THE USE OF ANTIDEPRESSANTS IN PORTUGAL: 1995-2009 Ricardo Gusmão, Sónia Quintão Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal OBJECTIVE To describe the evolution of antidepressant utilization in order to ascertain if, in Portugal, there is excessive consumption of antidepressants. Costs growth, euros, per year, 1995-2007 12-Month Prevalence of DSM-IV disorders, Portugal, 2009 METHODS We obtained raw data of number of units of pharmaceutical substance sold per year, for antidepressant N06 (1) using the WHO-ATC classification (2) and the estimated annual population, and then we derived the assumed average maintenance dose per day for a drug used for its main indication in adults (DDD), per thousand inhabitants per day (DHD). We calculated an estimate of DHD that would meet the needs requirements established in the National Census of Psychiatric Morbidity for the year 2009 (3), knowing that about 1% prevalence of treatable disorders correspond to 10 DHD (4). RESULTS Packages utilization growth, 1995-2009 DDD growth, 1995-2009 (number of treatment days/year) DHD growth, 1995-2009 (DDD per 100.000 habitants per day) CONCLUSIONS Utilization of antidepressants in Portugal is one of the highest in Europe concurring with an lower GDP than other high-utilization countries (5). DHD of antidepressants grew from 18,7 in 1995 to 74,7 in 2009, corresponding to a maximum of treated prevalence of 7,5%. Nevertheless, this means that more citizens had access to treatment at the same cost: in 13 years, the DHD cost increased 25%, the average growth of inflation in the period. The available data from the National Census of Psychiatric Morbidity point to an annual prevalence of mental disorders of 22,9% and a treatable prevalence with antidepressants of 15,6% for serious and moderate severity anxiety and depressive disorders, the highest prevalence in Europe (6). The resulting 156 DHD of antidepressants, needed to treat those disorders, not accounting co-therapy nor higher daily dosage, considering an ideal model of putative adequate prescription and full adhesion, is the double than the 2009 figures, 75 DHD. As such, it is not possible to state an excessive utilization. Comments on antidepressant utilization must always be in relation to needs for indicated treatment. 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2.366.313 2.581.498 2.832.616 3.100.293 3.430.580 3.967.799 4.412.851 4.870.559 5.142.052 5.765.330 5.825.318 6.081.868 6.309.986 6.531.000 6.590.000 9,1% 9,7% 9,4% 10,7% 15,7% 11,2% 10,4% 5,6% 12,1% 1,0% 4,4% 3,8% 3,5% 0,9% 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 68.296.012 77.296.577 85.025.477 94.285.016 101.783.772 118.291.869 134.805.975 152.287.206 162.514.342 185.104.893 196.842.602 222.619.859 255.000.677 283.891.917 289.852.583 13,2% 10,0% 10,9% 8,0% 16,2% 14,0% 13,0% 6,7% 13,9% 6,3% 13,1% 14,5% 11,3% 2,1% 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 18,7 21,1 23,1 25,5 27,4 31,7 35,9 40,2 42,6 48,3 51,1 57,6 65,8 73,0 74,7 12,9% 9,6% 10,5% 7,5% 15,6% 13,2% 12,1% 6,0% 13,2% 5,9% 12,7% 14,2% 11,0% 2,3% 0 1.000.000 2.000.000 3.000.000 4.000.000 5.000.000 6.000.000 7.000.000 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 0 50.000.000 100.000.000 150.000.000 200.000.000 250.000.000 300.000.000 350.000.000 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 0,0 10,0 20,0 30,0 40,0 50,0 60,0 70,0 80,0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 BIBLIOGRAPHIC REFERENCES 1. IMS, Health Inc., Portugal, 2009 2. WHO Collaborating Centre for Drug Statistics Methodology WHO-CCFDSM. Guidelines for ATC classification and DDD assignment, 2010. Oslo: WHO Collaborating Centre for Drug Statistics Methodology; 2009. 3. Caldas de Almeida, J. M., & Xavier, M. (2010). Estudo epidemiológico nacional sobre morbilidade psiquiátrica.Congresso Nacional de Psiquiatria. Estoril. 4. Isacsson G, Holmgren P, Wasserman D, Bergman U. Use of antidepressants among people committing suicide in Sweden. BMJ. 1994 February 2;308(6927):506-9. 5. OECD. OECD Health Data: Pharmaceutical market. 6. Wittchen HU, Jacobi F, Rehm J, Gustavsson A, Svensson M, Jönsson B, et al. The size and burden of mental disorders and other disorders of the brain in europe 2010. Eur Neuropsychopharmacol 2011, Sep;21(9):655-79. 1995 2007 Growth % Raw global national cost 27.884.274 122.920.915 340,8% Cost by daily treatment 0,41 0,48 18,1% Number of DDD bought with €1,00 2,45 2,07 -15,3% Expense by inhabitant 2,78 11,58 316,4% Cost by DHD 1.494.769 1.868.111 25,0% Average package cost 11,78 19,48 65,3% 178,5% 324,4% 300,4% Total sample (n=3849) % Moderate and Serious Disorders % any Anxiety disorder 16,5 11,2 any Mood disorder 7,9 7 any Mental Disorder with indica;on for AD treatment 22,9 15,6