Trends in antidepressant consumption

Marit Rønning Senior adviser Department of pharmacoepidemiology Norwegian Institute of Public Health

OECD Health Data National Correspondents meeting, Paris 23 October 2014

Outline

• A few words on the methodological issues underlying the data

• A broad view on European trends in use of antidepressants and other high volume pharmaceuticals

• A more detailed view on Nordic trends in use of antidepressants

• A closer look on Norwegian data

Coverage of the data

• Total or sample?

• Hospital, primary care or both?

• If non-reimbursed drugs are excluded, changes in reimbursement regulations will influence time trends

ATC/DDD methodological challenges

• Use of national ATC codes and DDDs (e.g. Germany)

• Changes in DDDs (e.g. statins, C10AA, in 2009)

• ATC versus EphMRA?

OECD data collection based on a shortlist of 28 pharmaceutical drugs

ATC 2014 codes

A-Alimentary tract and metabolism Antacids Drugs for peptic ulcer and gastro-oesophageal reflux diseases (GORD) Drugs used in diabetes B-Blood and blood forming organs C-Cardiovascular system Cardiac glycosides Antiarrhythmics, Class I and III Antihypertensives Diuretics Beta blocking agents Calcium channel blockers Agents acting on the renin-angiotensin system Lipid modifying agents G-Genito urinary system and sex hormones Sex hormones and modulators of the genital system H-Systemic hormonal preparations, excluding sex hormones and insulins J-Antiinfectives for systemic use Antibacterials for systemic use M-Musculo-skeletal system Antiinflammatory and antirheumatic products non-steroids N-Nervous system Analgesics Anxiolytics Hypnotics and sedatives Antidepressants R-Respiratory system Drugs for obstructive airway diseases

A A02A A02B A10 B C C01A C01B C02 C03 C07 C08 C09 C10 G G03 H J J01 M M01A N N02 N05B N05C N06A R R03

Results from 2014 OECD data collection (European countries only) 3.11.1. Hypertension drugs consumption, 2000 and 2012 (or nearest year)

3.11.2. Anticholesterols consumption, 2000 and 2012 (or nearest year)

41

66

71

80

80

92

93

95

97

98

100

102

102

107

116

120

127

131

134

83

118

0 30 60 90 120 150

Estonia

Austria

Germany

Italy

Sweden

France

Spain

Portugal

EU-18

Finland

Czech Republic

Hungary

Slovenia

Netherlands

Luxembourg

Denmark

Belgium

Slovak Republic

United Kingdom

Iceland

Norway

Defined daily dose, per 1000 people per day

2000 2012

191

225

252

266

270

304

329

330

357

362

365

378

392

395

411

421

442

534

567

271

278

0 100 200 300 400 500 600

Austria

Luxembourg

Portugal

France

Spain

Netherlands

Estonia

Belgium

EU-18

Sweden

Slovak Republic

United Kingdom

Italy

Denmark

Slovenia

Finland

Czech Republic

Hungary

Germany

Iceland

Norway

Defined daily dose, per 1000 people per day

2000 2012

Source: Health at a Glance: Europe 2014

Results from 2014 OECD data collection (European countries only) 3.11.3. Antidiabetics consumption, 2000 and 2012 (or nearest year)

3.11.4. Antidepressants consumption, 2000 and 2012 (or nearest year)

39

51

54

54

58

61

62

63

66

66

66

66

71

74

75

78

80

83

85

40

49

0 25 50 75 100

Austria

Denmark

Sweden

Estonia

Slovak Republic

Portugal

Belgium

Luxembourg

Italy

France

Spain

EU-18

Slovenia

Netherlands

Hungary

Czech Republic

United Kingdom

Germany

Finland

Iceland

Norway

Defined daily dose, per 1000 people per day

2000 2012

21

27

30

42

42

46

50

51

52

52

56

58

64

70

70

75

81

83

85

57

109

0 30 60 90 120

Estonia

Hungary

Slovak Republic

Italy

Netherlands

Czech Republic

France

Slovenia

Germany

Luxembourg

EU-18

Austria

Spain

Finland

Belgium

United Kingdom

Sweden

Denmark

Portugal

Norway

Iceland

Defined daily dose, per 1000 people per day

2000 2012

Source: Health at a Glance: Europe 2014

Trends in use of high volume pharmaceuticals – EU average

Drug groups 2000 DDD/1000inh/day

2012 DDD/1000inh/day

% increase

Drugs for treatment of hypertension (C02,C03,C07,C08,C09)

191 357 87

Lipid modifying agents (C10)

26 97 273

Drugs used in diabetes (A10)

35 66 89

Antidepressants (N06A)

27 56 107

Source: OECD

OECD figures for antidepressants (N06A) 2000-2012

• Average increase in «the middle» of other high volume drug groups

• Larger differences between high and low consuming countries than in the other chosen groups

• All the Nordic countries above the EU average

21

27

30

42

42

46

50

51

52

52

56

58

64

70

70

75

81

83

85

57

109

0 30 60 90 120

Estonia

Hungary

Slovak Republic

Italy

Netherlands

Czech Republic

France

Slovenia

Germany

Luxembourg

EU-18

Austria

Spain

Finland

Belgium

United Kingdom

Sweden

Denmark

Portugal

Norway

Iceland

Defined daily dose, per 1000 people per day

2000 2012

Source: Health at a Glance: Europe 2014

Use of antidepressants in the Nordic countries 2000 and 2012

0

20

40

60

80

100

120

DD

D/1

00

0 in

hab

itan

ts/d

ay

2000

2012

Source: OECD

Nordic countries 2000 and 2013 detailed according to subgroups of antidepressants

0

20

40

60

80

100

120

140

2000 2013 2000 2013 2000 2013 2000 2013 2000 2013

Norway Finland Sweden Denmark Iceland

DD

D/1

00

0 in

hab

itan

ts/d

ay

N06AX

N06AG

N06AB

N06AA

Source: Nomesco

Andreas Vilhelmsson, Nordic School of Public Health, Sweden, 2013

Trends and differences:

• Accessibility of drugs

• Available treatment alternatives

• Clinical practice and national guidelines

• Attitudes towards medicines

Proportion (%) of the population on antidepressants in three Nordic countries

0

1

2

3

4

5

6

7

8

9

10

2007 2010 2013

Pro

po

rtio

n (

%)

of

the

p

op

ula

tio

n

Norway

Denmark

Sweden

Source:

NorPD, Norway

Medstat, Denmark

Socialstyrelsen, Sweden

Antidepressant expenditure in Norway 1999-2013

0

100

200

300

400

500

600

700

800

Mill

NO

K

Indications for antidepressant prescriptions in Norway 2013

Pain

Anxiety

Depression

Inter-county differences in use of antidepressants in Norway – 2000 and 2013

0

10

20

30

40

50

60

70

80

90

100

DD

D/1

00

0 in

h/d

ay

2000

2013

Summary

Use of most major drug groups have increased in the last decades

Large variation in drug use between countries and within countries

Nordic countries have a higher use of antidepressants than most EU countries

Level of drug use is influenced by: health system, treatment guidelines, therapy traditions (national and local), reimbursement regulations, marketing, availability, attitudes, population etc

Overtreatment or undertreatment??

Web addresses and reports

• ATC and DDD: www.whocc.no

• Norwegian Prescription database: www.norpd.no

• Norwegian drug wholesales statistics: www.drugconsumption.no

Thank you for your attention!