The analysis used PACTLINE and level 3 PACT to identify the British National Formulary (BNF) chapters and sections most responsible for cost increases. In support of this analysis, a “bottom up” analysis was also carried out. This involved empirically selecting therapeutic areas that might have made significant contributions, then calculating, using levels 2 and 3 PACT, the extent of the contribution.Despite the different approaches, several classes of agents were identified by both methods. The top down analysis indicated that just six therapeutic areas had contributed almost £11m to the total increase of £22m+: they accounted for over 100 per cent of the “excess” growth in the four high growth rate BNF chapters (1, 3, 4 and 6). As various authoritative guidelines have recently been published concerning the use of many of the drugs in these therapeutic areas, the bases exist for a detailed evaluation of whether or not the large increases in their use can be justified.Analysis of prescriptions dispensed for medicines in chapter 2, which served as a control because of a large increase in prescription numbers but a below average increase in costs, supported the contention that the increased use of generic products and/or some sort of price control (eg, their inclusion in the Drug Tariff) can release considerable resources to be exploited, allowing the introduction of newer and more expensive drugs even in situations of tightly‐co
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