Refugia-based drenching regimes have been widely recommended to slow development of anthelmintic resistance but there are few comparisons between different treatment approaches in the UK. The impact of four ivermectin treatment regimes on drug efficacy, lamb body weight and nematode contamination during a 154 day grazing season were evaluated in a consecutive five year field study. Regimes were whole-flock treatment every 4 weeks (NST), targeted selective treatment (TST) based on individual performance, strategic whole-flock treatments at pre-determined times (SPT) or whole-flock treatment when clinical signs were apparent (MT). Mean numbers of ivermectin drenches administered per season were 4.0, 1.8, 2.0 and 1.4 for NST, TST, SPT and MT groups, respectively. The mean anthelmintic efficacy (AE) for each treatment group was based on faecal egg count reduction post-treatment employing a bootstrap sampling based algorithm. Mean AE was 95-98% for all groups in 2006 and mean AE (95% confidence limits) for NST declined to 62% (55%, 68%) in 2010. In comparison, AE for TST, SPT and MT in 2010 were 86% (81%, 92%), 86% (83%, 90%) and 83% (78%, 88%), respectively. Body weight in TST and SPT was similar to NST in all years (p > 0.05), however MT lambs were lighter than NST in 2006-2008 (p ⩽ 0.04). Tracer lamb worm burdens was lowest in NST but was not significantly different between other groups. Overall, both the TST and SPT regimes appeared to maintain animal performance and conserve anthelmintic efficacy compared with a neo-suppressive anthelmintic treatment regime.