Antidepressant prescribing in five European countries: application of common definitions to assess the prevalence, clinical observations, and methodological implications
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Drug utilization studies have applied different methods to various data types to describe medication use, which hampers comparisons across populations. The aim of this study was to describe the time trends in antidepressant prescribing in the last decade and the variation in the prevalence, calculated in a uniform manner, in seven European electronic healthcare databases.
Annual prevalence per 10,000 person-years (PYs) was calculated for 2001–2009 in databases from Spain, Germany, Denmark, the United Kingdom (UK), and the Netherlands. Prevalence data were stratified according to age, sex, antidepressant type (selective serotonin re-uptake inhibitors [SSRIs] or tricyclic antidepressants [TCAs]) and major indications.
The age- and sex-standardized prevalence was lowest in the two Dutch (391 and 429 users per 10,000 PYs) and highest in the two UK (913 and 936 users per 10,000 PYs) populations in 2008. The prevalence in the Danish, German, and Spanish populations was 637, 618, and 644 users per 10,000 PY respectively. Antidepressants were prescribed most often in 20- to 60-year-olds in the two UK populations compared with the others. SSRIs were prescribed more often than TCAs in all except the German population. In the majority of countries we observed an increasing trend of antidepressant prescribing over time. Two different methods identifying recorded indications yielded different ranges of proportions of patients recorded with the specific indication (15–57 % and 39–69 % for depression respectively).
Despite applying uniform methods, variations in the prevalence of antidepressant prescribing were obvious in the different populations. Database characteristics and clinical factors may both explain these variations.
KeywordsAntidepressants Selective serotonin reuptake inhibitors Tricyclic antidepressants Prevalence Electronic healthcare databases Standardization
The research leading to these results was conducted as part of the PROTECT consortium (Pharmacoepidemiological Research on Outcomes of Therapeutics by a European ConsorTium, www.imi-protect.eu), which is a public–private partnership coordinated by the European Medicines Agency. Roman Gerlach and Martin Tauscher from the KVB (National Association of Statutory Health Insurance Physicians of Bavaria, Munich, Germany) are acknowledged for their support in data acquisition.
The PROTECT project has received support from the Innovative Medicine Initiative (IMI) Joint Undertaking (www.imi.europa.eu) under Grant Agreement no. 115004, the resources of which are composed of financial contributions from the European Union’s Seventh Framework Programme (FP7/2007-2013) and the kind contribution of the EFPIA companies. In the context of the IMI Joint Undertaking (IMI JU), the Department of Pharmacoepidemiology, Utrecht University, also received a direct financial contribution from Pfizer. The views expressed are those of the authors only and not of their respective institutions or companies.
The Division of Pharmacoepidemiology and Clinical Pharmacology has received unrestricted funding from the Netherlands Organisation for Health Research and Development (ZonMW), the Dutch Health Care Insurance Board (CVZ), the Royal Dutch Pharmacists Association (KNMP), the privately/publically funded Top Institute Pharma (www.tipharma.nl), includes co-funding from universities, government, and industry), the EU Innovative Medicines Initiative (IMI), the EU 7th Framework Program (FP7), the Dutch Ministry of Health, and industry (including GlaxoSmithKline, Pfizer, and others).
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