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Gutiérrez-Abejón E, Pedrosa-Naudín MA, Fernández-Lázaro D, Alvarez FJ. Medication economic burden of antidepressant non-adherence in Spain. Front Pharmacol 2023; 14:1266034. [PMID: 38035007 PMCID: PMC10682177 DOI: 10.3389/fphar.2023.1266034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction: Non-adherence to antidepressants is associated with worse disease outcomes (morbidity and mortality) and correlates with higher healthcare resource utilization and costs. Methods: A population-based registry study was conducted to assess non-adherence and to analyze the economic burden of treatment and from non-adherence to antidepressants in 2021. Non-adherence was measured by the Medication Possession Ratio and those below 80% were classified as non-adherent. Results: In 2021, 246,718 patients (10.60% [95% CI: 10.48-10.72]) received antidepressants at a cost of €29 million. The median antidepressant cost per patient/year was €70.08€, ranging from €7.58 for amitriptyline to €396.66 for agomelatine. Out-of-pocket costs represented 6.09% of total expenditures, with a median copayment of €2.78 per patient. The 19.87% [95% CI 19.52-20.22)] of patients were non-adherent to antidepressants, costing €3.9 million (13.30% of total antidepressant costs). Non-adherence rates exceeded 20% for the tricyclic antidepressants, fluoxetine (23.53%), fluvoxamine (22.42%), and vortioxetine (20.58%). Venlafaxine (14.64%) and citalopram (14.88%) had the lowest non-adherence rates, of less than 15%. The median cost of non-adherent medications per patient/year was €18.96 and ranged from €2.50 (amitriptyline) to €133.42 (agomelatine). Conclusion: Reducing non-adherence to antidepressants is critical to improving clinical and economic outcomes. The implementation of interventions and standardized measures, including early detection indicators, is urgently needed. Antidepressants differ with regard to non-adherence and their cost, and this should be considered when prescribing this medication. The Medication Possession Ratio could be used by the healthcare provider and clinician to identify non-adherent patients for monitoring, and to take necessary corrective actions.
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Affiliation(s)
- Eduardo Gutiérrez-Abejón
- Pharmacological Big Data Laboratory, Department of Cell Biology, Genetics, Histology and Pharmacology, Faculty of Medicine, University of Valladolid, Valladolid, Spain
- Valladolid Este Primary Care Department, Valladolid, Spain
- Pharmacy Directorate, Castilla y León Health Council, Valladolid, Spain
- Facultad de Empresa y Comunicación, Universidad Internacional de la Rioja (UNIR), Logroño, Spain
| | | | - Diego Fernández-Lázaro
- Department of Cellular Biology, Genetics, Histology and Pharmacology, Faculty of Health Sciences, Campus of Soria, University of Valladolid, Soria, Spain
- Neurobiology Research Group, Faculty of Medicine, University of Valladolid, Valladolid, Spain
| | - F. Javier Alvarez
- Pharmacological Big Data Laboratory, Department of Cell Biology, Genetics, Histology and Pharmacology, Faculty of Medicine, University of Valladolid, Valladolid, Spain
- CEIm, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Madeira L, Queiroz G, Henriques R. Prepandemic psychotropic drug status in Portugal: a nationwide pharmacoepidemiological profile. Sci Rep 2023; 13:6912. [PMID: 37106018 PMCID: PMC10139661 DOI: 10.1038/s41598-023-33765-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
The prescription of psychotropic drugs has been rising in Europe over the last decade. This study provides a comprehensive profile of prepandemic consumption patterns of antidepressant, antipsychotic, and anxiolytic drugs in Portugal considering full nationwide psychotropic drug prescription and dispensing records (2016-2019) against several criteria, including active ingredient, sociodemographics, medical specialty, and incurred costs. An increase of 29.6% and 34.7% in the consumption of antipsychotics and antidepressants between 2016 and 2019 is highlighted, accompanied by an increase of 37M Eur in total expenditure (> 20M Eur in public copay) for these classes of drugs. Disparities in sociodemographic and geographical incidence are identified. Amongst other pivotal results, 64% of psychotropic drug prescriptions are undertaken by general practitioners, while only 21% undertaken by neurological and psychiatric specialties. Nationwide patterns of psychotropic drug prescription further reveal notable trends and determinants, establishing a reference point for cross-regional studies and being currently assessed at a national level to establish psychosocial initiatives and guidelines for medical practice and training.
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Affiliation(s)
- Luís Madeira
- Instituto de Medicina Preventiva, Faculdade de Medicina da Universidade de Lisboa; Hospital CUF Descobertas, Lisbon, Portugal
| | | | - Rui Henriques
- INESC-ID and Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal.
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Non-Adherence to Antidepressant Treatment and Related Factors in a Region of Spain: A Population-Based Registry Study. Pharmaceutics 2022; 14:pharmaceutics14122696. [PMID: 36559190 PMCID: PMC9782667 DOI: 10.3390/pharmaceutics14122696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/26/2022] [Accepted: 11/30/2022] [Indexed: 12/05/2022] Open
Abstract
Antidepressants are a commonly prescribed psychotropic medication, and their use has increased in recent years. Medication non-adherence in patients with mental disorders is associated with worse health outcomes. A population-based registry study to assess antidepressant non-adherence during 2021 has been carried out. An indirect method based on the medication possession ratio (MPR) has been utilized. Patients with a MPR under 80% were classified as non-adherent. A multivariate logistic regression to identify non-adherence predictors has been used, considering sociodemographic (age, sex, institutionalization and urbanicity) and health related variables (diagnostics, antidepressant class, multiple prescribers, and polypharmacy). In 2021, 10.6% of the Castile and Leon population used antidepressants. These patients were institutionalized (7.29%), living in urban areas (63.44%), polymedicated with multiple prescribers (57.07%), and using serotonin selective reuptake inhibitors (SSRIs) (54.77%), other antidepressants (46.82%) or tricyclic antidepressants (TCAs) (13.76%). Antidepressants were prescribed mainly for depression (36.73%) and anxiety (29.24%). Non-adherence to antidepressants was more frequent in men (20.56%) than in woman (19.59%) and decreased with increasing age (32% up to 17 years old vs. 13.76% over 80 years old). TCAs were associated with the highest prevalence of non-adherence (23.99%), followed by SSRIs (20.19%) and other antidepressants (18.5%). Predictors of non-adherence in patients on antidepressants were: living in urban areas, using TCAs, and pain occurrence. Non-adherence to antidepressants decreases with aging. Being female, institutionalization, being polymedicated and having depression/anxiety alongside another psychiatric diagnosis are protective factors against non-adherence. The MPR is a robust indicator for the clinician to identify non-adherent patients for monitoring, and adopt any necessary corrective actions.
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Lunghi C, Dugas M, Leclerc J, Poluzzi E, Martineau C, Carnovale V, Stéfan T, Blouin P, Lépine J, Jalbert L, Espinoza Suarez NR, Svyntozelska O, Dery MP, Ekanmian G, Nogueira DM, Akinola PS, Turcotte S, Skidmore B, LeBlanc A. Global prevalence of antidepressant drug utilization in the community: protocol for a systematic review. BMJ Open 2022; 12:e062197. [PMID: 35641008 PMCID: PMC9157341 DOI: 10.1136/bmjopen-2022-062197] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/09/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Antidepressant drugs are the most frequently prescribed medication for mental disorders. They are also used off-label and for non-psychiatric indications. Prescriptions of antidepressants have increased in the last decades, but no systematic review exists on the extent of their use in the community. METHODS AND ANALYSIS We will conduct a systematic review to estimate the prevalence of antidepressant use in the community. We will search for studies published from 1 January 2010 in the Embase and MEDLINE databases using a combination of controlled vocabulary and keywords adjusted for each database without any language restriction. The main inclusion criterion is the presence of prevalence data of antidepressant utilization. Thus, we will include all studies with a descriptive observational design reporting the prevalence of antidepressant use in the community. Study selection (by title/abstract and full-text screening) and data extraction for included studies will be independently conducted by pairs of reviewers. We will then synthesize the data on the prevalence of antidepressant use in individuals living in the community. If possible, we will perform a meta-analysis to generate prevalence-pooled estimates. If the data allows it, we will conduct subgroup analyses by antidepressant class, age, sex, country and other sociodemographic categories. We will evaluate the risk of bias for each included study through a quality assessment using the Joanna Briggs Institute Critical Appraisal tool: Checklist for Studies Reporting Prevalence Data. DistillerSR software will be used for the management of this review. ETHICS AND DISSEMINATION Ethical approval is not required for this review as it will not directly involve human or animal subjects. The findings of our systematic review will be disseminated through publications in peer-reviewed journals, the Qualaxia Network (https://qualaxia.org), presentations at international conferences on mental health and pharmacoepidemiology, as well as general public events. PROSPERO REGISTRATION NUMBER CRD42021247423.
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Affiliation(s)
- Carlotta Lunghi
- Department of Health Sciences, Université du Québec à Rimouski, Lévis, Quebec, Canada
- Population Heath and Optimal Health Practices Axis, CHU de Québec-Université Laval Research Center, Quebec, Quebec City, Canada
- CISSS de Chaudière-Appalaches Research Center, Lévis, Quebec, Canada
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Michèle Dugas
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Jacinthe Leclerc
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
- Quebec Heart and Lung Institute Research Centre - Université Laval, Quebec City, Quebec, Canada
- Faculty of Pharmacy, Université Laval, Quebec City, Quebec, Canada
| | - Elisabetta Poluzzi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Cathy Martineau
- Department of Health Sciences, Université du Québec à Rimouski, Lévis, Quebec, Canada
| | - Valérie Carnovale
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Théo Stéfan
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Patrick Blouin
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Johanie Lépine
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Laura Jalbert
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Nataly R Espinoza Suarez
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Olha Svyntozelska
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Marie-Pier Dery
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Giraud Ekanmian
- Population Heath and Optimal Health Practices Axis, CHU de Québec-Université Laval Research Center, Quebec, Quebec City, Canada
- CISSS de Chaudière-Appalaches Research Center, Lévis, Quebec, Canada
- Faculty of Pharmacy, Université Laval, Quebec City, Quebec, Canada
| | | | - Pelumi Samuel Akinola
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
- Department of Nursing, University of Pecs, Pecs, Hungary
| | - Stéphane Turcotte
- CISSS de Chaudière-Appalaches Research Center, Lévis, Quebec, Canada
| | | | - Annie LeBlanc
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
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