Growth in Antidepressant use in 10 Countries in the last decade
Milea
1Lundbeck,
1,2
D ,
Bent-Ennakhil
1
N ,
Jarosławski
3
S ,
Zard
3
J ,
Toumi
2,
3
M
Issy les Moulineaux, France; 2University Claude Bernard Lyon I, Lyon, France; 3Creativ-Ceutical, Paris, France
Background
 Substantial increase in antidepressant use has been observed over the last two decades.
 This growth has been largely attributed to the introduction of new pharmacologic classes such as
(SSRIs, SNRIs) that have lower incidence of side effects than older medications (TCA,IMAO) and are
easier for physicians to dose and titrate, and other factors such as increased diagnosis rate of
depression, longer duration of treatment.
 Growth in antidepressant use may differ in lower income countries that devote a smaller portion of
their economy to health expenditures.
 To date, no study has compared trends in antidepressant use in countries with different economic
characteristics.
Objectives
 To describe and compare the growth in antidepressant use by pharmacologic class between 10
countries between 1999 and 2008.
 To compare the evolution of antidepressant use to that of the Gross Domestic Product (GDP), total
health expenditures (HE) and the pharmaceutical expenditures (PE) in each country.
 To identify the impact of access conditions such as reimbursement and recommendations of health
technology assessments (HTA) on the level of antidepressant use.
Methods
 A retrospective analysis of sales volumes and expenditures were extracted from IMS Health
commercial database between 1999 and 2008, for US, France, Germany, UK, Spain, Italy, Greece,
Poland, Hungary and Czech Republic.
 Antidepressants were classified in 4 categories: SSRIs, SNRIs, TCA and ‘other antidepressants’,
according to a slightly modified ATC classification to better reflect the current use of
antidepressants.
 Data were expressed in Defined Daily Doses (DDD) per capita.
 A descriptive comparison of trends between countries was made first by overall per-capita
antidepressant consumption and then for each class of antidepressants based on GDP (Gross
Domestic Product), HE (Health Expenditures) and PE (Pharmaceutical Expenditures).
 HTA and reimbursement restrictions were searched in national websites.
 No statistical tests were performed.
Table 1. Change in antidepressant sale (volume per capita) between 1999 and 2008
Country
Volume
[billion DDD]
(1999-2008)
0.02-0.1
0.7-1.1
0.4-1.1
0.04-0.2
0.05-0.1
0.2-0.8
0.1-0.4
0.4-1.0
0.6-1.3
Czech Republic
France
Germany
Greece
Hungary
Italy
Poland
Spain
UK
Figure 1. Evolution of antidepressant sales (volume per capita) between 1999 and 2008
Volume/capita 1999
DDD
Volume/capita 2008
DDD
Volume/capita
% change (1999-2008)
2.7
12.8
5.1
4.8
5
4.3
2.2
10.6
12.6
11.6
18
13.3
18.5
9.6
13.2
5.7
22.6
22
325%
41%
161%
283%
91%
205%
164%
112%
75%
35
30
25
20
15
10
Table 2. Values of GDP, HE and PE in all studied countries in 1999 and 2008
GDP (USD/capita)
1999
2008
HE (USD/capita)
% change
5
PE (USD/capita)
PE as % GDP
0
1999
2008
% change
1999
2008
% change
1999
2008
% change
Czech Rep.
5,854
20,673
253
386
France
24,170
44,508
84
2,441
Germany
26,114
44,446
70
2,690
Greece
12,350
31,670
156
1,062
Hungary
4,693
15,408
228
338
Italy
21,096
38,492
82
1,645
Poland
4,345
13,845
219
248
Spain
15,476
35,215
128
1,130
UK
25,605
43,541
70
1,767
USA
33,028
46,350
40
4,426
Average
17,273
33,415
93
1,613
Values of GPD, HE and PHE are given in 2009 USD/capita
1,468
4,985
4,667
3,072
1,125
3,503
969
3,169
3,788
7,416
3,416
280
104
73
189
233
113
291
180
114
68
112
89
391
363
153
95
364
69
243
239
478
248
299
818
705
768
355
645
219
650
447
883
579
236
109
94
402
274
77
217
167
87
85
133
1.52%
1.62%
1.39%
1.24%
2.02%
1.72%
1.60%
1.57%
0.93%
1.45%
1.50%
1.45%
1.84%
1.59%
2.43%
2.31%
1.67%
1.58%
1.85%
1.03%
1.90%
1.76%
-5
14
14
96
14
-3
-1
18
11
31
17
1999
Etats-Unis
2000
2001
2002
2003
2004
Tchéquie
France
Allemagne
Grèce
Hongrie
2005
Italie
2006
Pologne
2007
Royaume Uni
2008
Espagne
Figure 2. Percent changes in GDP, HE and PE (all per capita) between 1999 and 2008
across countries
Figure 3. Comparison of percent changes in PE and antidepressant volume between 1999 and 2008
Results
 Three groups of countries could be identified: high use country (US with approximately 2-fold
higher use), medium use countries (France, Spain, UK and in 2008 Greece) and low use countries
(Italy, Germany, Czech Republic, Hungary, Poland and in 1999 Greece). (Table1, figure1)
 Antidepressant growth was observed in all countries, with an average volume growth of 153%, and
an increase of 7.8 to 16.4 DDD/capita. This was more pronounced in low use countries in 1999.
(Table1, figure1)
 The relation was more steady between GDP growth and HE growth than between GDP and HE
growths. (Table 2, figure2)
 Countries with high PE growth between 1999 and 2008, presented the highest antidepressant use
increase; the association was more pronounced when considering antidepressant expenditures.
(Figure 3)
 In 2008, SSRIs were the predominant class in all countries; followed by SNRIs whereas TCAs
consumption went down. “Other antidepressants” sale volumes increased during the overall period
with growth rates varying widely across countries (5-362%). (Table3)
Table 3. Changes in antidepressant sales (DDD/capita) by therapeutic class between 1999 and 2008
Class
SSRI
SNRI
TCA
Other antidepressants
Major class (by volume of sales)
Country
1999
2008
change
1999
2008
change
1999
2008
change
1999
2008
change
1999
2008
Czech Republic
France
Germany
Greece
Hungary
Italy
Poland
Spain
UK
USA
1.2
7.6
1.2
2.5
3.6
2.3
0.4
7.5
7.2
13.3
8.6
11.5
5.9
12.5
6.5
9.7
3
15.3
14.8
19.8
617%
51%
392%
400%
81%
322%
650%
104%
106%
49%
0.04
0.46
0.12
0.49
0.01
0.14
0.01
0.49
0.62
1.5
0.74
2.7
1.5
3.2
0.97
1.7
0.43
3.8
1.9
4.5
(n.s)
480%
1167%
551%
(n.s.)
1093%
(n.s.)
682%
213%
200%
1.1
2.1
3.1
1
0.6
1
1.3
1.6
3.9
2.4
0.6
1.3
3.8
0.7
0.3
0.6
1.2
1.2
3.4
1.6
-46%
-36%
25%
-23%
-43%
-39%
-9%
-27%
-13%
-33%
0.4
2.6
0.8
0.9
0.8
0.8
0.4
1
0.8
2.6
1.7
2.5
2.1
2
1.8
1.2
1.1
2.2
1.9
3.8
362%
-5%
174%
139%
122%
39%
151%
117%
128%
47%
SSRI 44%
SSRI 60%
TCA 59%
SSRI 52%
SSRI 72%
SSRI 53%
TCA 61%
SSRI 71%
SSRI 57%
SSRI 67%
SSRI 74%
SSRI 64%
SSRI 44%
SSRI 68%
SSRI 68%
SSRI 74%
SSRI 53%
SSRI 68%
SSRI 67%
SSRI 67%
CONCLUSIONS
 Results suggest that countries with lower GDP/capita (and higher
GDP growth) and lower baseline antidepressant volumes are
heading in the same direction as the higher income countries did
in the past, recording a 200-300% volume growth between 1999
and 2008.
 This offers a unique opportunity, which was missed in the past (in
higher-income countries), to monitor the anticipated health
outcomes of their prescription, and which are valuable for future
mental health policy.
n.s. (not significant); % change were not calculated when initial value was ≤ 0.04
ISPOR 17th Annual International Congress, Washington, Washington DC., USA, June 2-6, 2012. PMH66